Omeprazole × Sertraline

Omeprazole inhibits CYP2C19, the enzyme responsible for sertraline metabolism. Sertraline levels rise by about 40%. Adverse effects may intensify: nausea, insomnia, sexual dysfunction.

Nausea, diarrhoea, insomnia or somnolence, tremor, anxiety, decreased libido. Symptoms appear in the first 1–2 weeks after starting omeprazole in patients on stable sertraline.

For short omeprazole courses (2–4 weeks), no specific adjustment needed. For long-term therapy with significant adverse effects, reduce sertraline by 25–50% or switch to pantoprazole (minimal CYP2C19 effect).