Lexapro, the brand name for escitalopram, is a selective serotonin reuptake inhibitor (SSRI) used to treat major depressive disorder (MDD) and generalized anxiety disorder (GAD). It works by increasing serotonin levels in the brain to help regulate mood. While generally safe and effective, Lexapro can cause serious side effects if combined with certain medications, supplements, or substances. The following guide provides essential information on potential interactions to help patients make informed decisions and stay safe.
Drugs that can cause serotonin syndrome with Lexapro
Serotonin syndrome is a potentially life-threatening condition caused by excessive levels of serotonin in the brain. The risk is significantly increased when Lexapro is taken with other drugs that also boost serotonin. It is imperative to discuss all medications with a healthcare provider before starting Lexapro to avoid this dangerous interaction.
Monoamine Oxidase Inhibitors (MAOIs)
This is one of the most critical drug interactions. MAOIs, an older class of antidepressants, block the enzyme that breaks down neurotransmitters like serotonin, dopamine, and norepinephrine. When combined with Lexapro, the risk of a severe and potentially fatal serotonin syndrome or hypertensive crisis is extremely high. A washout period of at least 14 days is required when switching between Lexapro and an MAOI. Examples of MAOIs include isocarboxazid, phenelzine, selegiline, and linezolid.
Other serotonergic medications
Mixing Lexapro with other drugs that increase serotonin levels can also trigger serotonin syndrome. It is crucial to inform your doctor if you are taking any of the following:
- Other SSRIs: Medications like sertraline (Zoloft) or fluoxetine (Prozac).
- Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs): Such as venlafaxine (Effexor) or duloxetine (Cymbalta).
- Tricyclic Antidepressants (TCAs): Including amitriptyline.
- Triptans: Migraine medications like sumatriptan (Imitrex).
- Certain Opioids: Medications such as tramadol and fentanyl.
- Lithium: Used to treat bipolar disorder, it can enhance Lexapro's serotonergic effects.
- Amphetamines and other stimulants: These can increase the risk of serotonin syndrome.
Combining Lexapro with alcohol and recreational drugs
Alcohol
It is generally recommended to avoid consuming alcohol while taking Lexapro. Although Lexapro does not necessarily enhance the cognitive effects of alcohol, the combination can have several negative consequences:
- Worsening depression and anxiety: Alcohol acts as a depressant, counteracting the benefits of Lexapro.
- Increased side effects: It can intensify Lexapro side effects like dizziness, drowsiness, and impaired coordination.
- Increased risk of suicidal thoughts: Particularly concerning in adolescents and young adults.
- Higher risk of liver damage: Both are processed by the liver, potentially increasing strain.
Recreational and illicit substances
Mixing Lexapro with recreational drugs is extremely dangerous and can lead to severe complications, including serotonin syndrome. Substances to avoid include:
- MDMA (Ecstasy): This combination is particularly risky and can cause severe serotonin syndrome.
- Cocaine and Methamphetamine: Stimulants can dangerously elevate serotonin levels and heart rate.
- Cannabis (Marijuana): Can increase drowsiness and potentially trigger serotonin syndrome.
Increased bleeding risk with NSAIDs and blood thinners
Both Lexapro and certain other medications can interfere with the blood's ability to clot, and combining them can significantly increase the risk of bleeding.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Common over-the-counter NSAIDs like ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin should be used with caution, especially long-term. The combination can raise the risk of bruising, nosebleeds, and gastrointestinal bleeding. A safer alternative for pain relief, if approved by your doctor, may be acetaminophen (Tylenol).
Blood thinners
For patients on prescription blood thinners (anticoagulants) such as warfarin (Coumadin), apixaban (Eliquis), or rivaroxaban (Xarelto), the risk of bleeding is heightened when taking Lexapro. Your doctor will need to monitor your blood clotting time (e.g., INR) closely.
Other noteworthy interactions to avoid
- Pimozide: This antipsychotic medication is contraindicated with Lexapro due to the risk of QT prolongation, a potentially life-threatening irregular heart rhythm.
- St. John's Wort: This herbal supplement has effects similar to SSRIs and should not be combined with Lexapro, as it can dangerously increase serotonin levels.
- Grapefruit Juice: May inhibit the enzymes that metabolize Lexapro, leading to higher drug concentrations and an increased risk of side effects.
- Benzodiazepines and other CNS depressants: Combining Lexapro with sedating medications like alprazolam (Xanax) or diphenhydramine (Benadryl) can cause excessive drowsiness and impaired cognitive function.
Lexapro interactions: Comparing risk levels
| Interaction Type | Examples | Primary Risk | Action Required |
|---|---|---|---|
| Major (Contraindicated) | MAOIs, Pimozide | Serotonin Syndrome, Hypertensive Crisis, QT Prolongation | Never combine. Requires a washout period. |
| Moderate-High | Other SSRIs, SNRIs, Opioids, St. John's Wort | Serotonin Syndrome, Increased Side Effects | Close monitoring or alternative therapy required. |
| Moderate (Increased Bleeding) | NSAIDs, Warfarin, Apixaban | Gastrointestinal bleeding, bruising | Requires caution; consult a doctor about alternatives. |
| Moderate (Worsened Side Effects) | Alcohol, Benzodiazepines | Increased sedation, impaired judgment, worsened symptoms | Avoid or use with extreme caution. |
| Minor-Moderate (Metabolic) | Grapefruit Juice, Cimetidine | Increased drug levels, higher risk of side effects | Avoid or monitor closely. |
Conclusion
Patients on Lexapro must be vigilant about potential drug, supplement, and substance interactions to ensure the medication's safety and efficacy. The most severe interactions, such as those with MAOIs and serotonergic drugs, can lead to life-threatening conditions like serotonin syndrome. Interactions with alcohol and recreational drugs can worsen psychiatric symptoms and increase side effects. Furthermore, combining Lexapro with NSAIDs or blood thinners can elevate the risk of dangerous bleeding. The importance of discussing all co-administered substances with a healthcare provider cannot be overstated. A comprehensive understanding of what not to mix with Lexapro is the first step toward safe and effective treatment. Always consult your doctor or pharmacist with any questions regarding your medication regimen. For more information on drug interactions, refer to authoritative sources like the U.S. National Library of Medicine.
