Summary

Vortioxetine and omeprazole have a potential pharmacokinetic interaction through CYP2D6 enzyme inhibition. Omeprazole may increase vortioxetine plasma concentrations, potentially leading to enhanced therapeutic effects or increased risk of adverse reactions.

Introduction

Vortioxetine (Trintellix) is a multimodal antidepressant that acts as a serotonin reuptake inhibitor and modulator, primarily used to treat major depressive disorder in adults. It belongs to a unique class of antidepressants with multiple mechanisms of action on serotonin receptors. Omeprazole (Prilosec) is a proton pump inhibitor (PPI) commonly prescribed to reduce stomach acid production for treating gastroesophageal reflux disease (GERD), peptic ulcers, and other acid-related conditions. Both medications are frequently prescribed and may be used concurrently in patients with depression and gastrointestinal disorders.

Mechanism of Interaction

The interaction between vortioxetine and omeprazole occurs through cytochrome P450 enzyme inhibition. Vortioxetine is primarily metabolized by the CYP2D6 enzyme, with additional metabolism through CYP3A4/5, CYP2C19, CYP2C9, CYP2A6, CYP2C8, and CYP2B6. Omeprazole is a moderate inhibitor of CYP2C19 and a weak inhibitor of CYP2D6. When co-administered, omeprazole can inhibit the metabolism of vortioxetine, particularly in patients who are extensive metabolizers of CYP2D6, potentially leading to increased plasma concentrations of vortioxetine. This pharmacokinetic interaction may result in enhanced therapeutic effects or increased risk of dose-related adverse reactions.

Risks and Symptoms

The primary clinical risk of this interaction is the potential for increased vortioxetine plasma levels, which may lead to enhanced side effects including nausea, dizziness, dry mouth, constipation, vomiting, and sexual dysfunction. In some patients, elevated vortioxetine concentrations could increase the risk of serotonin-related adverse effects, though clinically significant serotonin syndrome is rare with vortioxetine monotherapy. The interaction significance is generally considered mild to moderate, as vortioxetine has multiple metabolic pathways, and the inhibition of one pathway may be compensated by others. However, patients who are poor metabolizers of CYP2D6 may be at higher risk for clinically significant effects.

Management and Precautions

Vortioxetine interactions with food and lifestyle

Vortioxetine can be taken with or without food. However, patients should avoid excessive alcohol consumption while taking vortioxetine, as alcohol may increase the risk of central nervous system side effects such as drowsiness, dizziness, and impaired coordination. Additionally, patients should use caution when driving or operating machinery, especially when first starting treatment or when the dose is changed, as vortioxetine may cause drowsiness or affect alertness.

Omeprazole interactions with food and lifestyle

Omeprazole should be taken on an empty stomach, preferably 30-60 minutes before meals, as food can significantly reduce its absorption and effectiveness. Alcohol consumption should be limited or avoided while taking omeprazole, as alcohol can increase stomach acid production and counteract the medication's acid-reducing effects. Additionally, alcohol may worsen gastroesophageal reflux disease (GERD) symptoms that omeprazole is treating. Smoking should be avoided or discontinued, as tobacco use increases stomach acid production and can reduce the effectiveness of omeprazole therapy. Patients should also be aware that omeprazole may interact with certain dietary supplements, particularly those containing magnesium, as long-term use of omeprazole can lead to magnesium deficiency.