Lexapro (escitalopram) is a selective serotonin reuptake inhibitor (SSRI) used to treat major depressive disorder and generalized anxiety disorder. Its therapeutic effect comes from increasing the levels of serotonin in the brain, a neurotransmitter that helps regulate mood. While generally safe when used as prescribed, its mechanism of action makes it prone to several significant and potentially dangerous drug interactions. These interactions can lead to life-threatening conditions such as serotonin syndrome, excessive bleeding, and irregular heart rhythms. Therefore, it is crucial to be aware of what medication to not mix with Lexapro and to consult a healthcare provider before combining any new substance with your prescription.
The Severe Risk of Serotonin Syndrome
Serotonin syndrome is a potentially life-threatening condition caused by an excess of serotonin in the brain. This can occur when Lexapro, which already increases serotonin levels, is combined with other substances that have serotonergic effects. Symptoms can range from mild (shivering, diarrhea) to severe (seizures, high fever, coma).
Monoamine Oxidase Inhibitors (MAOIs)
MAOIs are a class of antidepressants that prevent the breakdown of serotonin. Combining an MAOI with Lexapro is strictly contraindicated and can cause severe, sometimes fatal, serotonin syndrome. A washout period of at least 14 days is required between stopping an MAOI and starting Lexapro. Examples of MAOIs include:
- Isocarboxazid (Marplan)
- Phenelzine (Nardil)
- Selegiline (Emsam, Azilect)
- Tranylcypromine (Parnate)
Other Serotonergic Agents
Even medications and supplements that aren't MAOIs can raise serotonin levels and increase the risk of serotonin syndrome when taken with Lexapro. These include:
- Other antidepressants: Including other SSRIs, SNRIs (e.g., venlafaxine, duloxetine), tricyclic antidepressants (e.g., amitriptyline, clomipramine), and mirtazapine.
- Triptans: Used for migraine headaches (e.g., sumatriptan, zolmitriptan).
- Opioids and Pain Medications: Certain pain relievers like tramadol, fentanyl, and meperidine.
- Stimulants: Amphetamines and similar ADHD medications, such as Adderall, can increase serotonin levels and lead to serotonin syndrome.
- Herbal supplements: St. John's wort and 5-hydroxytryptophan (5-HTP).
- Antibiotics: The antibiotic linezolid also has MAOI properties and must be avoided.
Increased Bleeding Risk
SSRIs, including Lexapro, can impair the blood's ability to clot, a function involving serotonin. When combined with other medications that also increase bleeding risk, the danger of bruising and severe gastrointestinal hemorrhage is significantly heightened.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs like ibuprofen (Advil, Motrin) and naproxen (Aleve) interfere with platelet function and can cause stomach irritation. Combining them with Lexapro further increases the risk of bleeding, especially in the digestive tract.
Blood Thinners (Anticoagulants and Antiplatelets)
Medications that thin the blood, such as warfarin (Coumadin), apixaban (Eliquis), rivaroxaban (Xarelto), and aspirin, dramatically increase the risk of bleeding when taken with Lexapro. Close monitoring is essential if this combination is deemed necessary.
Risk of Heart Rhythm Issues (QT Prolongation)
In rare cases, Lexapro can cause a heart rhythm abnormality known as QT prolongation, which can lead to life-threatening irregular heartbeats. This risk is amplified when combined with other drugs that have the same effect.
Medications to Avoid
- Pimozide: An antipsychotic used for Tourette's syndrome, pimozide significantly increases the risk of QT prolongation and should not be combined with Lexapro.
- Certain Antiarrhythmics: Drugs like quinidine, amiodarone, and sotalol are used to treat heart rhythm problems but can worsen the risk when combined with Lexapro.
- Certain Antibiotics: Some antibiotics, including clarithromycin, moxifloxacin, and azithromycin, can cause QT prolongation.
Other Significant Interactions
Alcohol
It is strongly advised to avoid drinking alcohol while on Lexapro. Alcohol is a depressant and can counteract the antidepressant's effects, potentially worsening symptoms of depression and anxiety. Combining the two can also increase the risk of side effects like drowsiness, impaired coordination, and liver damage. While a rare occurrence, it can also lead to serotonin syndrome.
Recreational Drugs
Recreational drugs that increase serotonin, such as ecstasy (MDMA), cocaine, and LSD, can lead to severe and potentially fatal serotonin syndrome when combined with Lexapro. Methadone, often used in addiction treatment, also increases the risk of side effects.
Comparison of Major Lexapro Interactions
| Interacting Drug Class | Mechanism of Interaction | Resulting Health Risk | Example Drugs to Avoid |
|---|---|---|---|
| Monoamine Oxidase Inhibitors (MAOIs) | Prevents serotonin breakdown, leading to excessive serotonin buildup. | Severe Serotonin Syndrome | Phenelzine (Nardil), Selegiline (Emsam), Isocarboxazid (Marplan) |
| Serotonergic Drugs | Increases or simulates serotonin, leading to excessive levels. | Serotonin Syndrome | Triptans (Sumatriptan), Tramadol, St. John's Wort |
| NSAIDs and Blood Thinners | Compounds the anti-clotting effects of Lexapro. | Increased bleeding, especially gastrointestinal | Ibuprofen (Advil), Warfarin (Coumadin), Apixaban (Eliquis) |
| Pimozide & Antiarrhythmics | Affects the electrical signals that regulate heart rhythm. | QT prolongation, risk of irregular heartbeat | Pimozide, Amiodarone, Sotalol |
| Alcohol | Depresses the central nervous system and counteracts Lexapro's effects. | Worsened depression/anxiety, drowsiness, impaired coordination | Any alcoholic beverage |
Conclusion
Interactions with Lexapro can range from mild discomfort to severe, life-threatening conditions. The most critical interactions involve other serotonergic drugs, particularly MAOIs, due to the high risk of serotonin syndrome. Care must also be taken with NSAIDs, blood thinners, and medications affecting heart rhythm to avoid serious consequences. Always inform your doctor or pharmacist of any and all medications, supplements, or recreational substances you are taking before starting or stopping Lexapro or any other medication. Your healthcare provider is the most reliable resource to ensure your safety and the effectiveness of your treatment.
For more detailed prescribing information, consult the official FDA label for escitalopram.
