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Lexapro time of day: Escitalopram: an antidepressant – NHS

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Escitalopram (Oral Route) Proper Use

Proper Use

Drug information provided by: IBM Micromedex

Take this medicine only as directed by your doctor to benefit your condition as much as possible. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.

This medicine should come with a Medication Guide. Read and follow these instructions carefully. Ask your doctor or pharmacist if you have any questions.

Escitalopram may be taken with or without food. If your doctor tells you to take it at a specific time, follow your doctor’s instructions.

If you are using the oral liquid, shake the bottle well before measuring each dose. Use a marked measuring spoon, oral syringe, or medicine cup to measure each dose. The average household teaspoon may not hold the right amount of liquid.

You may have to take escitalopram for a month or longer before you begin to feel better.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.


  • For oral dosage forms (solution or tablets):


    • For depression:


      • Adults and children 12 years of age and older—10 milligrams (mg) once a day, taken either in the morning or evening. Your doctor may adjust your dose as needed. However, the dose is usually not more than 20 mg per day.

      • Older adults—10 mg once a day, taken either in the morning or evening.

      • Children younger than 12 years of age—Use and dose must be determined by your doctor.

    • For generalized anxiety disorder:


      • Adults—At first, 10 milligrams (mg) once a day, taken either in the morning or evening. Your doctor may adjust your dose as needed. However, the dose is usually not more than 20 mg per day.

      • Older adults—10 mg once a day, taken either in the morning or evening.

      • Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

 

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Portions of this document last updated: Oct. 01, 2021

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Escitalopram. Dosages & Side Effects. Anxiety treatment info

About escitalopram

Type of medicine A selective serotonin reuptake inhibitor (SSRI) antidepressant
Used for Depression, and anxiety disorders (such as panic disorder, social anxiety disorder, generalised anxiety disorder and obsessive-compulsive disorder) in adults
Also called Cipralex®
Available as Tablets and oral liquid drops

Escitalopram belongs to a group of medicines called SSRI antidepressants. It is prescribed for the treatment of some mood and anxiety disorders. These are depression, panic disorder, social anxiety disorder, generalised anxiety disorder and obsessive-compulsive disorder.

Both depression and anxiety disorders can develop for no apparent reason, but they can also be triggered by a life event such as a relationship problem, a work-related problem, bereavement, or illness. Whatever the cause of the problem, when the symptoms are severe enough, they can interfere with normal day-to-day activities. When this happens, taking a medicine such as escitalopram can help to ease the symptoms and restore normal daily routines. Escitalopram works by regulating the level of a certain chemical in your brain, called serotonin.

Before taking escitalopram

Some medicines are not suitable for people with certain conditions, and sometimes a medicine can only be used if extra care is taken. For these reasons, before you start taking escitalopram it is important that your doctor knows:

  • If you are pregnant, trying for a baby or breastfeeding.
  • If you have any problems with the way your liver works, or any problems with the way your kidneys work.
  • If you have a heart condition or heart rhythm disorder.
  • If you have epilepsy.
  • If you have diabetes (diabetes mellitus).
  • If you have increased eye pressure (called glaucoma).
  • If you have ever had a bleeding disorder, or a stomach or duodenal ulcer.
  • If you have ever had abnormally ‘high’ moods, called mania.
  • If you are being treated with electroconvulsive therapy (ECT).
  • If you have ever had an allergic reaction to a medicine.
  • If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.

How to take escitalopram

  • Before you start the treatment, read the manufacturer’s printed information leaflet from inside the pack. It will give you more information about escitalopram and will provide you with a full list of the side-effects which you may experience from taking it.
  • Take escitalopram exactly as your doctor tells you to. It is prescribed as a once-daily dose. You can generally take it at a time to suit you, but try to take your doses at the same time of day, each day. You can take escitalopram either with or without food.
  • There are several strengths of tablet available; 5 mg, 10 mg and 20 mg. Your doctor will tell you which strength is right for you. This information will also be on the label of the pack you have been supplied with.
  • If you have been given escitalopram oral drops, your doctor will tell you how many drops to take each day:
    • Turn the bottle completely upside down. If no drops come out, tap the bottle lightly to start the flow.
    • Count the correct number of drops into a drink of water, orange juice or apple juice. Stir the liquid briefly, and then drink it straightaway.
  • If you forget to take a dose, take it as soon as you remember. If you do not remember until the following day, leave out the forgotten dose from the previous day and take the dose that is due as normal. Do not take two doses at the same time to make up for a missed dose.

Getting the most from your treatment

  • Try to keep your regular appointments with your doctor. This is so your doctor can check on your progress.
  • You may feel that escitalopram is not helping you straightaway. This is because it can take a week or two before the effect begins to build up, and a few weeks more before you feel the full benefit. It is important that you continue to take escitalopram, even if it takes a little while for your condition to improve.
  • If you develop any depressing or suicidal thoughts or ideas, you should let your doctor know about it as soon as possible. These thoughts can be associated with your condition and also with your treatment (particularly when the treatment is first started). It is very important that you tell your doctor about any distressing thoughts or ideas.
  • There are several types of antidepressants and they differ in their possible side-effects. If you find that escitalopram does not suit you then let your doctor know, as another may be found that will.
  • If you drink alcohol, ask your doctor for advice about drinking while you are on escitalopram. Drinking alcohol could increase the risk of unwanted effects such as feeling sleepy.
  • If you buy any medicines, check with a pharmacist that they are suitable to take with escitalopram. This is because several medicines which are available from general retail outlets can increase the risk of unwanted effects. In particular, do not take the herbal remedy called St John’s wort, and please ask for advice before buying any anti-inflammatory painkillers such as ibuprofen or aspirin.
  • Keep taking escitalopram until your doctor tells you otherwise. Your treatment is likely to last for several months – this is normal and helps to prevent your symptoms from recurring. Stopping suddenly can cause symptoms such as headache, sickness, anxiety, dizziness, shakiness and sleeping problems, so when it is time for your treatment to finish, your doctor will reduce your dose gradually over a week or two.

Can escitalopram cause problems?

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the more common ones associated with escitalopram. The best place to find a full list of the side-effects which can be associated with your medicine, is from the manufacturer’s printed information leaflet supplied with the medicine. Alternatively, you can find an example of a manufacturer’s information leaflet in the reference section below. Speak with your doctor or pharmacist if any of the following continue or become troublesome.

Very common escitalopram side-effects (these affect more than 1 in 10 people) What can I do if I experience this?
Headache Drink plenty of water and ask your pharmacist to recommend a suitable painkiller. If the headaches continue, speak with your doctor
Feeling sick (nausea) Stick to simple meals – avoid fatty or spicy food
Common escitalopram side-effects (these affect less than 1 in 10 people)
What can I do if I experience this?
Being sick (vomiting), tummy (abdominal) pain, diarrhoea, indigestion Stick to simple meals – avoid fatty or spicy food
Feeling dizzy, or sleepy Do not drive and do not use tools or machines while affected
Constipation Try to eat a well-balanced diet containing plenty of fibre, and drink several glasses of water each day
Dry mouth Try chewing sugar-free gum, or sucking sugar-free sweets
Unusual dreams, sleeping problems, tingling feelings, yawning, feeling hot, sweating, changes in appetite or weight, feeling restless or shaky, sexual problems If any becomes troublesome, speak with your doctor

If you experience any other symptoms which you think may be due to escitalopram, please speak with your doctor or pharmacist for further advice.

How to store escitalopram

  • Keep all medicines out of the reach and sight of children.
  • Store in a cool, dry place, away from direct heat and light.
  • You can use escitalopram drops for eight weeks after first opening the bottle. After this time, make sure you have a fresh supply to use.

Important information about all medicines

Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.

This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.

If you are having an operation or any dental treatment, tell the person carrying out the treatment which medicines you are taking.

Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.

If you have any questions about this medicine ask your pharmacist.

Expert Answers on Treating Depression

Q1. I have been on Lexapro for a month, and I am seeing some help with depression and anxiety, but the problem is that I take it (10 mg) in the morning around 8 a.m. and don’t feel the effects until at least three hours later. Should I be taking it at night so that I can get up happier in the morning? I have been missing work and school just because I don’t want to get up in the morning. But I also don’t want to start taking it at night if it makes it wear off by the next day.

Medications like Lexapro (escitalopram) generally don’t have acute mood-lifting effects, where you’d feel a difference within hours of taking a pill. Rather, the pathways by which these drugs relieve depression result in changes to the central nervous system that take weeks to develop.

I think what is more likely is that the change in your mood reflects a classic symptom of depression called diurnal mood variation, which basically means that mornings are the worst time of the day. What may be happening is that as the medication is starting to help, you are noticing its beneficial effects later in the day, when it is biologically easier to feel better.

Changing when you take your medication probably won’t help speed things along, but if you do not get significantly better after a few more weeks, you may want to talk with your doctor about increasing the dose of escitalopram to 20 mg a day or considering another treatment option.

Q2. Can nightmares or night terrors cause depression? I have bad dreams almost every night, and I wake up feeling very anxious and sad. I was recently diagnosed with depression and take Cipralex. I’ve been wondering if these dreams could have an impact on my mental health, or vice versa.

— Miryelin

Depression is often associated with an increase in dream, or rapid eye movement (REM), sleep, and often with dreams that have more negative themes.

It is also the case that medications such as escitalopram (the generic name of Cipralex, which is sold as Lexapro in the United States) can be associated with an increase in the occurrence of bad dreams, the result of the tendency of these medications to “push back” dream sleep from the beginning of the night to the last few hours of sleep.

Recurrent nightmares or night terrors are more characteristic of post-traumatic stress disorder and related conditions, which are also associated with an increased risk of depression. If this pattern of dreaming persists, please talk about it with your doctor. Perhaps a change in your treatment might be indicated.

Q3. I was on Wellbutrin XL (buproprion) 150 mg for a month and just upped it to 300 mg/day. I love everything about the new dosage except the insomnia. I fall asleep for an hour and then wake up for about five hours. Is this a short-term thing that will go away? I don’t want to rely on a sleeping pill but if I have to, I guess I will.

About one in 10 people get insomnia on bupropion, and usually this will get better over time and not get in the way of your recovery. If your insomnia persists, you should talk with your doctor about the pros and cons of the conventional sleeping pills, as well as other medications that may promote sleep but do not have the potential for being habit-forming.

There is also another, drug-free approach involves improving your sleep hygiene and trying some fairly simple behavioral exercises. For example, don’t use your bed for anything other than sleep and sex. Go to bed at the same time each night. Eliminate alcohol, caffeine and nicotine. Exercise in the morning and try relaxation exercises in the evening. Ask your doctor for more ideas and see if this works for you.

Q4. Can you give me some tips on how to handle all the horrible news I hear daily in regards to infants, babies, and children being harmed or killed? I am having such a hard time getting over these terrible stories. How can I let it go?

— Jennifer, Ohio

This is such a good question, Jennifer. We are so bombarded by stimulation in the form of television, Internet, radio, and word-of-mouth that it has become imperative that we learn what to pay attention to and what to shut out. I am not proposing a “head in the sand” approach, but our bodies and minds were not built to take in the amount and intensity of negative information that flows our way.

Lousy, tragic, awful things do happen and remind us of our vulnerability; the trick is to figure out how to do the following:

  1. Limit the amount of awful news that reaches you
  2. Recognize the tiny probability of it happening to you or someone close to you
  3. Find things to read or do to combat the effect of these negative stories.

First, if you are watching or listening to the news and a tragic story about infants, babies, or children begins, change the channel immediately. Say to yourself something like, “I cannot help that child by listening to this story and will just get myself upset.” Then send out a prayer or good wish for the child and his or her family. Similarly, when others start to tell you such horror stories, politely and firmly say, “I do not want to hear this” and change the subject. If you are among a larger group of people when this happens and it’s too much to ask the speaker to stop, then quietly ask a friend or the person next to you to come and get you when the conversation switches to a more positive topic, and walk out of the room.

You might think of this approach as deciding where to shine your flashlight in a dark room, focusing it on the things that you want to see. In other words, a person can only absorb so much: If you focus attention on tragic or negative events, then you have less attention to give to positive or triumphant events. Second, remind yourself that while truly awful things do happen, they are extremely rare. We hear about them only because they are so well publicized. Third, if you are not already doing this (which you may be since you are sensitive to relevant issues), invest some time in making a positive difference in the lives of children in need. Specifically, get involved in activities with children in which you will be able to see your direct positive impact. I hope that helps.

Learn more in the Everyday Health Depression Center.

Lexapro (escitalopram) dosing, indications, interactions, adverse effects, and more

  • 5-HTP

    Monitor Closely (1)escitalopram and 5-HTP both increase serotonin levels. Modify Therapy/Monitor Closely.

  • abametapir

    Serious – Use Alternative (1)abametapir will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir.

  • acebutolol

    Minor (1)escitalopram increases levels of acebutolol by decreasing metabolism. Minor/Significance Unknown.

  • aceclofenac

    Monitor Closely (1)escitalopram, aceclofenac.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

  • acemetacin

    Monitor Closely (1)escitalopram, acemetacin.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

  • albuterol

    Monitor Closely (1)albuterol and escitalopram both increase QTc interval. Use Caution/Monitor.

  • alfentanil

    Serious – Use Alternative (1)alfentanil, escitalopram.
    Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

  • alfuzosin

    Monitor Closely (2)escitalopram and alfuzosin both increase QTc interval. Use Caution/Monitor.

    alfuzosin and escitalopram both increase QTc interval. Use Caution/Monitor.

  • almotriptan

    Monitor Closely (1)almotriptan, escitalopram.
    Either increases toxicity of the other by serotonin levels. Modify Therapy/Monitor Closely. Exercise caution when concomitantly using agents that enhance serotonin activity. Monitor for the development of serotonin toxicity/serotonin syndrome during such therapy.Minor (1)escitalopram, almotriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.

  • amifampridine

    Monitor Closely (1)escitalopram increases toxicity of amifampridine by Other (see comment). Modify Therapy/Monitor Closely.
    Comment: Amifampridine can cause seizures. Coadministration with drugs that lower seizure threshold may increase this risk.

  • amiodarone

    Serious – Use Alternative (1)escitalopram increases toxicity of amiodarone by QTc interval. Avoid or Use Alternate Drug.

  • amitriptyline

    Serious – Use Alternative (2)escitalopram and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

    escitalopram increases toxicity of amitriptyline by QTc interval. Avoid or Use Alternate Drug.

  • amobarbital

    Monitor Closely (1)amobarbital will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • amoxapine

    Monitor Closely (1)escitalopram increases toxicity of amoxapine by QTc interval. Use Caution/Monitor.Serious – Use Alternative (1)escitalopram and amoxapine both increase serotonin levels. Avoid or Use Alternate Drug.

  • apalutamide

    Serious – Use Alternative (2)apalutamide will decrease the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP2C19 inducer, with drugs that are CYP2C19 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered.

    apalutamide will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.

  • apixaban

    Monitor Closely (1)escitalopram increases effects of apixaban by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

  • apomorphine

    Monitor Closely (1)escitalopram increases toxicity of apomorphine by QTc interval. Use Caution/Monitor.

