During the past 1000 years, eruptions of Vesuvius have often been accompanied by large earthquakes in the Apennines 50–60 km to the northeast. Statistical investigations had shown that earthquakes often preceded eruptions, typically by less than a decade, but did not provide a physical explanation for the correlation. Here, we explore elastic stress interaction between earthquakes and eruptions under the hypothesis that small stress changes can promote events when the Apennine normal faults and the Vesuvius magma body are close to failure. We show that earthquakes can promote eruptions by compressing the magma body at depth and opening suitably oriented near-surface conduits. Voiding the magma body in turns brings these same normal faults closer to Coulomb failure, promoting earthquakes. Such a coupling is strongest if the magma reservoir is a dike oriented normal to the regional extension axis, parallel to the Apennines, and the near-surface conduits and fissures are oriented normal to the Apennines. This preferred orientation suggests that the eruptions issuing from such fissures should be most closely linked in time to Apennine earthquakes. Large Apennine earthquakes since 1400 are calculated to have transferred more stress to Vesuvius than all but the largest eruptions have transferred to Apennine faults, which may explain why earthquakes more commonly lead than follow eruptions. A two-way coupling may thus link earthquakes and Vesuvius eruptions along a 100-km-long set of faults. We test the statistical significance of the earthquake-eruption correlation in the two-way coupling zone, and find a correlation significant at the 95% confidence level.