Can You Take Nexium And Lexapro Together?

Answer

You are correct that there is a drug interaction between Nexium (esomeprazole) and Lexapro (escitalopram). Specifically, Nexium can inhibit the metabolism of Lexapro, increasing concentrations of the drug, and potentially increasing the risk of side effects.

Interaction Detail

Nexium (esomeprazole) is an inhibitor of the metabolizing enzyme CYP2C19, the same enzyme that is responsible for the metabolism of Lexapro (escitalopram).

Therefore, inhibition of CYP2C19 can increase concentrations of Lexapro due to this decrease in metabolism. This can increase the risk of dose-dependent side effects, such as:

• Nausea
• Diarrhea
• Headache
• Fatigue
• Dizziness
• Insomnia

Additionally, there is always a small, but serious risk, of serotonin syndrome when dealing with drugs that affect the neurotransmitter serotonin, as Lexapro does. Serotonin syndrome is uncommon, but nevertheless serious medical condition that requires immediate attention if symptoms occur. It is thought to occur due to a buildup of serotonin in the brain. Symptoms include:

• Confusion
• Increased body temperature
• Shaking
• Sweating
• Muscle spams
• Mental status changes

Several studies have documented the interaction between Nexium and Lexapro.

One such study reported the following:

Citalopram concentrations were significantly higher in patients treated with omeprazole (+35.3%; P < 0.001), esomeprazole (+32.8%; P < 0.001), and lansoprazole (+14.7%; P = 0.043). Escitalopram concentrations were significantly higher in patients treated with omeprazole (+93.9%; P < 0.001), esomeprazole (+81.8%; P < 0.001), lansoprazole (+20.1%; P = 0.008), and pantoprazole (+21.6%; P = 0.002).

Another study found that co-administration of a proton pump inhibitor, like Nexium, decreased how fast Lexapro was cleared from the body by 19%.

The prescribing information for Nexium also warns of potential interactions with drugs metabolized by CYP2C19.

How To Manage The Interaction

You have a few options to manage the interaction between Nexium and Lexapro:

• Reduce your dose of Lexapro
• Switch to an alternative PPI (proton pump inhibitor) that is less likely to interact
• Switch to another acid-reducing medication class

Lexapro Dose Adjustment

A reduction of your current Lexapro dose is likely the method that is most challenging. The Canadian labeling for Nexium suggests using no more than a 10mg dose of Lexapro if being used with Nexium.

However, if you are currently well-managed on Lexapro and are having a good response to it, changing your dosage of it wouldn't generally be advised.

Alternative PPI

In regard to switching to a different proton pump inhibitor, all the drugs in that class are metabolized by, and perhaps inhibit, CYP2C19 to some extent. Studies show that omeprazole (Prilosec) and esomeprazole (Nexium) are the worst offenders here.

Some PPIs, like Protonix (pantoprazole) and Aciphex (rabeprazole), have been reported to be the least likely to cause a clinically significant interaction, so if you and your doctor want to keep you on a proton pump inhibitor, those would likely be safer options to Nexium.

Switch Acid-Reducing Medications

Lastly, if you wanted to avoid an interaction altogether, you could switch to a different class of acid-reducing medication. Your options include acid neutralizers, like TUMS and Rolaids, or H2-blockers, like Pepcid (famotidine) and Zantac (ranitidine).

If you have a chronic problem with acid reflux, an H2-blocker is the way to go since they last around 12 hours per dose, and are generally more effective over the long term. They don't interact with Nexium. TUMS and Rolaids are more for intermittent usage when you need immediate relief.

Final Words

You asked specifically in your question if there was a different '24-hour antacid' you could take if Nexium isn't an option. The only 24-hour options would be an alternative proton pump inhibitor, like Protonix and Aciphex. Again, they still may interact with Lexapro but studies do suggest it is to a much lesser degree.

I hope you found this answer helpful! Reach back out anytime. We are always more than happy to help.