  • arformoterol

    Monitor Closely (1)escitalopram increases toxicity of arformoterol by QTc interval. Use Caution/Monitor.

  • aripiprazole

    Monitor Closely (1)aripiprazole and escitalopram both increase QTc interval. Use Caution/Monitor.

  • arsenic trioxide

    Serious – Use Alternative (1)escitalopram increases toxicity of arsenic trioxide by QTc interval. Avoid or Use Alternate Drug.

  • artemether

    Serious – Use Alternative (1)artemether and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.

  • artemether/lumefantrine

    Serious – Use Alternative (1)escitalopram increases toxicity of artemether/lumefantrine by QTc interval. Avoid or Use Alternate Drug.

  • asenapine

    Serious – Use Alternative (1)escitalopram increases toxicity of asenapine by QTc interval. Avoid or Use Alternate Drug.

  • aspirin

    Monitor Closely (1)escitalopram, aspirin.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

  • aspirin rectal

    Monitor Closely (1)escitalopram, aspirin rectal.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

  • aspirin/citric acid/sodium bicarbonate

    Monitor Closely (1)escitalopram, aspirin/citric acid/sodium bicarbonate.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

  • atazanavir

    Monitor Closely (1)atazanavir increases levels of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased risk of serotonin syndrome.

  • atenolol

    Minor (1)escitalopram increases levels of atenolol by decreasing metabolism. Minor/Significance Unknown.

  • atomoxetine

    Monitor Closely (2)atomoxetine and escitalopram both increase QTc interval. Use Caution/Monitor.

    escitalopram increases levels of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

  • azithromycin

    Monitor Closely (1)azithromycin increases toxicity of escitalopram by QTc interval. Use Caution/Monitor.Serious – Use Alternative (1)escitalopram increases toxicity of azithromycin by QTc interval. Avoid or Use Alternate Drug.

  • bedaquiline

    Monitor Closely (1)escitalopram and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely

  • belzutifan

    Monitor Closely (1)belzutifan will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information.

  • benzhydrocodone/acetaminophen

    Monitor Closely (1)benzhydrocodone/acetaminophen, escitalopram.
    Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

  • betaxolol

    Minor (1)escitalopram increases levels of betaxolol by decreasing metabolism. Minor/Significance Unknown.

  • betrixaban

    Monitor Closely (1)escitalopram, betrixaban.
    Either increases levels of the other by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

  • bisoprolol

    Minor (1)escitalopram increases levels of bisoprolol by decreasing metabolism. Minor/Significance Unknown.

  • bortezomib

    Minor (1)bortezomib will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.

  • bumetanide

    Minor (1)bumetanide, escitalopram. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible additive hyponatremia.

  • buprenorphine subdermal implant

    Monitor Closely (1)escitalopram, buprenorphine subdermal implant.
    Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.

  • buprenorphine, long-acting injection

    Monitor Closely (1)escitalopram, buprenorphine, long-acting injection.
    Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.

  • bupropion

    Serious – Use Alternative (1)escitalopram increases toxicity of bupropion by unspecified interaction mechanism. Avoid or Use Alternate Drug. May lower seizure threshold; keep bupropion dose as low as possible.

  • buspirone

    Serious – Use Alternative (1)escitalopram and buspirone both increase serotonin levels. Avoid or Use Alternate Drug.

  • butabarbital

    Monitor Closely (1)butabarbital will decrease the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

  • butalbital

    Monitor Closely (1)butalbital will decrease the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

  • cannabidiol

    Monitor Closely (1)cannabidiol will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider reducing the dose of sensitive CYP2C19 substrates, as clinically appropriate, when coadministered with cannabidiol.

  • carbamazepine

    Monitor Closely (1)carbamazepine will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • carvedilol

    Minor (1)escitalopram increases levels of carvedilol by decreasing metabolism. Minor/Significance Unknown.

  • celecoxib

    Monitor Closely (1)escitalopram, celecoxib.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

  • celiprolol

    Minor (1)escitalopram increases levels of celiprolol by decreasing metabolism. Minor/Significance Unknown.

  • cenobamate

    Monitor Closely (3)cenobamate, escitalopram.
    Either increases effects of the other by sedation. Use Caution/Monitor.

    cenobamate will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

    cenobamate will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.

  • ceritinib

    Serious – Use Alternative (1)ceritinib and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.

  • chloramphenicol

    Monitor Closely (1)chloramphenicol will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • chloroquine

    Monitor Closely (1)chloroquine increases toxicity of escitalopram by QTc interval. Use Caution/Monitor.

  • chlorpromazine

    Serious – Use Alternative (1)escitalopram increases toxicity of chlorpromazine by QTc interval. Avoid or Use Alternate Drug.

  • choline magnesium trisalicylate

    Monitor Closely (1)escitalopram, choline magnesium trisalicylate.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

  • ciprofloxacin

    Monitor Closely (1)escitalopram increases toxicity of ciprofloxacin by QTc interval. Use Caution/Monitor.

  • cisapride

    Contraindicated (1)escitalopram increases toxicity of cisapride by QTc interval. Contraindicated.

  • citalopram

    Serious – Use Alternative (1)citalopram and escitalopram both increase serotonin levels. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

  • clarithromycin

    Serious – Use Alternative (3)clarithromycin, escitalopram.
    Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. To monitor for the prolongation of QT/QTc and/or development of ventricular tachyarrhythmias the labeling recommends monitoring QT interval or ECG.

    escitalopram increases toxicity of clarithromycin by QTc interval. Avoid or Use Alternate Drug.

    clarithromycin will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

  • clofazimine

    Monitor Closely (1)escitalopram increases toxicity of clofazimine by QTc interval. Modify Therapy/Monitor Closely.

  • clomipramine

    Monitor Closely (1)escitalopram increases toxicity of clomipramine by QTc interval. Use Caution/Monitor.Serious – Use Alternative (1)escitalopram and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug.

  • clonidine

    Monitor Closely (1)clonidine, escitalopram.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration enhances CNS depressant effects.

  • clopidogrel

    Monitor Closely (1)escitalopram increases effects of clopidogrel by pharmacodynamic synergism. Use Caution/Monitor. SSRIs affect platelet activation; coadministration of SSRIs with clopidogrel may increase the risk of bleeding.

  • clozapine

    Monitor Closely (2)escitalopram increases levels of clozapine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Plasma levels of clozapine may be increased, resulting in increased pharmacologic and toxic effects. Adjust clozapine dose as needed when initiating or discontinuing certain SSRIs. .

    escitalopram increases toxicity of clozapine by QTc interval. Use Caution/Monitor.

  • cobicistat

    Monitor Closely (2)cobicistat will increase the level or effect of escitalopram by Other (see comment). Use Caution/Monitor. Carefully titrate dose of the antidepressant to the desired effect, including using the lowest feasible initial or maintenance dose, and monitor its response during coadministration with SSRIs and cobicistat.

    cobicistat will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • cocaine

    Monitor Closely (1)escitalopram and cocaine both increase serotonin levels. Modify Therapy/Monitor Closely.

  • crizotinib

    Monitor Closely (2)crizotinib and escitalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

    crizotinib increases levels of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Dose reduction may be needed for coadministered drugs that are predominantly metabolized by CYP3A.Serious – Use Alternative (1)escitalopram increases toxicity of crizotinib by QTc interval. Avoid or Use Alternate Drug.

  • cyclobenzaprine

    Serious – Use Alternative (1)escitalopram and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

  • cyproheptadine

    Monitor Closely (1)cyproheptadine decreases effects of escitalopram by pharmacodynamic antagonism. Use Caution/Monitor. Cyproheptadine may diminish the serotonergic effect of SSRIs.

  • dabrafenib

    Monitor Closely (1)dabrafenib will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

  • darunavir

    Minor (1)darunavir will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown. Coadministration with SSRIs, TCAs, or trazodone may require dose titration of antidepressant to desired effect (eg, using the lowest feasible initial or maintenance dose). Monitor for antidepressant response.

  • dasatinib

    Monitor Closely (1)escitalopram increases toxicity of dasatinib by QTc interval. Use Caution/Monitor.

  • defibrotide

    Monitor Closely (1)defibrotide increases effects of escitalopram by Other (see comment). Use Caution/Monitor.
    Comment: Defibrotide may enhance effects of platelet inhibitors.

  • degarelix

    Monitor Closely (1)escitalopram increases toxicity of degarelix by QTc interval. Use Caution/Monitor.

  • desflurane

    Serious – Use Alternative (1)desflurane and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.

  • desipramine

    Monitor Closely (1)escitalopram increases toxicity of desipramine by QTc interval. Use Caution/Monitor.Serious – Use Alternative (1)escitalopram and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.

  • desvenlafaxine

    Serious – Use Alternative (1)escitalopram and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.

  • deutetrabenazine

    Monitor Closely (1)escitalopram increases toxicity of deutetrabenazine by QTc interval. Use Caution/Monitor.

  • dexfenfluramine

    Monitor Closely (1)escitalopram and dexfenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.

  • dexmethylphenidate

    Monitor Closely (1)dexmethylphenidate increases effects of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • dextroamphetamine

    Monitor Closely (1)escitalopram and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.

  • dextromethorphan

    Serious – Use Alternative (1)escitalopram and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.

  • diazepam intranasal

    Monitor Closely (1)diazepam intranasal, escitalopram.
    Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.

  • dichlorphenamide

    Monitor Closely (1)dichlorphenamide, escitalopram. sedation. Use Caution/Monitor.

  • diclofenac

    Monitor Closely (1)escitalopram, diclofenac.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

  • diflunisal

    Monitor Closely (1)escitalopram, diflunisal.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

  • dihydroergotamine

    Monitor Closely (1)escitalopram and dihydroergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.

  • dihydroergotamine intranasal

    Monitor Closely (1)escitalopram and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.

  • disopyramide

    Serious – Use Alternative (1)escitalopram increases toxicity of disopyramide by QTc interval. Avoid or Use Alternate Drug.

  • dofetilide

    Serious – Use Alternative (2)dofetilide increases toxicity of escitalopram by QTc interval. Avoid or Use Alternate Drug.

    escitalopram increases toxicity of dofetilide by QTc interval. Avoid or Use Alternate Drug.

  • dolasetron

    Monitor Closely (2)dolasetron, escitalopram.
    Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Monitor ECG, symptoms of serotonin syndrome especially during initiation/titration.

    escitalopram increases toxicity of dolasetron by QTc interval. Use Caution/Monitor.

  • donepezil

    Monitor Closely (1)donepezil and escitalopram both increase QTc interval. Use Caution/Monitor.

  • dosulepin

    Serious – Use Alternative (1)escitalopram and dosulepin both increase serotonin levels. Avoid or Use Alternate Drug.

  • doxepin

    Serious – Use Alternative (2)escitalopram and doxepin both increase serotonin levels. Avoid or Use Alternate Drug.

    doxepin and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.

  • dronedarone

    Contraindicated (1)escitalopram increases toxicity of dronedarone by QTc interval. Contraindicated.

  • droperidol

    Serious – Use Alternative (1)escitalopram increases toxicity of droperidol by QTc interval. Avoid or Use Alternate Drug.

  • duloxetine

    Monitor Closely (1)duloxetine and escitalopram both increase serotonin levels. Use Caution/Monitor.

  • duvelisib

    Monitor Closely (1)duvelisib will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration with duvelisib increases AUC of a sensitive CYP3A4 substrate which may increase the risk of toxicities of these drugs. Consider reducing the dose of the sensitive CYP3A4 substrate and monitor for signs of toxicities of the coadministered sensitive CYP3A substrate.

  • edoxaban

    Monitor Closely (1)escitalopram increases effects of edoxaban by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

  • efavirenz

    Monitor Closely (2)efavirenz will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

    efavirenz will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • elagolix

    Monitor Closely (2)elagolix will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak CYP2C19 inhibitor. Caution with sensitive CYP2C19 substrates.

    elagolix will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.

  • eletriptan

    Monitor Closely (1)eletriptan and escitalopram both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)escitalopram, eletriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.

  • elvitegravir/cobicistat/emtricitabine/tenofovir DF

    Monitor Closely (1)elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

  • encorafenib

    Monitor Closely (1)encorafenib, escitalopram. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.Serious – Use Alternative (1)escitalopram increases toxicity of encorafenib by QTc interval. Avoid or Use Alternate Drug.

  • entrectinib

    Serious – Use Alternative (1)escitalopram and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.

  • enzalutamide

    Serious – Use Alternative (1)enzalutamide will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

  • ergotamine

    Monitor Closely (1)escitalopram and ergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.

  • eribulin

    Serious – Use Alternative (1)escitalopram increases toxicity of eribulin by QTc interval. Avoid or Use Alternate Drug.

  • erythromycin base

    Serious – Use Alternative (1)escitalopram increases toxicity of erythromycin base by QTc interval. Avoid or Use Alternate Drug.

  • erythromycin ethylsuccinate

    Serious – Use Alternative (1)escitalopram increases toxicity of erythromycin ethylsuccinate by QTc interval. Avoid or Use Alternate Drug.

  • erythromycin lactobionate

    Serious – Use Alternative (1)escitalopram increases toxicity of erythromycin lactobionate by QTc interval. Avoid or Use Alternate Drug.

  • erythromycin stearate

    Serious – Use Alternative (1)escitalopram increases toxicity of erythromycin stearate by QTc interval. Avoid or Use Alternate Drug.

  • eslicarbazepine acetate

    Monitor Closely (1)eslicarbazepine acetate will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

  • esmolol

    Minor (1)escitalopram increases levels of esmolol by decreasing metabolism. Minor/Significance Unknown.

  • esomeprazole

    Monitor Closely (1)esomeprazole will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

  • ethacrynic acid

    Minor (1)ethacrynic acid, escitalopram. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible additive hyponatremia.

  • etodolac

    Monitor Closely (1)escitalopram, etodolac.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

  • etravirine

    Monitor Closely (2)etravirine will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

    etravirine will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • ezogabine

    Monitor Closely (2)escitalopram increases toxicity of ezogabine by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed, particularly when dose titrated to 1200mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.

    ezogabine, escitalopram.
    Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.

  • fedratinib

    Monitor Closely (2)fedratinib will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.

    fedratinib will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2C19 substrates as necessary.

  • felbamate

    Monitor Closely (1)felbamate will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

  • felodipine

    Minor (1)felodipine will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.

  • fenbufen

    Monitor Closely (1)escitalopram, fenbufen.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

  • fenfluramine

    Monitor Closely (2)fenfluramine, escitalopram.
    Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

    escitalopram and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.

  • fenoprofen

    Monitor Closely (1)escitalopram, fenoprofen.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

  • fentanyl

    Serious – Use Alternative (1)fentanyl, escitalopram.
    Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

  • fentanyl intranasal

    Serious – Use Alternative (1)fentanyl intranasal, escitalopram.
    Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

  • fentanyl transdermal

    Serious – Use Alternative (1)fentanyl transdermal, escitalopram.
    Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

  • fentanyl transmucosal

    Serious – Use Alternative (1)fentanyl transmucosal, escitalopram.
    Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

  • fexinidazole

    Monitor Closely (1)fexinidazole will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.Serious – Use Alternative (2)fexinidazole and escitalopram both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.

    fexinidazole will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.

