Who Should Avoid Taking Lexapro? A Critical Guide

October 14, 2025 •

3 min read

According to a boxed warning from the FDA, antidepressants like Lexapro carry an increased risk of suicidal thoughts and behaviors in young adults aged 24 and younger. Understanding who should avoid taking Lexapro is critical to ensure patient safety, prevent serious side effects, and avoid dangerous drug interactions.

Quick Summary

A guide covering the contraindications, warnings, and drug interactions associated with Lexapro, outlining the high-risk patient groups who should use caution or avoid the medication entirely.

Key Points

MAO Inhibitors are strictly prohibited: Combining Lexapro with Monoamine Oxidase Inhibitors (MAOIs) is a direct contraindication due to the risk of life-threatening serotonin syndrome.
Heart and bleeding conditions require caution: Patients with a history of heart problems, especially those taking pimozide, and individuals with bleeding disorders should be cautious due to increased risks of heart rhythm issues and abnormal bleeding.
Age-specific warnings: Young adults under 25 face an FDA boxed warning for increased suicidal thoughts, while elderly patients have a higher risk of low sodium levels (hyponatremia).
Consult during pregnancy/breastfeeding: Lexapro's use during pregnancy or breastfeeding requires careful medical consultation due to potential risks to the infant, including withdrawal symptoms and other complications.
Drug interactions are common: Nonsteroidal anti-inflammatory drugs (NSAIDs) and herbal supplements like St. John's Wort can cause serious interactions and should be discussed with a doctor.
Bipolar disorder risk: Use of Lexapro in individuals with undiagnosed bipolar disorder can precipitate a manic or hypomanic episode.
Eye and organ health considerations: Individuals with narrow eye angles (risk of glaucoma), severe liver or kidney disease, or a history of seizures must exercise caution.

Lexapro (escitalopram) is a selective serotonin reuptake inhibitor (SSRI) used to treat major depressive disorder and generalized anxiety disorder. While effective for many, it's not suitable for everyone. Certain conditions, medications, and demographics increase the risk of serious side effects and adverse events. A thorough discussion with a healthcare provider is essential to determine if Lexapro is appropriate.

Absolute Contraindications: When Lexapro Must Not Be Taken

Taking Lexapro is dangerous and strictly prohibited in certain situations.

Monoamine Oxidase Inhibitors (MAOIs): Combining Lexapro with MAOIs, or within 14 days of stopping one, is strictly contraindicated due to the risk of life-threatening serotonin syndrome. Examples of MAOIs include isocarboxazid, phenelzine, and selegiline.
Pimozide: The antipsychotic pimozide should not be taken with Lexapro as it increases the risk of a serious heart rhythm abnormality (prolonged QT interval).
Hypersensitivity: Do not take Lexapro if you have a known allergy to escitalopram, citalopram, or any inactive ingredients. Allergic reactions can include swelling and breathing difficulties.

High-Risk Patient Populations Requiring Caution

Some groups require careful monitoring when using Lexapro due to increased adverse effect risks.

Pediatric and Young Adults: An FDA boxed warning highlights an increased risk of suicidal thoughts and behaviors in those under 25, especially early in treatment or after dose changes. Lexapro is approved for MDD in patients 12 and older and GAD in those 7 and older, but close monitoring is vital.
Pregnant or Breastfeeding Individuals: Use during the third trimester may pose risks to newborns. Lexapro can pass into breast milk, potentially causing infant side effects. A risk-benefit assessment with a healthcare provider is crucial.
Patients with Bipolar Disorder: Taking an SSRI like Lexapro alone can trigger manic or hypomanic episodes. Screening for bipolar disorder history is necessary.
Individuals with Glaucoma: Lexapro can dilate pupils, potentially causing angle-closure glaucoma in those with narrow eye angles. An eye exam might be recommended.
Patients with Bleeding Problems: Lexapro can affect platelet function and increase bleeding risk, especially when combined with NSAIDs, aspirin, or warfarin.
Patients with Severe Hepatic or Renal Impairment: Liver or kidney problems can slow Lexapro clearance, increasing side effect risk. Dose adjustments or caution are advised.
Patients with a History of Seizures: Lexapro has been associated with convulsions, so caution is advised for those with epilepsy.

