Navigating medication protocols is a critical aspect of patient safety, and it's especially important for antidepressants like Lexapro (escitalopram). A failure to recognize and avoid certain drug and substance combinations can lead to dangerous, or even life-threatening, health consequences. The most severe risks involve serotonin syndrome, an increased risk of bleeding, and heart rhythm abnormalities.
The Critical Risk of Serotonin Syndrome
Serotonin syndrome is a potentially life-threatening condition caused by excessive levels of serotonin in the brain. Lexapro, as a Selective Serotonin Reuptake Inhibitor (SSRI), works by increasing serotonin, so adding any other medication that also increases serotonin can lead to a dangerous build-up. Patients should be vigilant for symptoms such as agitation, confusion, rapid heart rate, high blood pressure, dilated pupils, muscle rigidity, sweating, and tremors.
Monoamine Oxidase Inhibitors (MAOIs)
MAOIs are a class of antidepressants that pose the greatest risk for serotonin syndrome when combined with Lexapro. The concurrent use is contraindicated, and a washout period of at least 14 days is required when switching between these medications. Examples of MAOIs include isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Emsam), and tranylcypromine (Parnate).
Other Serotonergic Drugs
Several other medications can also raise serotonin levels and should be used with extreme caution or avoided entirely with Lexapro.
- Triptans: Used for migraine headaches, such as sumatriptan (Imitrex) and zolmitriptan (Zomig).
- Opioids: Certain pain medications, including tramadol (Ultram) and fentanyl, can increase serotonin.
- Other antidepressants: Combining Lexapro with Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) like venlafaxine or other SSRIs can be risky.
- Amphetamines: Prescription stimulants like those found in Adderall can also contribute to serotonin build-up.
- Herbal supplements: St. John's wort is a notable offender that increases serotonin and must be avoided.
Increased Risk of Bleeding
Lexapro can interfere with the function of platelets, the blood cells responsible for clotting, thereby increasing the risk of bleeding or bruising. This risk is compounded when Lexapro is combined with other medications that also affect blood clotting.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Common over-the-counter and prescription NSAIDs can heighten the risk of gastrointestinal bleeding when taken with Lexapro. These include:
- Ibuprofen (Advil, Motrin)
- Naproxen (Aleve)
- Aspirin
Blood Thinners (Anticoagulants and Antiplatelets)
For patients on blood thinners, the combination with Lexapro requires careful monitoring by a doctor. Increased bleeding has been reported with medications such as:
- Warfarin (Coumadin)
- Apixaban (Eliquis)
- Rivaroxaban (Xarelto)
Concerns with Heart Rhythm Abnormalities
Lexapro can cause a rare but serious side effect known as QT interval prolongation, a condition that can lead to abnormal heart rhythms (arrhythmias). Combining Lexapro with other drugs that have a similar effect on heart rhythm is contraindicated.
Pimozide (Orap)
Pimozide is an antipsychotic medication that should not be taken with Lexapro under any circumstances due to the increased risk of dangerous heart rhythm problems.
Other QT-prolonging drugs
Several other drugs can also cause QT prolongation, and their combination with Lexapro should be avoided or closely monitored. Examples include certain antiarrhythmics, antipsychotics, and some antibiotics.
Alcohol and Other Sedatives
While not a direct drug interaction in the same way as serotonin syndrome, combining Lexapro with alcohol is strongly discouraged. Alcohol is a central nervous system depressant and can worsen symptoms of depression and anxiety. It can also amplify side effects of Lexapro, such as dizziness and drowsiness, severely impairing judgment and coordination. Other CNS depressants, like benzodiazepines (e.g., Xanax, Ativan) and sleeping pills, can have a similar additive sedative effect.
Summary of Lexapro Drug Interactions
To illustrate the varying levels of risk, the following table summarizes key interactions.
| Substance/Class | Risk Level | Primary Danger | What to Do |
|---|---|---|---|
| MAOIs | High | Serotonin Syndrome | Strictly avoid; requires a 14-day washout period. |
| Other Serotonergic Drugs (Triptans, Tramadol, St. John's Wort) |
High to Moderate | Serotonin Syndrome | Inform your doctor of all supplements and drugs; close monitoring is required. |
| Pimozide | High | Prolonged QT Interval (Heart arrhythmia) | Strictly contraindicated; never combine. |
| NSAIDs and Blood Thinners | High (for bleeding) | Increased Bleeding Risk | Use caution; your doctor may suggest an alternative pain reliever. |
| Alcohol | Moderate to High | Worsened Depression & Sedation | Avoid alcohol completely; it counteracts Lexapro's effects. |
| Other SSRIs/SNRIs | Moderate to High | Serotonin Syndrome | Avoid unless under close medical supervision; typically not combined. |
| Cimetidine (Tagamet) | Moderate | Increased Lexapro Levels | Inform your doctor; may require dose adjustment. |
Conclusion
Understanding what medication to not take with Lexapro is vital for your health and safety. The most severe interactions include combining it with MAOIs, other serotonergic agents, and pimozide, all of which can cause life-threatening conditions. Other common substances like NSAIDs, alcohol, and certain herbal supplements also pose significant risks. It is critical to have an open and comprehensive conversation with your healthcare provider and pharmacist about all medications, supplements, and even dietary habits. Never start, stop, or change a medication regimen without medical guidance. For further detailed information on escitalopram, refer to reputable sources such as the Mayo Clinic drug information page.