  • fish oil triglycerides

    Monitor Closely (1)fish oil triglycerides will increase the level or effect of escitalopram by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

  • flecainide

    Serious – Use Alternative (1)escitalopram increases toxicity of flecainide by QTc interval. Avoid or Use Alternate Drug.

  • fluconazole

    Monitor Closely (2)fluconazole will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

    escitalopram increases toxicity of fluconazole by QTc interval. Use Caution/Monitor.

  • fluoxetine

    Monitor Closely (1)escitalopram and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.Serious – Use Alternative (2)escitalopram and fluoxetine both increase serotonin levels. Avoid or Use Alternate Drug.

    fluoxetine will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug.

  • fluphenazine

    Monitor Closely (1)escitalopram increases toxicity of fluphenazine by QTc interval. Use Caution/Monitor.

  • flurbiprofen

    Monitor Closely (1)escitalopram, flurbiprofen.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

  • fluvoxamine

    Serious – Use Alternative (1)fluvoxamine and escitalopram both increase serotonin levels. Avoid or Use Alternate Drug.

  • fondaparinux

    Monitor Closely (1)escitalopram increases effects of fondaparinux by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

  • formoterol

    Monitor Closely (1)escitalopram increases toxicity of formoterol by QTc interval. Use Caution/Monitor.

  • fosamprenavir

    Monitor Closely (1)fosamprenavir increases levels of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. Increased risk of serotonin syndrome.

  • foscarnet

    Serious – Use Alternative (1)escitalopram increases toxicity of foscarnet by QTc interval. Avoid or Use Alternate Drug.

  • fosphenytoin

    Monitor Closely (1)fosphenytoin will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • fostemsavir

    Monitor Closely (1)escitalopram and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

  • frovatriptan

    Monitor Closely (1)frovatriptan and escitalopram both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)escitalopram, frovatriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.

  • furosemide

    Minor (1)furosemide, escitalopram. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible additive hyponatremia.

  • gabapentin

    Monitor Closely (1)gabapentin, escitalopram.
    Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

  • gabapentin enacarbil

    Monitor Closely (1)gabapentin enacarbil, escitalopram.
    Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

  • gemifloxacin

    Monitor Closely (1)escitalopram increases toxicity of gemifloxacin by QTc interval. Use Caution/Monitor.

  • gemtuzumab

    Monitor Closely (1)escitalopram increases toxicity of gemtuzumab by QTc interval. Use Caution/Monitor.

  • gilteritinib

    Serious – Use Alternative (1)gilteritinib will decrease the level or effect of escitalopram by Other (see comment). Avoid or Use Alternate Drug. Coadministration of gilteritinib with drugs that inhibit 5HT2B or sigma nonspecific receptors. Avoid use of these drugs with gilteritinib unless coadministration is necessary.

  • glasdegib

    Serious – Use Alternative (1)escitalopram and glasdegib both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, monitor for increased risk of QTc interval prolongation.

  • goserelin

    Contraindicated (1)goserelin increases toxicity of escitalopram by QTc interval. Contraindicated. Increases risk of torsades de pointes.

  • granisetron

    Serious – Use Alternative (1)granisetron, escitalopram.
    Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

  • green tea

    Monitor Closely (1)green tea, escitalopram. Other (see comment). Use Caution/Monitor.
    Comment: Combination may increase risk of bleeding.

  • haloperidol

    Monitor Closely (2)escitalopram increases toxicity of haloperidol by QTc interval. Use Caution/Monitor.

    haloperidol and escitalopram both increase QTc interval. Use Caution/Monitor.

  • histrelin

    Serious – Use Alternative (1)histrelin increases toxicity of escitalopram by QTc interval. Avoid or Use Alternate Drug. Increases risk of torsades de pointes.

  • hydrocodone

    Monitor Closely (1)hydrocodone, escitalopram.
    Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

  • hydromorphone

    Serious – Use Alternative (1)hydromorphone, escitalopram.
    Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

  • hydroxychloroquine sulfate

    Serious – Use Alternative (2)hydroxychloroquine sulfate and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.

    escitalopram increases toxicity of hydroxychloroquine sulfate by QTc interval. Avoid or Use Alternate Drug.

  • hydroxyurea

    Monitor Closely (1)escitalopram, hydroxyurea. Other (see comment). Use Caution/Monitor.
    Comment: Combination may increase risk of myelosuppression.

  • ibrutinib

    Monitor Closely (1)ibrutinib will increase the level or effect of escitalopram by anticoagulation. Use Caution/Monitor. Ibrutinib may increase the risk of hemorrhage in patients receiving antiplatelet or anticoagulant therapies and monitor for signs of bleeding.

  • ibuprofen

    Monitor Closely (1)escitalopram, ibuprofen.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

  • ibuprofen IV

    Monitor Closely (1)escitalopram, ibuprofen IV.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

  • ibutilide

    Serious – Use Alternative (1)escitalopram increases toxicity of ibutilide by QTc interval. Avoid or Use Alternate Drug.

  • idelalisib

    Serious – Use Alternative (1)idelalisib will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates

  • iloperidone

    Monitor Closely (1)iloperidone increases levels of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4.Serious – Use Alternative (1)escitalopram increases toxicity of iloperidone by QTc interval. Avoid or Use Alternate Drug.

  • imipramine

    Serious – Use Alternative (1)escitalopram and imipramine both increase serotonin levels. Avoid or Use Alternate Drug.

  • indacaterol, inhaled

    Monitor Closely (2)indacaterol, inhaled, escitalopram. QTc interval. Use Caution/Monitor. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.

    escitalopram increases toxicity of indacaterol, inhaled by QTc interval. Use Caution/Monitor.

  • indapamide

    Monitor Closely (1)escitalopram increases toxicity of indapamide by QTc interval. Use Caution/Monitor.

  • indinavir

    Monitor Closely (1)indinavir increases levels of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. Increased risk of serotonin syndrome.

  • indomethacin

    Monitor Closely (1)escitalopram, indomethacin.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

  • inotuzumab

    Serious – Use Alternative (1)escitalopram increases toxicity of inotuzumab by QTc interval. Avoid or Use Alternate Drug.

  • ioflupane I 123

    Monitor Closely (1)escitalopram decreases effects of ioflupane I 123 by receptor binding competition. Use Caution/Monitor. Drugs that bind to dopamine transporter receptor with high affinity may interfere with the image following ioflupane I 123 administration.

  • isocarboxazid

    Contraindicated (1)isocarboxazid and escitalopram both increase serotonin levels. Contraindicated.

  • isoniazid

    Monitor Closely (2)isoniazid will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

    escitalopram and isoniazid both increase serotonin levels. Modify Therapy/Monitor Closely.

  • isradipine

    Monitor Closely (1)escitalopram increases toxicity of isradipine by QTc interval. Use Caution/Monitor.

  • istradefylline

    Monitor Closely (1)istradefylline will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.

  • itraconazole

    Monitor Closely (1)itraconazole will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • ivosidenib

    Serious – Use Alternative (2)ivosidenib and escitalopram both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.

    ivosidenib will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternate therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.

  • ketoprofen

    Monitor Closely (1)escitalopram, ketoprofen.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

  • ketorolac

    Monitor Closely (1)escitalopram, ketorolac.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

  • ketorolac intranasal

    Monitor Closely (1)escitalopram, ketorolac intranasal.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

  • L-tryptophan

    Monitor Closely (1)escitalopram and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.

  • labetalol

    Minor (1)escitalopram increases levels of labetalol by decreasing metabolism. Minor/Significance Unknown.

  • lamotrigine

    Monitor Closely (1)lamotrigine increases toxicity of escitalopram by unspecified interaction mechanism. Modify Therapy/Monitor Closely. CNS depressants may increase the toxic effects of selective serotonin reuptake inhibitors; psychomotor impairment may be enhanced.

  • lapatinib

    Monitor Closely (1)escitalopram increases toxicity of lapatinib by QTc interval. Use Caution/Monitor.

  • lasmiditan

    Monitor Closely (2)lasmiditan, escitalopram.
    Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.

    escitalopram increases effects of lasmiditan by serotonin levels. Use Caution/Monitor. Coadministration may increase risk of serotonin syndrome.

  • lefamulin

    Contraindicated (1)lefamulin will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Lefamulin is contraindicated with CYP3A substrates know to prolong the QT interval.

  • lemborexant

    Monitor Closely (1)lemborexant, escitalopram.
    Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

  • lenvatinib

    Monitor Closely (1)escitalopram and lenvatinib both increase QTc interval. Use Caution/Monitor. Lenvatinib prescribing information recommends monitoring ECG closely when coadministered with QT prolonging drugs.

  • leuprolide

    Contraindicated (1)leuprolide increases toxicity of escitalopram by QTc interval. Contraindicated. Increases risk of torsades de pointes.

  • levofloxacin

    Monitor Closely (1)escitalopram increases toxicity of levofloxacin by QTc interval. Use Caution/Monitor.

  • levomilnacipran

    Serious – Use Alternative (1)escitalopram and levomilnacipran both increase serotonin levels. Avoid or Use Alternate Drug.

  • linezolid

    Serious – Use Alternative (1)linezolid and escitalopram both increase serotonin levels. Avoid or Use Alternate Drug. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first.

  • lisdexamfetamine

    Monitor Closely (1)escitalopram, lisdexamfetamine.
    Either increases effects of the other by serotonin levels. Use Caution/Monitor. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue along with concomitant serotonergic drug(s).

  • lithium

    Monitor Closely (1)escitalopram and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)escitalopram, lithium. Mechanism: unknown. Minor/Significance Unknown. Risk of neurotoxicity.

  • lofepramine

    Serious – Use Alternative (1)escitalopram and lofepramine both increase serotonin levels. Avoid or Use Alternate Drug.

  • lofexidine

    Monitor Closely (1)escitalopram increases toxicity of lofexidine by QTc interval. Use Caution/Monitor.

  • lonafarnib

    Serious – Use Alternative (1)lonafarnib will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Lonafarnib may increase the AUC and peak concentration of CYP2C19 substrates. If coadministration unavoidable, monitor for adverse reactions and reduce the CYP2C19 substrate dose in accordance with its approved product labeling.

  • lopinavir

    Monitor Closely (1)lopinavir increases levels of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. Increased risk of serotinin syndrome.Serious – Use Alternative (1)escitalopram increases toxicity of lopinavir by QTc interval. Avoid or Use Alternate Drug.

  • lorcaserin

    Serious – Use Alternative (1)escitalopram and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

  • lorlatinib

    Monitor Closely (1)lorlatinib will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • lornoxicam

    Monitor Closely (1)escitalopram, lornoxicam.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

  • lsd

    Monitor Closely (1)escitalopram and lsd both increase serotonin levels. Modify Therapy/Monitor Closely.

  • lumacaftor/ivacaftor

    Monitor Closely (2)lumacaftor/ivacaftor will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. A higher dose of escitalopram may be required to obtain desired therapeutic effect. Escitalopram is a CYP3A and CYP2C19 substrate. Lumacaftor/ivacaftor is a strong inducer of CYP3A and has the potential to induce CYP2C19.

    lumacaftor/ivacaftor, escitalopram. affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. In vitro studies suggest that lumacaftor may induce and ivacaftor may inhibit CYP2C19 substrates. .

  • lurasidone

    Monitor Closely (1)lurasidone, escitalopram.
    Either increases toxicity of the other by Other (see comment). Use Caution/Monitor.
    Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

  • macimorelin

    Serious – Use Alternative (1)macimorelin and escitalopram both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.

  • maprotiline

    Monitor Closely (1)escitalopram increases toxicity of maprotiline by QTc interval. Use Caution/Monitor.Serious – Use Alternative (1)escitalopram and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

  • meclofenamate

    Monitor Closely (1)escitalopram, meclofenamate.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

  • mefenamic acid

    Monitor Closely (1)escitalopram, mefenamic acid.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

  • mefloquine

    Monitor Closely (1)escitalopram increases toxicity of mefloquine by QTc interval. Use Caution/Monitor.Serious – Use Alternative (1)mefloquine increases toxicity of escitalopram by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

  • meloxicam

    Monitor Closely (1)escitalopram, meloxicam.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

  • meperidine

    Serious – Use Alternative (2)escitalopram and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

    meperidine, escitalopram.
    Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

  • metformin

    Monitor Closely (1)escitalopram increases effects of metformin by pharmacodynamic synergism. Use Caution/Monitor.

  • methadone

    Serious – Use Alternative (1)escitalopram increases toxicity of methadone by QTc interval. Avoid or Use Alternate Drug.

  • methylene blue

    Serious – Use Alternative (1)methylene blue and escitalopram both increase serotonin levels. Avoid or Use Alternate Drug. Methylene blue may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first.

  • metoclopramide

    Serious – Use Alternative (1)metoclopramide and escitalopram both increase serotonin levels. Avoid or Use Alternate Drug. Additive effects; increased risk for serotonin syndrome, neuroleptic malignant syndrome, dystonia, or other extrapyramidal reactions

  • metoclopramide intranasal

    Serious – Use Alternative (1)escitalopram, metoclopramide intranasal.
    Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug.
    Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

  • metoprolol

    Minor (1)escitalopram increases levels of metoprolol by decreasing metabolism. Minor/Significance Unknown.

  • midazolam intranasal

    Monitor Closely (1)midazolam intranasal, escitalopram.
    Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

  • mifepristone

    Monitor Closely (3)mifepristone will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

    escitalopram increases toxicity of mifepristone by QTc interval. Use Caution/Monitor.

    mifepristone, escitalopram. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.

  • milnacipran

    Serious – Use Alternative (1)escitalopram and milnacipran both increase serotonin levels. Avoid or Use Alternate Drug.

  • mirtazapine

    Monitor Closely (1)escitalopram and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.

  • mitotane

    Monitor Closely (1)mitotane decreases levels of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.

  • mobocertinib

    Serious – Use Alternative (1)mobocertinib and escitalopram both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.

  • modafinil

    Monitor Closely (1)modafinil will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely.

  • morphine

    Monitor Closely (1)escitalopram and morphine both increase serotonin levels. Modify Therapy/Monitor Closely.Serious – Use Alternative (1)morphine, escitalopram.
    Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

  • moxifloxacin

    Monitor Closely (2)escitalopram and moxifloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

    moxifloxacin and escitalopram both increase QTc interval. Modify Therapy/Monitor Closely.

  • nabumetone

    Monitor Closely (1)escitalopram, nabumetone.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

  • nadolol

    Minor (1)escitalopram increases levels of nadolol by decreasing metabolism. Minor/Significance Unknown.

  • nafcillin

    Monitor Closely (1)nafcillin will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • naproxen

    Monitor Closely (1)escitalopram, naproxen.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

  • naratriptan

    Monitor Closely (1)naratriptan and escitalopram both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)escitalopram, naratriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.

  • nebivolol

    Minor (1)escitalopram increases levels of nebivolol by decreasing metabolism. Minor/Significance Unknown.

