As is the case with any other medication, there may be some instances where Lexapro (escitalopram oxalate) use is not recommended or usage will have to be adjusted in order to prevent or reduce the risk of negative interactions occurring from other drugs, medical conditions, or even food and drink.
Serotonin Syndrome Warning
Serotonin syndrome (SS) is a rare but potentially fatal condition. It results from too much serotonin flooding the central nervous system (CNS). As a result, according to the U.S. National Library of Medicine, it may cause symptoms such as:
- “Agitation or restlessness
- Abnormal eye movements
- Fast heartbeat and high blood pressure
- Increased body temperature
- Loss of coordination
- Nausea and vomiting
- Overactive reflexes
- Rapid changes in blood pressure”
People who suspect they have SS should contact their doctor right away.
The risk of SS increases when taking more than one medication that increases the body’s levels of serotonin, such as selective serotonin reuptake inhibitors (SSRIs) like Lexapro, selective serotonin-norepinephrine reuptake inhibitors (SNRIs), tramadol (ConZip, Ultram, Ultram ER), and monoamine oxidase inhibitors (MAOIs).
According to the FDA, drugs that may interact with Lexapro include the following.
- Monoamine oxidase inhibitors (MAOIs), such as isocarboxazid (Marplan) and selegiline (Emsam) ((Separate escitalopram and MAOI’s by 14 days))
- Serotonergic drugs, such as other SSRIs SNRIs
- Triptans like sumatriptan
- CNS drugs
- Drugs that interfere with hemostasis, such as non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil), aspirin, and warfarin (Jantoven, Coumadin)
- Cimetidine (Tagamet HB, Acid Reducer, Heartburn Relief)
- Sumatriptan (Onzetra Xsail, Sumavel DosePro, Zembrace Symtouch, Alsuma, Imitrex STATdose Pen, Migranow, Imitrex STATdose Kit Refill)
- Drugs metabolized by cytochrome P4502D6
- Metoprolol (Toprol XL, Lopressor)
Please note that this list may not be complete, and other interactions with drugs not listed here may occur.
Lexapro and Adderall
Adderall is technically an amphetamine, and can increase the body’s levels of serotonin. Therefore, taking Lexapro and Adderall at the same time can increase the risk of SS.
Lexapro and Wellbutrin
Wellbutrin (bupropion) is an antidepressant as well as a drug that many people use to help them stop smoking. It works in part as an antidepressant by inhibiting the reuptake (reabsorption) of the neurotransmitters dopamine and norepinephrine (noradrenaline). In other words, while Lexapro primarily affects serotonin, Wellbutrin primarily affects dopamine and norepinephrine. Therefore, the risk of SS syndrome is low when taking these two drugs together.
However, despite this risk being low, it is not nonexistent, as a few cases of bupropion-related SS have been reported. In fact, one such case was reported following one elderly woman taking bupropion and the SSRI sertraline (Zoloft).
Lexapro and Benadryl
Diphenhydramine, commonly sold under the brand name Benadryl, is an antihistamine that many people use to manage allergy symptoms. However, this medication can also inhibit the reuptake up serotonin. As such, there may be an increased risk of SS when taking Lexapro and Benadryl together.
Lexapro and Tylenol
Tylenol is the brand name of the pain-relieving drug acetaminophen (paracetamol). Now, the FDA warns that Lexapro can negatively interact with drugs that affect hemostasis (aka “blood thinners” like warfarin and ibuprofen). Therefore, Tylenol may be a better choice for managing pain for those taking Lexapro than NSAIDs and other similar medications.
Escitalopram and Hydroxyzine
Hydroxyzine (Vistaril, Atarax) is an antihistamine that can treat allergies as well as anxiety-related issues. It has some ability to inhibit serotonin reuptake and can also affect the CNS. As a result, interactions with escitalopram may occur.
Escitalopram and Ibuprofen
Ibuprofen (Advil) is a non-steroidal anti-inflammatory drug (NSAID), a class of drugs that the FDA warns can interact with escitalopram.
Escitalopram and Citalopram
Like escitalopram, citalopram (Celexa) is an SSRI; taking more than one SSRI at a time increases the risk of SS.
Escitalopram and Melatonin
Melatonin is a natural hormone that plays a vital role in the sleep-wake cycle; it is also available as an over-the-counter sleep aid. Currently, no major studies report negative interactions between escitalopram and melatonin.
Escitalopram and Trazodone
Trazodone is a serotonin modulator, which means it affects serotonin. As a result, concomitant (at the same time) use of this medication and escitalopram may increase the risk of SS.
Sometimes the foods we eat and the beverages we drink can also interact with our medications.
Food and drink that may interact with Lexapro include:
Please note that this list may not be complete, and there may be other foods and beverages that interact with this drug.
Lexapro and Alcohol
For more information, please visit our page on Lexapro and alcohol interactions.
Disease & Conditions Interactions
Sometimes certain medications can increase the risk of negative side effects for patients with certain diseases or other medical conditions.
According to the FDA, diseases and medical conditions that respond poorly to Lexapro include:
Please note that this list may not be complete, and there may be other diseases and medical conditions where patients should not take Lexapro.
Lexapro and Pregnancy
For more information, please visit our page on Lexapro and pregnancy risks.
Lexapro and Breastfeeding
For more information, please visit our page on pregnancy risks.
Other interactions may include the following.
Lexapro and Weight Gain
Weight gain may occur while taking Lexapro, although this weight gain may happen for several reasons. For example, serotonin is linked to appetite. As a result, increased serotonin levels may lead to an increase in appetite that in turn leads to someone eating more, thus causing weight gain.
Lexapro and Sleep
As is the case with many other SSRIs and even SNRIs, sleep-related issues (e.g., insomnia and fatigue) are common for those taking this medication. Those who experience sleeping problems while taking this drug should talk to their doctor.
Lexapro and Sex Drive
SSRIs like Lexapro may reduce someone’s libido, or sex drive, and some people may even experience the inability to orgasm. People who experience these side effects can talk with their doctor for solutions.