Can I take Esomeprazole and Sertraline together?

It is generally considered safe to take esomeprazole and sertraline together.

Esomeprazole however can slow down the liver's ability to break down sertraline (specifically by inhibiting an enzyme called CYP2C19). This causes the sertraline to stay in your body longer and reach higher levels than usual.

How to take esomeprazole and sertraline safely

You can take these medicines together, but you should be aware of any new or worsening side effects.

Speak to your doctor if you notice:

• Increased jitteriness.

• Sleep problems.

• Feeling sick (nausea).

They may decide to adjust your dose of sertraline.

Important precautions

Depression and anxiety disorders

You may experience an increase in suicidal thoughts or the urge to self-harm when first starting sertraline or changing the dose. This is more common in young adults under 25. Contact your doctor or go to hospital immediately if you notice any changes in your mood or behaviour.

Bleeding risk

Sertraline increases your risk of bleeding, especially in the stomach. Taking it with esomeprazole can sometimes mask the symptoms of a stomach ulcer, so you must report any black, tarry stools or vomit that looks like coffee grounds immediately.

Low sodium (hyponatraemia)

Both medicines can cause the salt levels in your blood to drop too low, which is more common in elderly patients. Seek medical help if you experience severe confusion, muscle weakness, or seizures.

Serotonin Syndrome

Do not take sertraline with other medicines that increase serotonin (such as St John’s Wort or certain painkillers). Seek urgent help if you develop high fever, agitation, shivering, or muscle twitching.

Severe diarrhoea (C. difficile) - esomeprazole

Seek medical help if you develop severe or persistent watery diarrhoea, as this medicine can increase the risk of a serious bowel infection.

Vitamin B12 deficiency and bone fractures - esomeprazole

Long-term use (over a year) can weaken bones and lead to low magnesium or B12 levels; your doctor should monitor these if you are on long-term treatment.

Severe kidney or liver disease

Your doctor may need to prescribe a lower dose, as your body will take longer to clear esomeprazole.

Magnesium deficiency

Taking esomeprazole for more than three months can cause your blood magnesium levels to drop significantly, leading to fatigue, muscle spasms, or dizziness.

Masking stomach cancer symptoms

Esomeprazole can hide the symptoms of stomach cancer. You must tell your doctor if you have unexplained weight loss, persistent vomiting, or difficulty swallowing before starting this medicine.

Food and drink warnings

Alcohol

It is best to avoid or strictly limit alcohol while taking sertraline. Combining alcohol with this medication can increase the risk of side effects like drowsiness, dizziness, and impaired coordination. Additionally, alcohol can worsen the symptoms of depression or anxiety that sertraline is being used to treat.

While alcohol does not directly interact with esomeprazole, it can increase stomach acid production and irritate the stomach lining, which may worsen the symptoms your medicine is intended to treat. It is best to limit alcohol intake.

Grapefruit juice

Avoid drinking large amounts of grapefruit juice. Grapefruit contains compounds that can increase the levels of sertraline in your blood, which may increase the risk of side effects.

Caffeine

Caffeine (found in coffee, tea, and some fizzy drinks) can trigger or worsen acid reflux and heartburn. This may make esomeprazole less effective at managing your symptoms.

Sertraline can sometimes cause nervousness or tremors. Consuming high amounts of caffeine may worsen these side effects or increase feelings of anxiety. It is advisable to monitor your caffeine intake.

Using other medicines

Taking multiple medicines? Our Medicines Interaction Checker helps you check whether your prescriptions, over-the-counter medicines, and supplements are safe to take together. Simply search for your medicines to see potential interactions and what to do about them.

Disclaimer

This information is for general educational purposes only and should not be relied upon as a substitute for professional medical advice. Always consult your GP, pharmacist, or another qualified healthcare professional before making decisions about your medications. Individual circumstances may vary, and only a healthcare professional who knows your medical history can provide personalised guidance.