  • nefazodone

    Serious – Use Alternative (2)escitalopram and nefazodone both increase serotonin levels. Avoid or Use Alternate Drug.

    nefazodone will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

  • nelfinavir

    Monitor Closely (1)nelfinavir increases levels of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. Increased risk of serotonin syndrome.

  • netupitant/palonosetron

    Serious – Use Alternative (1)netupitant/palonosetron, escitalopram.
    Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

  • nilotinib

    Serious – Use Alternative (1)escitalopram increases toxicity of nilotinib by QTc interval. Avoid or Use Alternate Drug.

  • nortriptyline

    Monitor Closely (1)escitalopram increases toxicity of nortriptyline by QTc interval. Use Caution/Monitor.Serious – Use Alternative (1)escitalopram and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

  • octreotide

    Monitor Closely (1)escitalopram increases toxicity of octreotide by QTc interval. Use Caution/Monitor.

  • ofloxacin

    Monitor Closely (1)escitalopram increases toxicity of ofloxacin by QTc interval. Use Caution/Monitor.

  • olanzapine

    Monitor Closely (1)escitalopram increases toxicity of olanzapine by QTc interval. Use Caution/Monitor. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval in rare instances.

  • oliceridine

    Monitor Closely (1)escitalopram, oliceridine.
    Either increases toxicity of the other by serotonin levels. Modify Therapy/Monitor Closely.

  • olodaterol inhaled

    Monitor Closely (1)escitalopram and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. Drugs that prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias

  • omeprazole

    Monitor Closely (1)omeprazole will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

  • ondansetron

    Serious – Use Alternative (2)escitalopram and ondansetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.

    ondansetron, escitalopram.
    Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

  • osilodrostat

    Monitor Closely (2)osilodrostat and escitalopram both increase QTc interval. Use Caution/Monitor.

    escitalopram and osilodrostat both increase QTc interval. Use Caution/Monitor. Dose dependent QT prolongation – avoid drugs known to prolong the QT interval

  • osimertinib

    Monitor Closely (1)osimertinib and escitalopram both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.Serious – Use Alternative (1)escitalopram increases toxicity of osimertinib by QTc interval. Avoid or Use Alternate Drug.

  • oxaliplatin

    Monitor Closely (1)oxaliplatin will increase the level or effect of escitalopram by Other (see comment). Use Caution/Monitor. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval.

  • oxaprozin

    Monitor Closely (1)escitalopram, oxaprozin.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

  • oxcarbazepine

    Monitor Closely (1)oxcarbazepine will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

  • oxycodone

    Monitor Closely (1)oxycodone increases effects of escitalopram by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Opioids may enhance the serotonergic effects of SSRIs and increase risk for serotonergic syndrome.

  • ozanimod

    Monitor Closely (1)ozanimod and escitalopram both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.Serious – Use Alternative (1)ozanimod increases toxicity of escitalopram by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.

  • paliperidone

    Serious – Use Alternative (1)escitalopram increases toxicity of paliperidone by QTc interval. Avoid or Use Alternate Drug.

  • palonosetron

    Serious – Use Alternative (1)palonosetron, escitalopram.
    Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

  • panax ginseng

    Minor (1)panax ginseng increases effects of escitalopram by pharmacodynamic synergism. Minor/Significance Unknown.

  • panobinostat

    Serious – Use Alternative (1)escitalopram and panobinostat both increase QTc interval. Avoid or Use Alternate Drug. Panobinostat is known to significantly prolong QT interval. Panobinostat prescribing information states use with drugs known to prolong QTc is not recommended.

  • parecoxib

    Monitor Closely (1)escitalopram, parecoxib.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.Minor (1)parecoxib will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.

  • paroxetine

    Serious – Use Alternative (1)escitalopram and paroxetine both increase serotonin levels. Avoid or Use Alternate Drug.

  • pasireotide

    Monitor Closely (1)escitalopram and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.

  • pazopanib

    Serious – Use Alternative (1)escitalopram increases toxicity of pazopanib by QTc interval. Avoid or Use Alternate Drug.

  • penbutolol

    Minor (1)escitalopram increases levels of penbutolol by decreasing metabolism. Minor/Significance Unknown.

  • pentamidine

    Serious – Use Alternative (1)escitalopram increases toxicity of pentamidine by QTc interval. Avoid or Use Alternate Drug.

  • pentazocine

    Monitor Closely (1)escitalopram and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

  • pentobarbital

    Monitor Closely (1)pentobarbital will decrease the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

  • perphenazine

    Monitor Closely (1)escitalopram increases toxicity of perphenazine by QTc interval. Use Caution/Monitor.

  • phenelzine

    Contraindicated (1)phenelzine and escitalopram both increase serotonin levels. Contraindicated.

  • phenobarbital

    Monitor Closely (2)phenobarbital will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

    phenobarbital will decrease the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

  • phentermine

    Serious – Use Alternative (1)escitalopram, phentermine.
    Either increases toxicity of the other by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of serotonin syndrome.

  • phenytoin

    Monitor Closely (1)phenytoin will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • pimavanserin

    Serious – Use Alternative (1)escitalopram increases toxicity of pimavanserin by QTc interval. Avoid or Use Alternate Drug.

  • pimozide

    Serious – Use Alternative (2)pimozide, escitalopram. Mechanism: unknown. Contraindicated. Risk of long QT syndrome.

    escitalopram increases toxicity of pimozide by QTc interval. Contraindicated.

  • pindolol

    Minor (1)escitalopram increases levels of pindolol by decreasing metabolism. Minor/Significance Unknown.

  • piroxicam

    Monitor Closely (1)escitalopram, piroxicam.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

  • pitolisant

    Serious – Use Alternative (1)escitalopram and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.

  • pleurisy root

    Minor (1)pleurisy root decreases effects of escitalopram by unspecified interaction mechanism. Minor/Significance Unknown. Theoretical interaction.

  • posaconazole

    Monitor Closely (2)posaconazole will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

    escitalopram increases toxicity of posaconazole by QTc interval. Use Caution/Monitor.

  • pregabalin

    Monitor Closely (1)pregabalin, escitalopram.
    Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

  • primidone

    Monitor Closely (2)primidone will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

    primidone will decrease the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

  • procainamide

    Serious – Use Alternative (1)escitalopram increases toxicity of procainamide by QTc interval. Avoid or Use Alternate Drug.

  • procarbazine

    Contraindicated (1)procarbazine and escitalopram both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

  • propafenone

    Monitor Closely (1)escitalopram increases toxicity of propafenone by QTc interval. Use Caution/Monitor.

  • propranolol

    Minor (1)escitalopram increases levels of propranolol by decreasing metabolism. Minor/Significance Unknown.

  • protriptyline

    Monitor Closely (1)escitalopram increases toxicity of protriptyline by QTc interval. Use Caution/Monitor.Serious – Use Alternative (1)escitalopram and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

  • quetiapine

    Monitor Closely (1)quetiapine, escitalopram.
    Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT.Serious – Use Alternative (1)escitalopram increases toxicity of quetiapine by QTc interval. Avoid or Use Alternate Drug.

  • quinidine

    Serious – Use Alternative (1)escitalopram increases toxicity of quinidine by QTc interval. Avoid or Use Alternate Drug.

  • quinine

    Monitor Closely (1)escitalopram and quinine both increase QTc interval. Use Caution/Monitor.

  • ranolazine

    Monitor Closely (1)escitalopram increases toxicity of ranolazine by QTc interval. Use Caution/Monitor.

  • rasagiline

    Serious – Use Alternative (1)rasagiline and escitalopram both increase serotonin levels. Avoid or Use Alternate Drug. Severe CNS toxicity associated with hyperpyrexia has been reported with the combined treatment of an antidepressant and rasagiline. Avoid combination within 14 days of MAOI use.

  • remifentanil

    Serious – Use Alternative (1)remifentanil, escitalopram.
    Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

  • remimazolam

    Monitor Closely (1)remimazolam, escitalopram.
    Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

  • ribociclib

    Monitor Closely (1)ribociclib will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious – Use Alternative (2)ribociclib increases toxicity of escitalopram by QTc interval. Avoid or Use Alternate Drug.

    escitalopram increases toxicity of ribociclib by QTc interval. Avoid or Use Alternate Drug.

  • rifabutin

    Monitor Closely (1)rifabutin will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • rifampin

    Monitor Closely (2)rifampin will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

    rifampin will decrease the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

  • rifapentine

    Monitor Closely (1)rifapentine will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • rilpivirine

    Monitor Closely (2)escitalopram increases toxicity of rilpivirine by QTc interval. Use Caution/Monitor.

    rilpivirine increases toxicity of escitalopram by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsades de Pointes.

  • risperidone

    Monitor Closely (1)escitalopram increases toxicity of risperidone by QTc interval. Use Caution/Monitor.

  • ritonavir

    Monitor Closely (1)ritonavir increases levels of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. Increased risk of serotonin syndrome.

  • rivaroxaban

    Monitor Closely (1)escitalopram increases effects of rivaroxaban by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

  • rizatriptan

    Monitor Closely (1)rizatriptan and escitalopram both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)escitalopram, rizatriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.

  • romidepsin

    Monitor Closely (1)escitalopram increases toxicity of romidepsin by QTc interval. Use Caution/Monitor.

  • safinamide

    Monitor Closely (1)escitalopram, safinamide.
    Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Monitor patients for symptoms of serotonin syndrome if SSRIs are coadministered with safinamide.

  • salicylates (non-asa)

    Monitor Closely (1)escitalopram, salicylates (non-asa).
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

  • salsalate

    Monitor Closely (1)escitalopram, salsalate.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

  • SAMe

    Monitor Closely (1)escitalopram and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.

  • saquinavir

    Serious – Use Alternative (2)saquinavir will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

    escitalopram increases toxicity of saquinavir by QTc interval. Avoid or Use Alternate Drug.

  • secobarbital

    Monitor Closely (2)secobarbital will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

    secobarbital will decrease the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

  • selegiline

    Contraindicated (1)selegiline and escitalopram both increase serotonin levels. Contraindicated. At least 14 days should elapse between discontinuation of selegiline and initiation of treatment with a serotonergic drug.

  • selegiline transdermal

    Serious – Use Alternative (1)selegiline transdermal and escitalopram both increase serotonin levels. Avoid or Use Alternate Drug.

  • selinexor

    Serious – Use Alternative (1)selinexor, escitalopram. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

  • selpercatinib

    Monitor Closely (1)selpercatinib increases toxicity of escitalopram by QTc interval. Use Caution/Monitor.

  • sertraline

    Serious – Use Alternative (2)escitalopram and sertraline both increase serotonin levels. Avoid or Use Alternate Drug.

    escitalopram increases toxicity of sertraline by QTc interval. Avoid or Use Alternate Drug.

  • sodium sulfate/?magnesium sulfate/potassium chloride

    Monitor Closely (1)sodium sulfate/?magnesium sulfate/potassium chloride increases effects of escitalopram by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using bowel preps together with drugs that lower the seizure threshold.

  • sodium sulfate/potassium sulfate/magnesium sulfate

    Monitor Closely (1)sodium sulfate/potassium sulfate/magnesium sulfate increases effects of escitalopram by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using bowel preps together with drugs that lower the seizure threshold.

  • sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol

    Monitor Closely (1)escitalopram, sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor.
    Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

  • solifenacin

    Monitor Closely (1)escitalopram increases toxicity of solifenacin by QTc interval. Use Caution/Monitor.

  • sorafenib

    Monitor Closely (1)sorafenib and escitalopram both increase QTc interval. Use Caution/Monitor.Serious – Use Alternative (1)escitalopram increases toxicity of sorafenib by QTc interval. Avoid or Use Alternate Drug.

  • sotalol

    Serious – Use Alternative (1)escitalopram and sotalol both increase QTc interval. Avoid or Use Alternate Drug.Minor (1)escitalopram increases levels of sotalol by decreasing metabolism. Minor/Significance Unknown.

  • St John’s Wort

    Serious – Use Alternative (1)escitalopram and St John’s Wort both increase serotonin levels. Avoid or Use Alternate Drug.

  • stiripentol

    Monitor Closely (1)stiripentol will decrease the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider reducing the dose of CYP2C19 substrates, if adverse reactions are experienced when administered concomitantly with stiripentol.

  • sufentanil

    Serious – Use Alternative (1)sufentanil, escitalopram.
    Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

  • sufentanil SL

    Monitor Closely (1)sufentanil SL, escitalopram.
    Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

  • sulfasalazine

    Monitor Closely (1)escitalopram, sulfasalazine.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

  • sulindac

    Monitor Closely (1)escitalopram, sulindac.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

  • sumatriptan

    Monitor Closely (1)sumatriptan and escitalopram both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)escitalopram, sumatriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.

  • sumatriptan intranasal

    Monitor Closely (1)sumatriptan intranasal and escitalopram both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)escitalopram, sumatriptan intranasal. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.

  • sunitinib

    Monitor Closely (1)escitalopram increases toxicity of sunitinib by QTc interval. Use Caution/Monitor.

  • tacrolimus

    Monitor Closely (1)escitalopram increases toxicity of tacrolimus by QTc interval. Use Caution/Monitor.

  • tapentadol

    Monitor Closely (1)escitalopram and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely.

  • tazemetostat

    Monitor Closely (1)tazemetostat will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • tecovirimat

    Monitor Closely (2)tecovirimat will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Tecovirimat is a weak inhibitor of CYP2C8 and CYP2C19. Monitor for adverse effects if coadministered with sensitive substrates of these enzymes.

    tecovirimat will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.

  • tedizolid

    Serious – Use Alternative (1)tedizolid, escitalopram.
    Either increases effects of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. both increase serotonin levels; increased risk of serotonin syndrome.

  • telavancin

    Monitor Closely (1)escitalopram increases toxicity of telavancin by QTc interval. Use Caution/Monitor.

  • tetrabenazine

    Serious – Use Alternative (1)escitalopram increases toxicity of tetrabenazine by QTc interval. Avoid or Use Alternate Drug.

  • thioridazine

    Contraindicated (1)escitalopram increases toxicity of thioridazine by QTc interval. Contraindicated.

  • timolol

    Minor (1)escitalopram increases levels of timolol by decreasing metabolism. Minor/Significance Unknown.

  • tipranavir

    Monitor Closely (1)tipranavir will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • tizanidine

    Monitor Closely (1)tizanidine increases toxicity of escitalopram by pharmacodynamic synergism. Use Caution/Monitor. CNS depressants may enhance the psychomotor impairment of escitalopram.

  • tolfenamic acid

    Monitor Closely (1)escitalopram, tolfenamic acid.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

  • tolmetin

    Monitor Closely (1)escitalopram, tolmetin.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

  • toremifene

    Serious – Use Alternative (1)escitalopram increases toxicity of toremifene by QTc interval. Avoid or Use Alternate Drug.

  • torsemide

    Minor (1)torsemide, escitalopram. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible additive hyponatremia.

  • tramadol

    Monitor Closely (1)escitalopram and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.

  • tranylcypromine

    Contraindicated (1)tranylcypromine and escitalopram both increase serotonin levels. Contraindicated.

  • trazodone

    Serious – Use Alternative (1)escitalopram and trazodone both increase serotonin levels. Avoid or Use Alternate Drug.

