Experiencing an upset stomach is a common and often temporary side effect for people starting the antidepressant Lexapro (escitalopram). As a selective serotonin reuptake inhibitor (SSRI), Lexapro works by increasing serotonin levels in the brain, but it also affects the gastrointestinal (GI) tract, where a large number of serotonin receptors are located. This can lead to various digestive complaints, such as nausea, diarrhea, and stomach pain. While these symptoms typically lessen over time as your body adjusts, knowing how to manage them safely is essential for maintaining your treatment.
Non-Medication Strategies for Managing Upset Stomach
Many effective and safe strategies for soothing an upset stomach while on Lexapro do not involve taking additional medication. These methods focus on dietary and behavioral adjustments that can help ease discomfort.
- Take Lexapro with food: One of the simplest and most effective ways to prevent nausea is to take your dose with a meal, unless otherwise directed by your doctor.
- Adjust dosing time: If your doctor agrees, taking your medication just before bedtime can allow you to sleep through the peak of the nausea.
- Eat smaller, more frequent meals: Instead of three large meals, consider eating smaller portions throughout the day. This can be gentler on your digestive system.
- Try ginger: Sip on ginger tea or slightly flattened ginger ale. Ginger has long been used as a natural remedy for nausea.
- Suck on hard candy: Sucking on a sugarless, hard candy can help distract from feelings of nausea.
- Adopt a bland diet: If you are experiencing diarrhea, sticking to bland foods (part of the BRAT diet: bananas, rice, applesauce, toast) can be helpful. Avoid spicy, greasy, or fried foods.
- Stay hydrated: Drink plenty of water throughout the day, especially if you have diarrhea. Adequate fluids are critical for hydration and can help with constipation.
- Increase fiber intake: For constipation, gradually adding more fiber-rich foods like fresh fruits and vegetables to your diet can help.
Safe Over-the-Counter Medications and Important Interactions
Before adding any new medication to your routine, always consult with your doctor or pharmacist. Some common over-the-counter (OTC) stomach remedies can have significant interactions with Lexapro, increasing the risk of serious side effects like bleeding or serotonin syndrome.
Comparison of OTC Stomach Remedies with Lexapro
| Medication Type | Is it Safe with Lexapro? | Important Considerations |
|---|---|---|
| Calcium Carbonate Antacids (e.g., Tums) | ✅ Generally Safe (with caution) | Safe for heartburn. Take at least 2 hours before or after Lexapro to avoid interfering with absorption. |
| Bismuth Subsalicylate (e.g., Pepto-Bismol) | ⚠️ Consult Your Doctor | Increases the risk of bleeding when combined with Lexapro. Avoid, especially if elderly or with liver/kidney issues, unless instructed by a healthcare provider. |
| H2 Blockers (e.g., Pepcid/famotidine) | ⚠️ Consult Your Doctor | Some products (like Pepcid Complete) can cause heart rhythm issues, particularly with electrolyte imbalances. Plain famotidine should still be cleared by a doctor. |
| NSAIDs (e.g., Advil/ibuprofen, Aleve/naproxen) | ❌ No, avoid | Significantly increases the risk of stomach bleeding. Use acetaminophen (Tylenol) for pain instead, after clearing with a doctor. |
| Meclizine (e.g., Bonine) | ⚠️ Consult Your Doctor | An OTC anti-nausea medication. GoodRx mentions it as a possibility, but a doctor or pharmacist should approve its use. |
| Probiotics | ✅ Generally Safe | No reported direct interactions and may help gut health. A promising low-risk option to discuss with your doctor. |
When to Seek Medical Attention
While many Lexapro side effects are temporary and mild, you should contact your doctor if they are severe, persistent, or accompanied by other concerning symptoms. Get immediate medical help for the following:
- Serotonin Syndrome: Symptoms include high fever, sweating, confusion, restlessness, shivering, severe diarrhea, or a fast heartbeat.
- Bleeding: Any signs of unusual bleeding or bruising, black or bloody stools, or vomiting blood.
- Low Sodium Levels: Symptoms such as headache, confusion, weakness, or seizures.
- Persistent Symptoms: If your upset stomach or other side effects continue for more than a few weeks without improvement, your doctor may need to adjust your dose.
Conclusion
An upset stomach is a manageable side effect of starting Lexapro, and for many, it improves as the body adjusts. Simple lifestyle adjustments, such as taking your medication with food, eating smaller meals, and using ginger, can provide significant relief. While some OTC remedies like calcium carbonate antacids are relatively safe with caution, it's critical to avoid drugs that increase bleeding risk, such as Pepto-Bismol and NSAIDs. Always prioritize discussing new supplements or medications with your healthcare provider to ensure safety and avoid potential interactions. Most importantly, never stop or alter your Lexapro dosage without consulting your doctor, as this can lead to uncomfortable withdrawal symptoms.
For more information on managing antidepressant side effects, consult this trusted resource from the Mayo Clinic guide on antidepressants.
