What Cannot Be Taken With Lexapro? Understanding Dangerous Interactions

October 11, 2025 •

4 min read

Millions of adults in the U.S. have taken Lexapro (escitalopram) for anxiety or depression, but this common antidepressant can have dangerous interactions with other medications, supplements, and substances. Understanding what cannot be taken with Lexapro is critical to ensuring your safety and the effectiveness of your treatment. Always consult a healthcare provider to review your full medication list and avoid serious health risks.

Quick Summary

This guide details the substances and medications that are dangerous to combine with Lexapro, explaining the associated risks, from severe serotonin syndrome to increased bleeding. It emphasizes the importance of patient education and medical supervision for safe treatment.

Key Points

Avoid MAOIs: Combining Lexapro with Monoamine Oxidase Inhibitors can cause a dangerous and potentially fatal serotonin syndrome.
Be Cautious with Blood Thinners: Using Lexapro with NSAIDs or other blood thinners significantly increases the risk of bleeding and bruising.
Never Mix with St. John's Wort: This herbal supplement also increases serotonin and should not be taken with Lexapro to avoid serotonin syndrome.
Avoid Alcohol: Alcohol can intensify Lexapro's sedative side effects and worsen symptoms of depression and anxiety.
Disclose All Medications: Inform your doctor of all prescriptions, over-the-counter drugs, and supplements you use to prevent harmful interactions.
Watch for Serotonin Syndrome: Be aware of symptoms like rapid heart rate, hallucinations, or fever, especially when starting a new medication.
Consult Your Pharmacist: When in doubt about a new medication or supplement, your pharmacist can provide guidance on potential interactions.

Severe and Life-Threatening Interactions

Certain combinations with Lexapro pose severe, sometimes fatal, risks and must be avoided. These are typically related to a dangerous buildup of serotonin or other critical physiological events.

Monoamine Oxidase Inhibitors (MAOIs)

Monoamine oxidase inhibitors (MAOIs) are a class of antidepressants that, like Lexapro, increase the availability of neurotransmitters like serotonin. Combining Lexapro with an MAOI can lead to a potentially life-threatening condition called serotonin syndrome, caused by excessive serotonin levels. Symptoms include rapid heart rate, high blood pressure, dilated pupils, fever, and hallucinations.

To prevent this, a washout period is required when switching between an MAOI and Lexapro. You must wait at least 14 days after stopping an MAOI before starting Lexapro, and vice versa.

Examples of MAOIs include:

Isocarboxazid (Marplan)
Phenelzine (Nardil)
Selegiline (Emsam, Azilect)
Tranylcypromine (Parnate)
The antibiotic linezolid (Zyvox)
Intravenous methylene blue

Other Serotonergic Drugs

Taking Lexapro with other medications that increase serotonin levels also elevates the risk of serotonin syndrome. This category includes several common drug types, and combining them with an SSRI like Lexapro requires careful medical monitoring.

Other antidepressants: Other SSRIs (e.g., sertraline, fluoxetine) and serotonin-norepinephrine reuptake inhibitors (SNRIs) like duloxetine can intensify serotonin effects.
Triptans: Migraine medications such as sumatriptan (Imitrex) and zolmitriptan (Zomig) affect serotonin receptors and can increase the risk when combined with Lexapro.
Opioids: Certain opioids, including tramadol and fentanyl, can increase serotonin and elevate the risk.
Lithium and Buspirone: These psychiatric medications can also enhance serotonergic effects and require careful management with Lexapro.

Pimozide

Pimozide is an antipsychotic medication, and its co-administration with Lexapro is contraindicated due to an increased risk of QT prolongation, a potentially fatal heart rhythm abnormality.

Significant Bleeding Risks

Both Lexapro and certain other medications can interfere with the body's ability to form blood clots. Combining them significantly increases the risk of bleeding or bruising, including serious gastrointestinal bleeding.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Common over-the-counter and prescription NSAIDs should be used cautiously with Lexapro, if at all.

Examples include:

Ibuprofen (Advil, Motrin)
Naproxen (Aleve)
Aspirin

Blood Thinners (Anticoagulants)

Individuals taking blood thinners for conditions like stroke prevention have an even higher risk of bleeding when taking Lexapro. Close medical supervision and blood monitoring are essential.

Examples include:

Warfarin (Coumadin)
Rivaroxaban (Xarelto)
Apixaban (Eliquis)

Important Substance and Supplement Interactions

In addition to prescription drugs, some common substances and supplements can interfere with Lexapro's function and safety.