  • triclabendazole

    Monitor Closely (1)triclabendazole will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. If plasma concentrations of the CYP2C19 substrates are elevated during triclabendazole, recheck plasma concentration of the CYP2C19 substrates after discontinuation of triclabendazole.

  • trimipramine

    Monitor Closely (1)escitalopram increases toxicity of trimipramine by QTc interval. Use Caution/Monitor.Serious – Use Alternative (1)escitalopram and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

  • triptorelin

    Serious – Use Alternative (1)triptorelin increases toxicity of escitalopram by QTc interval. Avoid or Use Alternate Drug. Increases risk of torsades de pointes.

  • tucatinib

    Serious – Use Alternative (1)tucatinib will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.

  • umeclidinium bromide/vilanterol inhaled

    Serious – Use Alternative (1)escitalopram increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

  • valerian

    Monitor Closely (1)valerian and escitalopram both increase sedation. Use Caution/Monitor.

  • vandetanib

    Serious – Use Alternative (1)escitalopram, vandetanib.
    Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.

  • vardenafil

    Monitor Closely (1)escitalopram increases toxicity of vardenafil by QTc interval. Use Caution/Monitor.

  • vemurafenib

    Serious – Use Alternative (2)escitalopram increases toxicity of vemurafenib by QTc interval. Avoid or Use Alternate Drug.

    vemurafenib and escitalopram both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.

  • venlafaxine

    Serious – Use Alternative (1)escitalopram and venlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.

  • vilanterol/fluticasone furoate inhaled

    Serious – Use Alternative (1)escitalopram increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

  • vilazodone

    Serious – Use Alternative (1)escitalopram, vilazodone.
    Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug. Concomitant therapy should be discontinued immediately if signs or symptoms of serotonin syndrome emerge and supportive symptomatic treatment should be initiated. .

  • voclosporin

    Monitor Closely (1)voclosporin, escitalopram.
    Either increases effects of the other by QTc interval. Use Caution/Monitor.

  • vorapaxar

    Monitor Closely (1)escitalopram, vorapaxar.
    Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive antiplatelet effect may occur; SSRIs and SNRIs may cause platelet serotonin depletion .

  • voriconazole

    Monitor Closely (3)voriconazole will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

    voriconazole will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

    escitalopram increases toxicity of voriconazole by QTc interval. Use Caution/Monitor.

  • vorinostat

    Monitor Closely (1)escitalopram increases toxicity of vorinostat by QTc interval. Use Caution/Monitor.

  • vortioxetine

    Serious – Use Alternative (1)escitalopram, vortioxetine.
    Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug.

  • voxelotor

    Serious – Use Alternative (1)voxelotor will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.

  • warfarin

    Serious – Use Alternative (1)escitalopram increases levels of warfarin by decreasing metabolism. Avoid or Use Alternate Drug.

  • zanubrutinib

    Monitor Closely (1)escitalopram, zanubrutinib.
    Either increases effects of the other by anticoagulation. Modify Therapy/Monitor Closely. Zanubrutinib-induced cytopenias increases risk of hemorrhage. Coadministration of zanubritinib with antiplatelets or anticoagulants may further increase this risk.

  • ziprasidone

    Contraindicated (2)escitalopram and ziprasidone both increase QTc interval. Contraindicated.

    ziprasidone and escitalopram both increase QTc interval. Contraindicated.

  • zolmitriptan

    Monitor Closely (1)zolmitriptan and escitalopram both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)escitalopram, zolmitriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.

  • How Long Does Lexapro Stay In Your System?

    Lexapro, the brand name of escitalopram, is a medication that is classified as a selective serotonin reuptake inhibitor, or SSRI. It can help increase the level of the neurotransmitter serotonin, which influences mood in the brain. While Lexapro can remain in the system for roughly six days after someone stops taking it, it is critical that a person not stop “cold turkey,” which can result in withdrawal. 

    This article will review some of the important details that you should know about taking Lexapro to decrease the risk of side effects. The exact length of time that Lexapro remains in a person’s system depends on a variety of factors, including the dosage taken and how long the person has been taking it. Based on the half-life of escitalopram, or how long it takes someone’s body to clear half of the drug, traces of the drug would remain in a person’s system for roughly six days, or a little less than a week.

    Article at a Glance:

    • Lexapro is a SSRI medication that can remain in your system for about six days after taking it.
    • The half-life of Lexapro is about 27 to 32 hours, depending on the person.
    • People who take high doses of Lexapro can experience withdrawal symptoms if they stop it suddenly.
    • Factors that affect Lexapro in the body include age, liver and kidney problems, and how long you’ve taken the medication.
    • Lexapro is not a controlled substance and has a low potential for misuse.

    Half-Life Of Escitalopram (Lexapro)

    All-drugs have a “half-life,” which is a term used to describe how long it takes for the amount of medication to decrease to half its starting dose in the body.

    Lexapro’s half-life ranges from 27 to 32 hours, depending on the person. For example, if a person took a single dose of 10 mg of Lexapro, within 27 to 32 hours, the dosage would be halved to 5 mg, and 27 to 32 hours from that point, the dosage would be halved to 2.5 mg. This will continue to halve until the medication is out of a person’s bloodstream.

    How Long Does Lexapro Stay In Your Urine And Blood?

    Because it takes around five half-lives for a drug to be cleared from your system, and because the half-life of Lexapro is up to 32 hours, it can take up to 160 hours, or roughly six days, to clear Lexapro from your bloodstream. Lexapro is not typically measured in urine screening tests as it is not a controlled substance. 

    Factors That Influence How Long Escitalopram Stays In Your System

    The largest factor that influences how long escitalopram remains in a person’s system is the dose that a person takes. The usual dose of Lexapro ranges from 10 to 20 mg daily. As a result, people who discontinue escitalopram and only take 10 mg a day are likely to clear the drug from their body without any significant problems and can sometimes even quit cold turkey. It is highly recommended to consult your physician when considering quitting Lexapro cold turkey.

    However, people who take higher doses of Lexapro may experience withdrawal symptoms if they stop the medication suddenly. For this reason, physicians often wean patients who take larger doses of escitalopram and might even prescribe a secondary medication for the patient to temporarily take instead of escitalopram.

    Other factors that influence how long Lexapro stays in a person’s system include:

    • The length of time a person takes the medication: A person who has been on Lexapro for a long time may have built up the drug in the body. They may, therefore, take longer to clear the drug from their system than someone who has taken only a single dose.
    • Age: In people aged 65 and older, Lexapro reaches greater concentrations in the bloodstream and its half-life increases by around 50%. Older adults may, therefore, take longer to clear the drug than younger adults.
    • Liver problems: The half-life of Lexapro is doubled in people with liver disease. Someone with liver problems will, therefore, take longer to clear the drug than someone with a healthy liver.
    • Kidney problems: Even in people with mild kidney problems, the half-life of Lexapro is increased by 17%. People with severe kidney problems have not been studied.
    Other FAQs About Lexapro

    Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.

    • Sources

      Hallare, Jericho; Gerriets, Valerie. “Half Life.” StatPearls, January 30, 2020. Accessed June 21, 2020.

      U.S. Food and Drug Administration. “Code of Federal Regulations Title 21.” April 1, 2019. Accessed June 21, 2020.

      U.S. National Library of Medicine. “Lexapro.” January 22, 2019. Accessed June 21, 2020.

    Major Depression Eased with High Doses of Lexapro

    Poor response to treatment is an unfortunate reality for many people with major depression (MDD). By some estimates, as few as 30% of people with MDD achieve complete and lasting remission of symptoms. Primary care physicians deal with this lack of treatment response in one of three ways: They may increase the dosage of an antidepressant medication, add a secondary medication, or switch to an alternative medication.

    Dosage increases are often the first choice, assuming higher doses remain within reasonable safety parameters. Because of its unique chemistry, the selective serotonin reuptake inhibitor Lexapro (escitalopram) is an ideal candidate for dose escalation. Whereas other antidepressants reach a sort of effectiveness plateau, Lexapro’s mechanism of action becomes stronger in proportion to dose.

    Lexapro is approved for daily doses of not more than 20 mg. In practice, however, doctors have prescribed up to 50 mg for patients showing no response to lower dosages. That said, little evidence exists on whether successively higher doses represent a good balance between efficacy and safety.

    A recent investigation in Scotland sought to answer this question. A starting group of 60 people diagnosed with MDD was switched from Celexa (citalopram) to Lexapro for a 32-week period. At regular intervals, Lexapro dosage was increased up to a maximum of 50 mg or until remission of symptoms. Researchers employed standard psychological measures to quantify severity of depression and occurrence of side effects.

    Results from the study revealed few problems with safety or tolerability of high-dose Lexapro. However, overall effectiveness was somewhat less than desirable. Of the 60 participants, 18 dropped out because of adverse effects or lack of efficacy. Most of these withdrawals happened earlier in the study, before reaching the higher dose levels.

    Half of study participants experienced remission of symptoms. Thirty-eight percent of those required a dosage of 50 mg. At doses higher than 40 mg, side effects became more pronounced although not necessarily more severe. Diarrhea was the most frequent complaint for those at doses of 40-50 mg. Other common side effects included headache, nausea, fatigue, and dizziness.

    Larger, more controlled studies will be useful in ascertaining whether the benefits of high-dose Lexapro outweigh the risks. The Scotland study indicated only marginal effectiveness, although participants generally tolerated the high doses of medication. It should be noted, of course, that the population in question has a history of poor response to treatment. It’s unlikely that any one avenue will prove beneficial to all.

    References:

    1. PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Escitalopram. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000214/
    2. Wade, A., Crawford, G., Yellowlees, A. (2011). Efficacy, safety and tolerability of escitalopram doses up to 50 mg in major depressive disorder (MDD): an open-label, pilot study. BMC Psychiatry, 11, 42. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068950/?tool=pmcentrez

    © Copyright 2012 GoodTherapy.org. All rights reserved.

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    The Physical and Emotional Symptoms

    Note: New Choices Treatment Center does not treat patients for Lexapro addiction. This article is for informational purposes only. If you are struggling with Lexapro, please speak to your doctor about it.

     

    Table of Contents

    What Are the Emotional Symptoms of Lexapro Withdrawal?
    What Are the Physical Symptoms of Lexapro Withdrawal?
    How to Quit Taking Lexapro Safely

    Lexapro is a popular antidepressant, perhaps one of the most often prescribed in the United States. Thus, it is important to be aware of the symptoms of Lexapro withdrawal. It functions as a selective serotonin reuptake inhibitor (SSRI). In addition to treating depression, Lexapro is also prescribed for anxiety disorder, obsessive-compulsive disorder, and panic disorder.

    Lexapro is usually taken for a period of many years, either until a person feels that they don’t need it anymore or until they begin experiencing negative side effects and decide to switch medications.

    However, ceasing to take Lexapro should not be undertaken lightly—or without clinical oversight. Lexapro withdrawal symptoms can be severe, particularly if you attempt to stop abruptly. Instead, the dosage should be slowly tapered down over a period of time and under the guidance of medical professionals who can help prevent or mitigate any withdrawal symptoms. Clinical oversight is especially valuable in the rare case of a complication as expertise is vital for both identifying and effectively addressing potential problems before they become critical. You should speak with your doctor about any concerns you have in stopping Lexapro.

    What Are the Emotional Symptoms of Lexapro Withdrawal?

    Changing or ceasing a medication can be an emotional experience in and of itself, but it becomes especially so when the medication in question directly affects your mood. As Lexapro is an antidepressant, it may come as no surprise that the symptoms of Lexapro withdrawal include emotional experiences such as:

    • Anxiety. This is a result of the low levels of serotonin levels in the brain.
    • Concentration problems. This is due in part to the negative effects of the other withdrawal symptoms but is also related to imbalanced neurotransmitter levels in the brain.
    • Depersonalization. This is a sort of inexplicable sensation where a person simply does not feel quite like his or her natural self. He or she may feel emotionless or listless. 
    • Depression. Since the drug is often used to treat depression, once a person stops taking it, it is possible that the depression may return or worsen in the absence of other treatments that can provide adequate emotional support in place of Lexapro.
    • Irritability or mood swings. Some people may experience bouts of unexplained anger as well as irritability and mood swings, either when taking or when quitting Lexapro.
    • Suicidal thoughts. These thoughts can increase or intensify during withdrawal. It is important to seek medical support as soon as possible if this occurs.

    Many of these effects can be difficult enough to deal with on their own. However, the effects of Lexapro withdrawal are not limited to merely the psychological—there may be physical effects as well.

    What Are the Physical Symptoms of Lexapro Withdrawal?

    There are a wide variety of potential physical symptoms you or your loved one may experience during Lexapro withdrawal, some of which can be quite serious. Possible effects include:

    • Appetite changes (generally, this will be opposite the appetite you experienced while on Lexapro).
    • “Brain zaps” (the sensation that small electrical shocks are running through one’s brain).
    • Dizziness, fatigue, or confusion.
    • Headaches.
    • Insomnia.
    • Fever.
    • Nausea or indigestion.
    • Sweating.
    • Weight changes (often, weight loss).
    • Dry mouth.
    • Frequent urination.
    • Altered perception of certain senses, such as smell or taste.

    Several factors can influence how severe withdrawal symptoms are. These factors include how long you or your loved one has been taking Lexapro, how high the dosage is, and other factors related to your unique individual physiology.

    In short, the longer you take the drug, the harder it will be to come off of it. Similarly, the higher the dosage, the harder the withdrawal process will be. There is no set timeline for how long you can expect withdrawal symptoms to last. Many people will see an improvement in symptoms after about three months—which can seem like an eternity if you are struggling with these symptoms on your own. It’s always good to have a medical professional behind you to help gently taper off Lexapro.

    How to Quit Taking Lexapro Safely

    Lexapro can be an effective solution for many people, but if it is time for you to change medications or quit taking antidepressants entirely, do not be discouraged by the long list of potential withdrawal symptoms. While withdrawal can be a serious challenge to manage at home, seeking clinical support from trained medical professionals can help prevent or mitigate these symptoms and provide the best possible results.

    Note: While we are glad to see the community actively helping each other in the comments section, these comments do not represent the opinion of New Choices Treatment Centers, nor do we endorse them. We remind everyone that medical advice should always be received from a medical professional.

    instructions for use, dosage, composition, analogs, side effects / Pillintrip

    Pharmacodynamic interaction

    Non-selective irreversible MAO inhibitors. Serious adverse reactions have been reported with the simultaneous use of SSRIs and non-selective irreversible MAO inhibitors, as well as the initiation of MAO inhibitors in patients who have recently stopped taking SSRIs. In some cases, patients have developed serotonin syndrome.

    It is contraindicated to use escitalopram simultaneously with non-selective irreversible MAO inhibitors. Acitalopram can be started 14 days after discontinuation of non-selective irreversible MAO inhibitors. Before you start taking non-selective irreversible MAO inhibitors, at least 7 days should pass after you stop taking escitalopram.