Significant Drug and Substance Interactions

Lexapro can interact dangerously with other substances.

Other Serotonergic Drugs: Combining Lexapro with other medications that increase serotonin (e.g., triptans, certain opioids, St. John's Wort) raises the risk of serotonin syndrome.
Nonsteroidal Anti-inflammatory Drugs (NSAIDs): NSAIDs like ibuprofen increase the risk of gastrointestinal bleeding when taken with Lexapro.
Warfarin and other Anticoagulants: Combining Lexapro with blood thinners increases bleeding risk and requires monitoring.
Alcohol: Avoiding alcohol with Lexapro is recommended as it can worsen drowsiness and impair function.

Drug Interaction Comparison Table


Interacting Substance	Potential Risk	Reason
MAO Inhibitors	Serotonin Syndrome (life-threatening)	Excessive serotonin accumulation
Pimozide	Irregular Heart Rhythm (prolonged QT)	Can interfere with heart's electrical activity
NSAIDs & Blood Thinners	Increased Bleeding Risk	Interference with platelet clotting ability
Alcohol	Increased Drowsiness & Impairment	Synergistic sedative effects
St. John's Wort	Serotonin Syndrome	Increases serotonin levels
Citalopram (Celexa)	QT Interval Prolongation	Both are very similar SSRIs; risk of overdose

Other Important Precautions and Warnings

Hyponatremia (Low Sodium): Lexapro can cause low blood sodium, especially in the elderly or those taking diuretics. Symptoms include headache and confusion.
Cognitive and Motor Impairment: Lexapro can cause drowsiness and affect judgment, requiring caution when driving or operating machinery.
Sexual Dysfunction: Common SSRI side effects include decreased libido and difficulty with orgasm.
Discontinuation Syndrome: Stopping Lexapro abruptly can cause withdrawal symptoms like dizziness and agitation. Gradual tapering under medical supervision is necessary.

Conclusion

Lexapro is an effective antidepressant but carries significant risks and contraindications. High-risk groups include young adults, pregnant/breastfeeding individuals, and those with bipolar disorder, glaucoma, or bleeding disorders. Dangerous interactions can occur with MAOIs, pimozide, NSAIDs, and alcohol. Sharing a complete medical history and current medications with a healthcare provider is essential to determine if Lexapro is safe and appropriate, allowing for a thorough assessment of benefits versus risks. For more details on antidepressant side effects, consult resources like the National Institutes of Health.

Frequently Asked Questions

Serotonin syndrome is a potentially life-threatening condition caused by an excess of serotonin in the brain. Symptoms can include agitation, hallucinations, rapid heartbeat, sweating, muscle stiffness, tremors, and seizures.

Taking Lexapro with NSAIDs increases the risk of abnormal bleeding, especially in the gastrointestinal tract. It is important to discuss this with a healthcare provider before combining them.

No, it is not recommended to consume alcohol while taking Lexapro. Alcohol can exacerbate certain side effects, particularly drowsiness and impaired coordination, and can also worsen symptoms of anxiety and depression.

Abruptly stopping Lexapro can lead to discontinuation syndrome, causing withdrawal symptoms such as dizziness, nausea, agitation, irritability, and mood changes. The dose should be gradually tapered under a doctor's supervision.

Yes, in rare cases, Lexapro can cause pupillary dilation (enlarged pupils), which may trigger an angle-closure glaucoma attack in people with anatomically narrow eye angles. Symptoms include severe eye pain and vision changes.

Yes, Lexapro can cause an irregular or fast heartbeat. The risk of a heart rhythm abnormality (QT prolongation) is heightened when combined with other drugs that affect heart rhythm, such as pimozide.

No, Lexapro is not safe for everyone. The decision to use it depends on a person's complete medical history, including existing conditions and other medications, and must be made in consultation with a healthcare provider to weigh the benefits against potential risks.