Open Community Question @SaltMarshBirder_SC • 45-59M • Omeprazole 20 mg + escitalop • Week 12

▲ 19 Helpful • 2 Peer Replies

Male • Age 45-59 • Week 12 Protocol Check: PPI plus escitalopram plus ondansetron, did anyone get Mg or ECG checked?

Cohort check-in for people taking a PPI alongside other common medications. Context: omeprazole inhibits CYP2C19 and, per the escitalopram label, omeprazole 30 mg raised escitalopram AUC by about 50%. Escitalopram and ondansetron can both prolong the QT interval, and low magnesium or potassium raises that risk. Questions: 1) Which PPI and dose are you on (omeprazole 20 mg, pantoprazole 40 mg)? 2) Did your prescriber review your medication list for interactions? 3) Were serum magnesium and potassium checked, and what were the values? 4) Did you have an ECG? 5) Did you get palpitations, dizziness, or cramps? 6) Did switching from omeprazole to pantoprazole, which has less CYP2C19 inhibition, come up? Please share lab values and timing, not dose-change advice.

⚕ Pinned FDA / NIH / PubMed Clinical Context • Karim El-Sayed — Literature & Label Auditor

FDA DailyMed escitalopram labeling reports omeprazole 30 mg increased escitalopram Cmax by about 51% and AUC by about 50%, and notes QT prolongation risk that increases with hypokalemia and hypomagnesemia. Omeprazole labeling also warns about hypomagnesemia with long-term use.

Connected Clinical Guides: Condition: Gastroesophageal Reflux Disease Condition: Irritable Bowel Syndrome Rx: Omeprazole Rx: Pantoprazole Supplement: Magnesium Glycinate Supplement: Vitamin B12

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Verified Peer Replies (2)

@CascadeRowing_WA • Verified Cohort Member • Week 10

Worth raising with your prescriber: ondansetron's QT effect is dose-related, and the label advises correcting low potassium or magnesium before use. Bring a full list including supplements. Palpitations, fainting, or severe dizziness warrant urgent evaluation rather than waiting for a routine visit.

@BayAreaBioTracker • Age 30-44 • Week 10

My pharmacist caught the omeprazole and escitalopram interaction. My doctor kept escitalopram at 10 mg, switched me to pantoprazole 40 mg, and ordered magnesium plus potassium. Magnesium was 1.6 mg/dL, borderline low for my lab, and we rechecked after 8 weeks.