    Reversible selective MAO A inhibitor (moclobemide). Due to the risk of developing serotonin syndrome, it is not recommended to use escitalopram simultaneously with the MAO A inhibitor moclobemide.If the intake of such a combination of drugs is recognized as clinically necessary, it is recommended to start with the lowest possible doses, as well as to conduct continuous clinical monitoring of the patient’s condition. You can start taking escitalopram at least one day after discontinuing the reversible MAO A inhibitor moclobemide.

    Reversible non-selective MAO inhibitor (linezolid). The antibiotic linezolid is a reversible, non-selective MAO inhibitor and should not be used in patients receiving escitalopram therapy.If the intake of such a combination of drugs is recognized clinically necessary, it is recommended to start with the lowest possible doses, as well as to conduct continuous clinical monitoring of the patient’s condition.

    Irreversible selective MAO B inhibitor (selegiline). Due to the risk of developing serotonin syndrome, care must be taken when taking escitalopram simultaneously with the irreversible MAO B inhibitor selegiline.

    PM, lengthening the QT interval. Pharmacokinetic and pharmacodynamic studies of the use of escitalopram in combination with other drugs that prolong the QT interval have not been conducted.The additive effect of escitalopram and these drugs cannot be ruled out. Therefore, the simultaneous use of escitalopram and drugs that prolong the QT interval, such as antiarrhythmics of classes IA and III, antipsychotics (for example, phenothiazine derivatives, pimozide, haloperidol), tricyclic antidepressants, some antimicrobial drugs (for example, sparfloxacin for in the introduction, pentamidine, drugs for the treatment of malaria, in particular halofantrine), some antihistamines (astemizole, mizolastine).

    Serotonergic drugs. Simultaneous use with serotonergic drugs (eg tramadol, sumatriptan and other triptans) can lead to the development of serotonin syndrome.

    Medicines that lower the seizure threshold. SSRIs can lower the seizure threshold. Care must be taken when concomitant use with escitalopram of other drugs that lower the seizure threshold (tricyclic antidepressants, SSRIs, antipsychotic drugs (neuroleptics) – derivatives of phenothiazine, thioxanthene and butyrophenone, mefloquine, bupropion and tramadol).

    Lithium, tryptophan. Since cases of increased action have been reported with the simultaneous use of SSRIs and lithium or tryptophan, it is recommended to be careful when using escitalopram with these drugs.

    St. John’s wort. The simultaneous use of SSRIs and preparations containing St. John’s wort may lead to an increase in the number of side effects.

    Anticoagulants and drugs affecting blood clotting. Blood clotting disorders can occur with the simultaneous use of escitalopram with oral anticoagulants and drugs that affect blood clotting (for example, atypical antipsychotics and phenothiazine derivatives, most tricyclic antidepressants, acetylsalicylic acid and NSAIDs, ticlopidamoline) and dipyridamoline. In such cases, when starting or ending therapy with escitalopram, careful monitoring of blood clotting parameters is necessary. Concomitant use with NSAIDs can lead to an increase in the number of bleeding.

    Ethanol. Escitalopram does not enter into pharmacodynamic or pharmacokinetic interactions with ethanol. However, as with other psychotropic drugs, the simultaneous use of escitalopram and ethanol is not recommended.

    Drugs causing hypokalemia / hypomagnesemia. Care is required with the simultaneous use of drugs that cause the development of hypokalemia / hypomagnesemia, since in these conditions the risk of developing malignant arrhythmias increases.

    Pharmacokinetic interaction

    The effect of other drugs on the pharmacokinetics of escitalopram. The metabolism of escitalopram is mainly carried out with the participation of the isoenzyme CYP2C19. To a lesser extent, isoenzymes CYP3A4 and CYP2D6 can participate in metabolism. The metabolism of the main metabolite, demethylated escitalopram, appears to be partially catalyzed by the CYP2D6 isoenzyme.

    The simultaneous use of escitalopram and omeprazole (an inhibitor of the isoenzyme CYP2C19) leads to a moderate (approximately 50%) increase in the concentration of escitalopram in the blood plasma.

    Simultaneous administration of escitalopram and cimetidine (an inhibitor of isoenzymes CYP2D6, CYP3A4 and CYP1A2) leads to an increase (approximately 70%) in the concentration of escitalopram in blood plasma.

    Thus, the maximum possible dose of escitalopram should be used simultaneously with inhibitors of the isoenzyme CYP2C19 (eg omeprazole, fluoxetine, fluvoxamine, lansoprazole, ticlopidine) and cimetidine should be used with caution. With the simultaneous administration of escitalopram and the above drugs, based on clinical assessment, a dose reduction of escitalopram may be required.

    Effect of escitalopram on the pharmacokinetics of other drugs. Escitalopram is an inhibitor of the isoenzyme CYP2D6. Care must be taken with the simultaneous use of escitalopram and drugs that are metabolized by this isoenzyme and have a low therapeutic index, such as flecainide, propafenone and metoprolol (in cases of use in heart failure) or drugs that are mainly metabolized by the isoenzyme CYP2D6 and acting on the central nervous system , for example antidepressants – desipramine, clomipramine, nortriptyline – or antipsychotic drugs – risperidone, thioridazine, haloperidol.In these cases, dose adjustment may be required.

    The simultaneous use of escitalopram and desipramine or metoprolol leads to a twofold increase in the concentration of the last two drugs.

    Escitalopram may slightly inhibit the isoenzyme CYP2C19. Therefore, it is recommended to be careful with the simultaneous use of escitalopram and drugs metabolized by the isoenzyme CYP2C19.

    Clinical Study Type I Bipolar Disorder: Escitalopram, Wellbutrin XL – Clinical Trials Registry

    Intervention

    Intervention type:

    Drug

    Intervention name:

    Escitalopram

    Description:

    Escitalopram will be prescribed in the dose range 10-30 mg daily.In patients randomized to the “8-week group”, escitalopram will be tapered, discontinued, and replaced with placebo over a period of 2 weeks, beginning at the week 6 study visit.
    The dose of escitalopram (or matching placebo) may be decreased in 10 mg increments only in the case of intolerable side effects. The dose must remain within the protocol-defined range of 10-30 mg daily at all time points.

    Arm Group label:

    8 week arm

    Another name:

    Lexapro / Cipralex

    Intervention type:

    Medicine

    Intervention name:

    Wellbutrin XL

    Description:

    Bupropion XL will be prescribed in a dose range of 150-450 mg per day.In patients randomized to the 8-week group, bupropion XL will be reduced, discontinued, and replaced with placebo within 2 weeks starting at week 6 of the study visit.
    The dose of bupropion XL (or an appropriate placebo) may be reduced in 150 mg increments only in case of intolerable effects. The dose should remain within the prescribed regimen of the range of 150-450 mg per day at all times.

    Arm Group label:

    52 week hand

    Another name:

    Wellbutrin

    Eligibility

    Criteria:

    Inclusion criteria: OPEN PHASE OF ACUTE TREATMENT 1.Diagnosis of BD, current episode of depression, MADRS score ≥ 20 in both cases. screening and baseline scores 2. Duration of current depressive episode ≥ 2 weeks but ≤ 52 weeks. 3. Acceptance or initiation of treatment with an anti-manic drug in a therapeutic dose. Anti-manic drugs and therapeutic doses: lithium, serum level 0.6–1.4 meq / l; divalproex, serum level 350-700 mM; risperidone 1-6 mg / day; olanzapine 5-30 mg / day; quetiapine IR or XR 300-900 mg / day; aripiprazole 10-30 mg / day; and ziprasidone 80-160 mg / day.Combinations of these drugs, as described above, or a combination of any of them with lamotrigine 100-400 mg per day, or a combination of mood stabilizers plus asenapine 5-20 mg / day, are also permitted. 4. If you are taking any other psychoactive drug (other than lorazepam ≤ 4 mg / day or equivalent), you can gradually reduce the dose and stop for ≤ 4 weeks. 5. If the woman and the child are childbearing, use an adequate method of contraception. 6. Age 18-70 inclusive 7. Speaks fluent English and can provide informed consent DUAL SERVICE SERVICE STAGE • Patients meeting all of the following criteria will be eligible for inclusion in the Double-Blind Study Phase: 1.taking escitalopram 10-30 mg / day or bupropion XL 150-450 mg / day in addition to their anti-manic drug. 2. adequately tolerates the combination of antidepressant and mood stabilizer; currently in remission ≥ 2 weeks and ≤ 8 weeks 3. If the woman is of childbearing potential, use an adequate method of contraception. Exclusion Criterion: OPEN ACUTE PHASE 1 Has a history of frequent mood swings defined as ≥ 4 mood episodes in the previous 12 months 2.Present manic, hypomanic, or subsyndromal hypomanic symptoms, defined as youthful Mania Rating Scale (YMRS) score ≥ 8 at screening or baseline visits for unbearable side effects or an allergic reaction 4. taking monoamine oxidase inhibitors such as phenelzine or tranylcypromine 5. escitalopram is contraindicated in patients taking pimozide or ziprasidone.those taking pimozide or ziprasidone may participate in the study and will be prescribed bupropion XL 6. Bupropion XL is contraindicated in patients taking other drugs containing bupropion in patients with active eating disorders, including anorexia nervosa and bulimia; and in patients with seizure disorders. may continue to participate in the study and will be prescribed escitalopram 7. Has dependence on active substances other than caffeine or nicotine for up to 3 months.Otherwise, patients with concomitant substance abuse or other comorbid mental illness will be eligible to participate in the study 8.have a high risk of suicide, on the score of ≥ 4 on the MADRS suicide item, or in the opinion of the investigator 9.has an unstable medical condition as determined by drug change or in other ways. treatment in the last 4 weeks or according to the researcher 10. Has significant abnormalities on the electrocardiogram. 11.pregnant or breastfeeding DOUBLE SERVICE SERVICE STEP 1.Has a history of frequent mood swings, defined as ≥ 4 mood episodes in the previous 12 months 2. Present manic, hypomanic, or subsyndromal hypomanic symptoms, defined as YMRS score ≥ 8 at screening or baseline visits 3. Is dependent on active substances other than caffeine or nicotine, for up to 3 months. Otherwise, patients with concomitant substance abuse or other comorbid mental illness would be eligible to participate in Study 4.has a high risk of suicide, based on a score of ≥ 4 on the MADRS suicide item, or according to an investigator of 5. Has an unstable medical condition as determined by drug change or other means. treatment in the past 4 weeks, or as determined by the investigator. 6. Has significant deviations in the electrocardiogram. 7. is pregnant or breastfeeding 8. experienced an episode of mania, hypomania, or a mixed episode while on antidepressant treatment for acute depression, as defined by a YMRS score ≥ 16 at any open study visit or as judged by a research psychiatrist.

    Floor:

    All

    Minimum age:

    18 years old

    Maximum age:

    70 years

    Healthy volunteers:

    No

    Viibryd vs. Lexapro: Differences, Similarities and What’s Best for You – Drug Vs. Friend

    Drug Vs. Friend

    Drug Review and Main Differences | Treatment conditions | Efficiency | Insurance coverage and cost comparison | Side Effects | Drug Interactions | Warnings | Frequently Asked Questions

    Viibrid (Vilazodone) and Lexapro (Escitalopram) are brand-name prescription drugs used to treat major depressive disorder (MDD).Both drugs can help treat symptoms of depression, which can include prolonged feelings of sadness, loss of energy, and sleep changes. Viibryd or Lexapro may be prescribed after a physical examination by a psychiatric doctor.

    Both Viibryd and Lexapro are antidepressants that primarily work to increase serotonin activity in the brain. Serotonin is a chemical neurotransmitter believed to play an important role in mood and well-being.Viibryd and Lexapro act as serotonin reuptake inhibitors (SSRIs), which help to increase overall serotonin levels in the brain.

    While both drugs can be used to treat depression, there are some differences in how they are used and how they work.

    What are the main differences between Viibryd and Lexapro?

    Viibryd

    Viibryd is a trademark of vilazodone. It was originally approved by the Food and Drug Administration (FDA) in 2011 for the treatment of major depressive disorder.There is currently no universal version on the market. In addition to being classified as an SSRI, Viibryd is also a partial agonist of the 5-HT1A receptor.

    Viibryd is available as 10 mg, 20 mg and 40 mg oral tablets taken once daily with meals. Viibryd may not work if not taken with food. It reaches its maximum blood level after five hours and has a half-life of approximately 25 hours.

    Lexapro

    Lexapro is a trademark of escitalopram.In 2002, it was approved by the FDA for the treatment of MDD in both adults and adolescents between the ages of 12 and 17. In addition to depression, Lexapro can treat generalized anxiety disorder. Generic Lexapro versions are also available in the market.

    How to get rid of an ear infection at home

    Lexapro can be taken as a 5 mg, 10 mg, or 20 mg oral tablet. It is usually taken once a day with or without food. Lexapro reaches peak blood levels within five hours and has a half-life of up to 32 hours.

    9010 Reverse serine inhibitor C136 HTA

    The main differences between Viibryd and Lexapro
    Viibryd Lexapro
    Drug class Selective Serotonin Reuptake Inhibitor (SSRI)
    Brand / Generic Status No generic version Brand and generic versions available
    What is the common name? Vilazodone Escitalopram
    In what form (s) is the drug included? Oral tablet Oral tablet
    What is the standard dosage? 20 mg once daily 20 mg once daily
    How long does a typical treatment last? Long-term Long-term
    Who usually takes this drug? Adults Adults and Adolescents

    Conditions Treated with Viibryd and Lexapro

    Viibryd and Lexapro are FDA-approved antidepressants used to treat major depressive disorder.Any drug can be prescribed in combination with psychotherapy and lifestyle changes to relieve symptoms of depression.

    Lexapro is also FDA approved for the treatment of generalized anxiety disorder (GAD). Although not approved for anxiety, Wiybrid has been studied in clinical trials for the treatment of anxiety. Viibryd or Lexapro can sometimes be used off-label to treat obsessive-compulsive disorder (OCD).

    9008 Obsessive-Compulsive Disorder
    Condition Viibryd Lexapro
    Severe depressive disorder yes yes
    Not as prescribed Not as prescribed

    Are Viibrid or Lexapro more effective?

    One randomized clinical trial compared vilazodone and escitalopram face-to-face in a sample of 50 patients.The Hamilton Anxiety Scale (HAM-A) and the Hamilton Depression Rating Scale (HAM-D) were reduced in both treatment groups. However, escitalopram was found to lower overall HAM-A and HAM-D scores more than vilazodone (P

    In a systematic review, escitalopram was compared with six other antidepressants, including fluoxetine, citalopram, and sertraline. reviewed several meta-analyzes and found escitalopram to be more effective and relieve symptoms of depression faster than other SSRIs.

    Compared with placebo or no treatment, Viibryd and Lexapro are effective treatment options for depression. However, differences in how a person responds can play an important role in how effective an antidepressant can be. Therefore, it is important to consult your doctor before starting or switching to a new antidepressant.

    Coverage and cost comparison Viibryd and Lexapro

    Viibryd is available only as a brand name drug.For this reason, it can be a more expensive option compared to other antidepressants. Some Medicare programs and insurances may be covered by Viibryd. Viibryd’s average cash price is around $ 389. Using a SingleCare Viibryd coupon can bring the cost down to $ 278 at participating pharmacies.