Alcohol

It is strongly recommended to avoid alcohol while taking Lexapro. Alcohol is a central nervous system depressant and can worsen the symptoms of depression and anxiety, counteracting the medication's effects. It can also intensify side effects like drowsiness, dizziness, and impaired judgment.

St. John's Wort

This popular herbal supplement is used by some to treat depression. However, it acts similarly to an SSRI and should not be combined with Lexapro due to the heightened risk of serotonin syndrome.

Grapefruit

Grapefruit and its juice can inhibit enzymes in the body that break down Lexapro. This can lead to increased levels of the medication in the bloodstream, raising the risk of side effects.

Interaction Summary: Lexapro and Other Substances


Substance Category	Risk Level	Explanation	Examples
Monoamine Oxidase Inhibitors (MAOIs)	Severe/Life-Threatening	High risk of serotonin syndrome due to combined serotonin increase. Requires a 14-day washout period.	Isocarboxazid, phenelzine, linezolid.
Other Antidepressants (SSRIs, SNRIs)	High	Increased risk of serotonin syndrome from additive effects.	Sertraline, duloxetine.
Blood Thinners & NSAIDs	High	Increases the risk of bleeding, bruising, and internal hemorrhage.	Warfarin, ibuprofen, aspirin.
St. John's Wort	High	Herbal supplement that can increase serotonin, raising the risk of serotonin syndrome.	N/A.
Alcohol	Moderate to High	Can intensify side effects like drowsiness and worsen depression.	Beer, wine, spirits.
Grapefruit	Moderate	Can increase Lexapro levels in the blood, leading to enhanced side effects.	Grapefruit juice.

Conclusion

While Lexapro is an effective treatment for many, it is not safe to combine with certain other substances. The most severe interactions, such as those with MAOIs and pimozide, can lead to life-threatening conditions like serotonin syndrome or heart rhythm abnormalities. Other risks, including increased bleeding with NSAIDs and blood thinners, and worsened side effects with alcohol, are also critical to consider. Always inform your doctor and pharmacist of all the medications, supplements, and herbal remedies you take. They are your best resource for navigating potential interactions and ensuring a safe and successful treatment plan.

For more detailed prescribing information and potential drug interactions, a healthcare professional can refer to Drugs@FDA: Drug Product Lexapro or other authoritative resources.

Important safety information: A boxed warning from the FDA for antidepressants like Lexapro notes an increased risk of suicidal thoughts and behaviors in a small number of children, teenagers, and young adults during the first few months of treatment or when the dose is adjusted. Depression or other serious psychiatric conditions are the most important causes of suicidal thoughts or actions. If you or your child have symptoms that worsen or include suicidal ideation, contact a healthcare provider immediately.

Note: This information is for educational purposes only and is not a substitute for professional medical advice. Always consult your doctor or pharmacist before taking any new medication or supplement.

Frequently Asked Questions

You should use caution when taking over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil) or naproxen (Aleve) with Lexapro, as this combination increases the risk of bleeding. Acetaminophen (Tylenol) is generally considered a safer alternative for pain relief, but you should still consult your doctor or pharmacist.

It is not recommended to drink alcohol while taking Lexapro. Alcohol is a depressant and can counteract the medication's benefits, worsen depression and anxiety symptoms, and increase side effects such as drowsiness and dizziness.

Serotonin syndrome is a potentially life-threatening condition caused by too much serotonin in the body, often from combining serotonergic drugs. Symptoms can range from mild (sweating, rapid heart rate) to severe (fever, seizures, hallucinations).

Combining Lexapro with other serotonergic antidepressants, such as other SSRIs or SNRIs, is generally not advised due to the high risk of serotonin syndrome. Any changes to your antidepressant regimen should be made under strict medical supervision.

You should avoid grapefruit and grapefruit juice while taking Lexapro. Grapefruit can interfere with the enzymes that break down the medication, potentially increasing its levels in your body and raising the risk of side effects.

If you suspect you are having a dangerous drug interaction, such as serotonin syndrome or abnormal bleeding, seek immediate medical attention. For milder side effects or questions, contact your healthcare provider or pharmacist.

You should not take the herbal supplement St. John's Wort with Lexapro due to the risk of serotonin syndrome. It's best to discuss all supplements, even seemingly benign ones like valerian, with your doctor before use.