    Lexapro is available as a brand name and generic drug. Compared to Viibryd, this is a cheaper option. It is also covered by most Medicare and insurance programs.The average price for a generic Lexapro is around $ 177. With a discount coupon from SingleCare, you can get a generic drug for around $ 15.

    Viibryd Lexapro
    Usually covered by insurance? yes yes
    Usually covered by Medicare Part D? yes yes
    Quantity 20 mg once daily (30 tablets) 20 mg once daily (30 tablets)
    Typical Medicare co-pay 1 –11 USD 0–30 USD
    SingleCare Cost USD 278 + USD 15+

    Common side effects Viibryd vs.Lexapro

    The most common side effects of Viibryd are diarrhea, nausea, dry mouth, headache, and increased sweating. Other possible side effects include dizziness, drowsiness, insomnia, and joint pain (arthralgia).

    The most common side effects of Lexapro are nausea, headache, diarrhea, increased sweating, and dry mouth. Other possible Lexapro side effects may include constipation and flu symptoms.

    Wiybrid and Lexapro, like other antidepressants, can cause appetite changes.In some people, this can lead to weight gain or loss.

    Both Wiybrid and Lexapro can also cause sexual side effects. Using any of the antidepressants can cause a decrease in your sex drive (libido). Viibryd and Lexapro can also cause sexual dysfunction such as erectile dysfunction and ejaculation problems. Because Viibryd also acts as a partial agonist of the 5-HT1A receptor, it may have a lower risk of sexual side effects than Lexapro.

    9 0083 yes

    Viibryd Lexapro
    Side effect Applicable? Frequency Applicable? Frequency
    Diarrhea yes 26% yes 8%
    Constipation No yes 3% yes * yes 5%
    Nausea yes 22% yes fifteen%
    Dry mouth yes 8% 6%
    Indigestion yes two% yes 3%
    Flu-like symptoms No yes 5%
    Headache yes

    fifteen% yes 24%
    Dizziness 6% yes 5%
    Drowsiness yes 4% yes 6%
    Insomnia yes yes 7% 9% %
    Heartbeat yes 1% yes *
    Increased appetite yes 1% yes *
    yes Weight gain % yes *
    Decreased appetite yes * yes 3%
    Joint pain yes two% yes * Erectile dysfunction yes 3% yes 3%
    Ejaculation disorder and yes 1% yes 9%
    Decreased libido yes 4% yes 3%

    * not reported
    Frequency not reported face-to-face trials.This cannot be a complete listing of side effects that may arise. Please talk to your doctor or healthcare provider to find out more.
    Source: DailyMed (Viibryd), DailyMed (Lexapro)

    Viibryd and Lexapro Drug Interactions

    Viibrid and Lexapro should be avoided when taking monoamine oxidase inhibitors (MAOIs) such as selegiline and phenelzine. Viibrid or Lexapro should not be taken within 14 days of stopping MAOIs, or there may be an increased risk of serotonin syndrome.Viibryd and Lexapro should also be avoided or monitored with other serotonergic drugs, such as antidepressants, which may increase the risk of serotonin syndrome.

    The use of Viibryd or Lexapro should be monitored when taking non-steroidal anti-inflammatory drugs (NSAIDs) or anticoagulants. Taking these drugs together may increase your risk of bleeding.

    Since Viibryd and Lexapro are primarily metabolized in the liver, their absorption may be affected by drugs that alter certain liver enzymes.Certain antifungals and antibiotics can raise blood levels of Viibryd and Lexapro, which may increase the risk of side effects. Other drugs, such as certain anticonvulsants, can lower blood levels of Viibryd and Lexapro, which may decrease their overall effectiveness.

    Lexapro is known to potentially cause an abnormal heart rhythm called prolonged QT interval. Taking Lexapro with certain antipsychotic medications such as aripiprazole or quetiapine may increase the risk of QT prolongation.

    Serotonine Reuptake and Norwegian

    9016 4

    4

    Anticoccal

    Phenytoin

    Drug Drug class Viibryd Lexapro
    Selegiline
    Phenelzine
    Mono-amino-Hydroxydehyde 9083 Paroxetine
    Sertraline
    Fluoxetine
    Selective Serotonin Reuptake Inhibitors (SSRIs) yes yes
    Venlafaxine
    Desvenlafaxine
    Duloxetine
    Amitriptyline
    Clomipramine
    Nortriptyline
    Tricyclic antidepressants (TCAs) yes yes
    Bupropion Aminoketone yes yes
    Buspirone Anxiolytic yes yes
    Aspirin
    Ibuprofen
    Naproxen
    Diclofenac
    Non-steroidal anti-inflammatory drugs (NSAIDs) yes Yes yes
    Digoxin Cardiac glycoside yes yes
    Sumatriptan
    Rizatriptan
    Eletriptan
    Triptans yes
    Ritonavir Protease inhibitors yes yes
    Clarithromycin Antibiotics yes yes
    Carbamazepin Anticonvulsants yes yes
    Aripiprazole
    Clozapine
    Quetiapine
    Antipsychotics No yes

    Consult your doctor for other possible drug interactions.

    Warnings Viibryd and Lexapro

    Antidepressants such as Viibryd or Lexapro may increase the risk of suicidal ideation, especially in young adult patients. Those taking Viibryd or Lexapro should be monitored for worsening depression and suicidal ideation.

    Selective serotonin reuptake inhibitors (SSRIs) can cause serotonin syndrome, a potentially serious condition that occurs when there is too much serotonin in the brain.The risk is increased when antidepressants are taken together with other serotonergic drugs. Signs and symptoms of serotonin syndrome can include rapid heart rate, increased blood pressure, sweating, tremors, and fever.

    Some people may be screened for a history of bipolar disorder before starting treatment with Viibryd or Lexapro. These antidepressants can activate mania or hypomania in some people with bipolar disorder.

    Viibryd and Lexapro should be reduced or discontinued gradually, if necessary.Abruptly stopping antidepressant medication may increase your risk of withdrawal symptoms.

    Consult a physician for other possible warnings and precautions.

    Frequently asked questions about Viibryd and Lexapro

    What is Viibryd?

    Viibryd is a brand-name prescription drug used to treat major depressive disorder (MDD). It is a brand name for vilazodone. Viibryd works as a selective serotonin reuptake inhibitor (SSRI) and a partial agonist of the 5-HT1A receptor.It is usually taken as a 20 mg tablet once daily with meals.

    What is Lexapro?

    Lexapro is a brand name drug approved by the FDA for the treatment of major depressive disorder (MDD). It is also approved for the treatment of generalized anxiety disorder (GAD). The common name for Lexapro is escitalopram. Lexapro is an SSRI drug that is taken once a day.

    Are Viibryd and Lexapro the same thing?

    Viibryd and Lexapro work in the same way for treating mental illness, but they are not the same thing.Viibryd works as an SSRI and 5-HT1A partial agonist, while Lexapro works primarily as an SSRI. Although Viibryd and Lexapro are approved for the treatment of major depression, Lexapro is also approved for the treatment of anxiety.

    Which is better: Viibryd or Lexapro?

    The best antidepressant is the one you respond best to. Viibryd and Lexapro are effective prescription medications for depression. Compared to Lexapro, Viibryd may cause fewer sexual side effects.

    Can I use Wiybrid or Lexapro during pregnancy?

    Antidepressants such as Viibryd or Lexapro may be safe to take during pregnancy. However, there is insufficient clinical evidence to support that Viibryd or Lexapro is completely safe or dangerous to take during pregnancy. These drugs should only be taken if the benefits outweigh the risks. Talk to your doctor about taking antidepressants during pregnancy.

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    Can I use Viibryd or Lexapro with alcohol?

    Moderate alcohol consumption is unlikely to cause any harm if you have been taking Viibryd or Lexapro all the time. However, drinking alcohol can increase the risk of side effects such as dizziness, drowsiness, and confusion. Talk to your doctor about the safety of antidepressants while drinking alcohol.

    Is Wiybrid suitable for alarm?

    Viibryd’s active ingredient, vilazodone, has been studied for the treatment of anxiety.According to clinical studies, vilazodone may be an effective treatment option for generalized anxiety disorder (GAD). However, more research is needed. Viibryd is not currently approved by the FDA for the treatment of anxiety.

    What is the best time of the day to take Viibrid?

    Wiybrid should be taken at the same time every day. Depending on your body’s response to the medication, it may be best to take Viibrid in the morning or evening. Most doctors recommend taking Viibrid in the morning with breakfast.

    What happens if I take Wiybrid without food?

    Wiybrid may not be as effective if taken without food. This is because Viibryd is better absorbed when taken with food. Compared to absorption with food, the absorption of Viibryd without food is almost an order of magnitude lower. fifty% .

    Preparations and medicines with the active substance Escitalopram

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    Indications for use

    According to the State Register1, escitalopram is indicated for the treatment of depression, panic disorders (incl.According to the Physicians Desk Reference (2009) 2, escitalopram is indicated for the treatment of major depressive disorder, generalized anxiety disorder.

    Pharmacological action

    Antidepressant The mechanism of antidepressant action is presumably associated with an increase in serotonergic activity in the central nervous system as a result of inhibition of neuronal reuptake of serotonin.In in vitro and in vivo studies on animals, the ability of escitalopram to highly selectively inhibit the neuronal reuptake of serotonin in the central nervous system with a minimal effect on the reuptake of norepinephrine and dopamine has been shown. Escitalopram is at least 100 times more potent serotonin reuptake inhibitor than the R-enantiomer. Tolerance when modeling the antidepressant effect does not develop with prolonged (up to 5 weeks) administration to rats. Escitalopram does not interact or has a very weak ability to bind to serotonin (5-HT1-7) or other receptors, incl.including alpha- and beta-adrenergic receptors, dopamine (D1-5), histamine (h2-3), muscarinic (M1-5) and benzodiazepine receptors (antagonism to muscarinic, histamine and adrenergic receptors, presumably causes various , cardiovascular side effects of other psychotropic drugs). Escitalopram also does not bind or has very low affinity for various ion channels, including Na +, K +, Cl- and Ca2 + channels. …Tablets and oral solution containing escitalopram oxalate are bioequivalent. The absorption of escitalopram is independent of food intake. When a single dose of 20 mg is taken orally, Tmax is about 5 hours. The binding of escitalopram to human plasma proteins is about 56%. When taken 1 time per day, the equilibrium plasma concentration is established within approximately 1 week of therapy. At equilibrium, the plasma level of escitalopram in young healthy subjects is 2.2–2.5 times higher than the concentration after taking a single dose.It is metabolized mainly in the liver with the formation of S-demethylcitalopram (S-DCT) and S-didemethylcitalopram (S-DDCT). In vitro studies using human liver microsomes indicate the involvement of isoenzymes CYP3A4 and CYP2C19 in the process of N-demethylation of escitalopram. In human blood plasma, escitalopram predominates in unchanged form. In the equilibrium state, the concentration of S-DCT in plasma is approximately 1/3 of the concentration of escitalopram. S-DDCT levels were undetectable in most subjects.In vitro studies have shown that the pharmacological activity of escitalopram (inhibition of serotonin reuptake) exceeds that of S-DCT by at least 7 times, S-DCT by 27 times, which indicates that metabolites do not significantly contribute to the antidepressant effect of escitalopram. … S-DCT and S-DCT also do not interact or have very weak affinity for serotonin (5-HT1-7) or other receptors, incl. alpha- and beta-adrenergic receptors, dopamine (D1-5), histamine (h2-3), muscarinic (M1-5) and benzodiazepine receptors, do not bind to various ion channels, including Na +, K +, Cl- and Ca2 + channels.It has been shown that after oral administration, escitalopram is determined in the urine unchanged (about 8%) and in the form of S-DCT – 10%. Oral clearance of escitalopram is 600 ml / min, of which approximately 7% is renal. Terminal T1 / 2 about 27-32 hours. Dependence of pharmacokinetic parameters on some factors Age. The pharmacokinetic parameters of escitalopram when taken in single and multiple doses in people over 65 years of age and young people are comparable. When taking the recommended dose (10 mg) in the elderly, AUC and T1 / 2 increased by about 50%, Cmax did not change.Floor. When using multiple doses of escitalopram (10 mg / day for 3 weeks) in 18 men (9 elderly and 9 young) and 18 women (9 elderly and 9 young), no differences were found in the values ​​of AUC, Cmax and T1 / 2. There is no need to adjust the dose depending on gender. Decreased liver function. For most patients with impaired liver function, the recommended dose of escitalopram is 10 mg. Decreased renal function. There is no information on the pharmacokinetic parameters of escitalopram in patients with severe renal failure (with Cl creatinine less than 20 ml / min).Clinical Trials Major Depressive Disorder The efficacy of escitalopram oxalate in the treatment of depression was established in 3 placebo-controlled studies of 8 weeks duration in adult outpatients (age 18–65 years) with major depressive disorder (according to DSM-IV criteria). The main criterion for efficacy in all 3 studies was the change in the total Montgomery-Asberg score (MADRS). A fixed-dose study comparing 10 and 20 mg / day escitalopram oxalate, placebo and 40 mg / day citalopram showed that the improvement was significantly more pronounced in groups of patients taking 10 and 20 mg / day of escitalopram, compared with placebo (according to the MADRS assessment).The efficacy rates in the groups of patients receiving 10 or 20 mg / day of escitalopram were similar. In another study with a fixed dose of escitalopram oxalate 10 mg / day, the improvement was significantly higher in this group compared to placebo (according to the MADRS score). In a study using different dose ranges of escitalopram titrated between 10 and 20 mg / day, compared with placebo and different doses of citalopram titrated between 20 and 40 mg / day, the improvement in the escitalopram oxalate group was significantly higher in compared with placebo (according to the MADRS score).The efficacy of escitalopram for maintenance therapy in the treatment of depression was evaluated in a placebo-controlled study with a 36-week open phase. The study included 274 patients with major depressive disorder (according to DSM-IV criteria) who were responders after an initial 8-week treatment for an acute condition and were then randomized to continue with escitalopram at the same dose (10 or 20 mg / day). ), or a placebo. The response to treatment in the open phase of the study was defined as a decrease in scores on the MADRS scale ≤.12. Relapse in a double-blind study was defined as an increase in MADRS scores & ge.22 or discontinuation of therapy due to an unsatisfactory clinical response. Patients who continued to receive escitalopram for 36 weeks had significantly longer remission times compared to placebo. There have been no adequate controlled studies of escitalopram in the treatment of hospitalized patients with depression. Generalized anxiety disorder (GAD) The effectiveness of escitalopram in the treatment of generalized anxiety disorder in 3 multicenter, placebo-controlled studies lasting 8 weeks using doses of 10–20 mg / day.The study included patients aged 18 to 80 years with a diagnosis of GAD (in accordance with the DSM-IV criteria). In all 3 studies, the improvement with escitalopram was significantly higher compared with placebo (assessed on the Hamilton Anxiety Scale, HAM-A). There were too few ethnic or age-specific patients in these groups to assess their effect on therapy. The response to treatment was gender independent, and the efficacy of escitalopram with prolonged (> 8 weeks) treatment for GAD has not been systematically evaluated in controlled trials.Panic Disorder * Escitalopram was shown to be effective in a 10-week, randomized, double-blind study in 351 patients. Patients after a 2-week induction placebo period were randomized to receive escitalopram (n = 125), placebo (n = 114), or the active comparator citalopram (n = 112).

    Overdose of

    During clinical trials of escitalopram, there were reports of overdose (up to 600 mg) without death.Treatment: providing and maintaining an airway for adequate ventilation and oxygenation, gastric lavage and the use of activated charcoal. Careful observation and monitoring of vital signs is recommended, incl. heart function, symptomatic and supportive therapy. Due to the large volume of distribution of escitalopram, the effectiveness of such measures as forced diuresis, dialysis, hemoperfusion and exchange transfusion is unlikely. There is no specific antidote.

    Contraindications

    Hypersensitivity, concomitant use of MAO inhibitors, age up to 18 years (see “Precautions”).

    Application during pregnancy and lactation

    During pregnancy, it is possible if the expected effect of therapy outweighs the potential risk to the fetus (adequate and strictly controlled studies of the safety of escitalopram in pregnant women have not been conducted).FDA category of action on the fetus – C. Administration of escitalopram to pregnant rats at doses of 6, 12, 24 or 48 mg / kg / day, starting from late gestation until weaning, led to a slight increase in offspring mortality and growth retardation at the dose 48 mg / kg / day (approximately 24 times the MRDC, calculated in mg / m2). At the same dose, mild maternal toxicity was noted (clinical signs, decreased weight gain and food intake). The dose of 12 mg / kg / day, at which no adverse effects were observed, is about 6 times higher than the MRSA, when calculated in mg / m2.According to the results of a study of embryo / fetal development in rats, the oral administration of escitalopram to pregnant rats at doses of 56, 112 or 150 mg / kg / day during organogenesis was accompanied by a decrease in fetal body weight and a delay in ossification at 2 higher doses (approximately 56 times higher than the MRDC – 20 mg / day, calculated in mg / m2). Maternal toxicity (clinical signs, decreased weight gain and food intake), moderate at 56 mg / kg / day, was observed at all dose levels.The dose of 56 mg / kg / day, at which there was no effect on fetal development, was approximately 28 times higher than the MRA, when calculated in mg / m2. There was no evidence of teratogenicity at any of the tested doses (up to more than 75 times higher than the MRDC, calculated in mg / m2). pregnancy of the mother, complications developed requiring prolonged hospitalization, maintaining breathing, feeding through a tube.Such complications can appear immediately after delivery. Reported clinical symptoms included: respiratory distress, cyanosis, apnea, seizures, unstable temperature, difficulty feeding, vomiting, hypoglycemia, hypotension, hyperreflexia, tremors, nervous excitement, irritability, constant crying. These symptoms are either associated with direct toxicity from SSRIs or serotonin and norepinephrine reuptake inhibitors, or may be manifestations of a withdrawal response in the newborn.In some cases, the clinical picture was similar to the development of serotonin syndrome. If the patient is taking escitalopram during the third trimester of pregnancy, the doctor should carefully assess the risk / benefit ratio, while taking into account the possibility of a drug discontinuation syndrome in the newborn. The doctor may decide to gradually discontinue treatment with escitalopram in the third trimester. The effect of escitalopram oxalate on labor and delivery in humans is not known.Lactation. Women who are breastfeeding should stop either breastfeeding or escitalopram oxalate.

    instructions for use, analogs, composition, indications

    Children up to age 18
    Escitalopram should not be prescribed to children and adolescents under the age of 18 years due to the increased risk of suicidal behavior (attempts at suicide and suicidal thoughts) and hostility (with a predominance of aggressive behavior, tendency to confrontation and irritation).If a decision on the need for escitalopram therapy is made on the basis of a clinical assessment, the patient should be closely monitored for symptoms of suicidal behavior.
    There are no data on the effect of long-term use of escitalopram on growth, maturation, and mental and behavioral development in children and adolescents.
    Paradoxical Anxiety
    Some patients with panic disorder may experience increased anxiety at the start of SSRI treatment.This paradoxical reaction usually disappears within the first two weeks of treatment. To reduce the likelihood of developing an anxiogenic effect, it is recommended to start treatment with a low dose of the drug.
    Epileptic seizures
    The drug should be discontinued if seizures develop. The use of escitalopram in patients with unstable epilepsy is not recommended; if seizures are controlled, close monitoring is necessary. With an increase in the frequency of seizures, it is necessary to stop taking SSRIs, including escitalopram.
    Mania
    SSRIs should be used with caution in patients with a history of mania or hypomania. With the development of a manic state, treatment should be discontinued.
    Diabetes mellitus
    Treatment with SSRIs can affect glycemic control in patients with diabetes mellitus (development of hypo- or hyperglycemia). Dose adjustment of insulin and / or oral antidiabetic agents may be required.
    Suicide / suicidal thoughts
    There is a risk of suicide during depression.It persists until a significant improvement in the condition that occurs spontaneously or as a result of therapy. Careful monitoring of patients receiving antidepressant treatment is necessary, especially at the beginning of therapy, since there is a possibility of clinical deterioration and / or the development of suicidal manifestations (thoughts and behavior).
    Other mental conditions for which escitalopram is prescribed may also be associated with an increased risk of suicidal events and events.In addition, these conditions can be a concomitant pathology in relation to a depressive episode. The same precautions should be followed when treating patients with other mental disorders as when treating patients with a depressive episode.
    In patients with a history of suicidal behavior, suicidal thoughts before starting treatment, there is a risk of increased suicidal tendencies during treatment with escitalopram. A meta-analysis of placebo-controlled clinical trials of antidepressants in adult patients with mental disorders showed that with the use of antidepressants in patients under 25 years of age there is an increased risk of suicidal behavior compared with taking placebo.
    Medical treatment of patients at high risk of suicide should be closely monitored, especially at the beginning of treatment and when the dose is changed. Patients and caregivers should be advised to monitor any manifestations of clinical deterioration, suicidal behavior or thoughts, and unusual changes in behavior. If you experience these symptoms, you should immediately consult a doctor.
    Akatizia. Psychomotor agitation
    The use of SSRIs has been associated with the development of akathisia, which is characterized by an inability to sit or stand still.Symptoms of akathisia are most often seen during the first weeks of treatment. These symptoms can also develop as the dose is increased.
    Hyponatremia
    Hyponatremia, probably associated with impaired secretion of antidiuretic hormone, occurs rarely with SSRIs and usually disappears with discontinuation of therapy. Caution should be exercised when prescribing escitalopram to patients at risk of developing hyponatremia: elderly patients, patients with cirrhosis of the liver and taking drugs that can cause hyponatremia.
    Bleeding
    Cases of hemorrhage (ecchymosis and purpura) have been reported with SSRIs. Patients concurrently taking oral anticoagulants or drugs that affect blood clotting (atypical antipsychotics and phenothiazines, most tricyclic antidepressants, acetylsalicylic acid and non-steroidal anti-inflammatory drugs (NSAIDs), ticlopidine and dipyridamole) are advised to be careful with blood clotting disorders. …
    Electroconvulsive therapy (ECT)
    Clinical experience with the simultaneous use of SSRIs and ECT is limited, so caution is advised with such a combination.
    Serotonin syndrome
    It is not recommended to combine escitalopram and MAO type A inhibitors due to the risk of developing serotonin syndrome. In patients taking escitalopram and other SSRIs concurrently with serotonergic drugs, there is a risk of developing serotonin syndrome.It is necessary to use escitalopram with caution simultaneously with drugs with serotonergic action. Symptoms such as agitation, tremors, myoclonus, and hyperthermia may indicate the development of serotonin syndrome. If serotonin syndrome develops, you should immediately stop taking SSRIs with serotonergic drugs and start symptomatic treatment.
    St. John’s wort
    The simultaneous use of SSRIs and herbal medicines containing St. John’s wort (Hypericum perforatum) may lead to an increase in the incidence of adverse reactions.
    Withdrawal syndrome upon discontinuation of treatment
    Withdrawal symptoms often occur when treatment is discontinued.
    In clinical trials, treatment discontinuation reactions occurred in approximately 25% of patients taking escitalopram and 15% of patients taking placebo. The risk of developing a withdrawal syndrome depends on the duration of treatment, the dosage, and the rate of dose reduction. The most common reactions are dizziness, sensory disturbances (paresthesias, burning), sleep disturbances (insomnia, intense dreams), agitation or anxiety, nausea, vomiting, tremors, confusion, increased sweating, headache, diarrhea, palpitations, emotional instability, irritability and visual impairment.Symptoms are usually mild to moderate, but may be more pronounced in some patients. Symptoms usually develop within the first few days after stopping the drug, but there are known cases of such symptoms in patients who miss the drug. Symptoms in most cases are transient and disappear within 2 weeks, but in some patients they last 2-3 months or more. To avoid the onset of withdrawal syndrome, a gradual reduction in the escitalopram dose is recommended when discontinuing therapy for 1-2 weeks.
    Ischemic heart disease
    Due to limited clinical experience, escitalopram should be used with caution in patients with coronary heart disease.
    QT extension
    Escitalopram can cause a dose-dependent prolongation of the QT interval. Cases of prolongation of the QT interval have been reported in post-marketing studies. Caution is advised in patients with hypokalemia, a history of QT prolongation episodes, bradycardia, a history of acute myocardial infarction, and patients with signs of heart failure.
    Electrolyte imbalance disorders (hypokalemia and hypomagnesemia) increase the risk of malignant arrhythmias. Such conditions should be corrected before starting escitalopram. The possibility of treating escitalopram in patients with stable heart disease is determined on the basis of a preliminary ECG study. If signs of heart rhythm disturbances appear during treatment with escitalopram, treatment should be discontinued and an ECG performed.

    90,000 16 reviews, instructions for use

    Use during pregnancy and lactation

    Use during pregnancy and lactation (breastfeeding) is contraindicated.

    Application for violations of liver function

    C should be used with caution in liver cirrhosis.

    Application for impaired renal function

    Caution should be used in patients with renal insufficiency (CC less than 30 ml / min).

    Use in children

    Contraindicated in children and adolescents under 15 years of age.

    Use in elderly patients

    Use with caution in elderly patients.

    Special instructions

    With caution should be used in patients with renal insufficiency (CC less than 30 ml / min), hypomania, mania, with pharmacologically uncontrolled epilepsy, with depression with suicidal attempts, diabetes mellitus, in elderly patients, with cirrhosis of the liver, with a tendency to bleeding, simultaneously with taking drugs that reduce the threshold of convulsive readiness, causing hyponatremia, with ethanol, with drugs metabolized with the participation of isoenzymes of the CYP2C19 system.

    Escitalopram should be prescribed only after 2 weeks. after the cancellation of irreversible MAO inhibitors and 24 hours after discontinuation of therapy with a reversible MAO inhibitor. Non-selective MAO inhibitors can be prescribed no earlier than 7 days after discontinuation of escitalopram.

    In some patients with panic disorder, at the beginning of treatment with escitalopram, an increase in anxiety may be observed, which usually disappears within the next 2 weeks. treatment. Low starting doses are recommended to reduce the likelihood of anxiety.

    Escitalopram should be discontinued in case of development of epileptic seizures or their increase in pharmacologically uncontrolled epilepsy.

    With the development of a manic state, escitalopram should be canceled.

    Escitalopram is able to increase the blood glucose concentration in diabetes mellitus, which may require a dose adjustment of hypoglycemic drugs.

    Clinical experience with escitalopram indicates a possible increase in the risk of suicidal attempts in the first weeks of therapy, and therefore it is very important to closely monitor patients during this period.

    Hyponatremia associated with a decrease in ADH secretion occurs rarely while taking escitalopram and usually disappears when it is canceled.

    With the development of serotonin syndrome, escitalopram should be discontinued immediately and symptomatic treatment should be prescribed.

    Influence on the ability to drive vehicles and control mechanisms

    During the period of treatment, patients should avoid driving vehicles and other activities that require a high concentration of attention and speed of psychomotor reactions.

    CELEXA VS LEXAPRO – DIFFERENCE BETWEEN – LIFE

    Life 2021

    Celexa and Lexapro are popular antidepressants. Although both drugs are used to treat depression, there are a few differences to be aware of before discussing options with your doctor. Celexa is

    Contents:

    Celexa and Lexapro are popular antidepressants. Although both drugs are used to treat depression, there are a few differences you should be aware of before discussing options with your doctor.

    Definitions

    Celexa is a brand name for citalopram, an antidepressant. This prescription-only drug has been approved by the US Food and Drug Administration for the treatment of major depression. It can be prescribed for the treatment of other (off-label) conditions as long as it does not violate any ethical or safety standards. For example, Celexa is prescribed for the treatment of panic disorder and depressive episodes in the UK, Australia, Germany, Portugal, and most European countries.This off-label drug is also used as a medication for obsessive-compulsive disorder.

    Celexa is known to cause sexual dysfunctions such as decreased interest in sex and difficulty with sexual arousal and orgasm (ie, anorgasmia). However, one study found that after major depression was cured, it was possible to improve a patient’s overall sexual performance. This drug is also known to cause increased apathy. Common side effects also include insomnia, weight gain, nausea, drowsiness, diarrhea, dry mouth, and fatigue.Some less common side effects include fluctuations in blood pressure, mood swings, vomiting, anxiety, headaches, and dilated pupils, just to name a few.

    Abruptly stopping Celexa can cause sleep problems and intense dreams, sweating, palpitations, tremors, eye problems, and more.

    Lexapro is a trademark of escitalopram that is used as a medication for depression.It is approved by the US Food and Drug Administration for the treatment of adults and children over 12 years of age with severe depressive disorders. It is also used to treat adults with generalized anxiety disorder. In Europe and Australia, it is used to treat certain anxiety disorders, panic disorders, and obsessive-compulsive disorder. Like other SRRIs, Lexapro is effective in reducing the symptoms of PMS.

    Lexapro can cause sexual dysfunctions such as decreased libido, anorgasmia and delayed ejaculation.Stopping the use of Lexapro can cause withdrawal symptoms such as sensations similar to “electric shock”, also called “brain shake” or “brain shake”, irritability, and severe depression.

    Celexa vs Lexapro

    So what’s the difference between Celexa and Lexapro? While both drugs act as antidepressants, they differ in several areas. The FDA has discouraged the use of Celexa above 40 mg / day. The recommended dosage of Lexapro does not exceed 20 mg / day.For elderly patients, the recommended dose for Celexa is 10-20 mg / day, and for Lexapro it is 5-10 mg / day. Both are available in pill and capsule form; Celexa is available in 10 mg, 20 mg and 40 mg tablets and capsules. Lexapro tablets and capsules are available in 5, 10 and 20 mg dosages. Celexa is available as orally disintegrating tablets, while Lexapro is not available in this form.

    Comparison table

    Celexa Lexapro
    The recommended dosage is not more than 40 mg per day. The recommended dosage is no more than 20 mg per day.
    Brand name citalopram Brand name escitalopram
    Withdrawal symptoms may include sleep problems, intense dreams, sweating, palpitations, tremors, eye problems, and more.

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