Absolute Contraindications for Lexapro
Several conditions and concurrent medications make using Lexapro (escitalopram) unsafe. These are known as absolute contraindications, meaning the medication should not be used under any circumstances due to significant health risks.
- Hypersensitivity or Allergic Reaction: Anyone with a known allergy or history of allergic reaction to escitalopram, citalopram (Celexa), or any other ingredients in Lexapro should avoid it. Symptoms of a severe allergic reaction can include swelling of the face, lips, tongue, or throat and difficulty breathing.
- Monoamine Oxidase Inhibitors (MAOIs): Combining Lexapro with an MAOI is strictly prohibited. This includes MAOIs used to treat depression (e.g., phenelzine, tranylcypromine) and others like linezolid (an antibiotic) and intravenous methylene blue. A dangerous condition called serotonin syndrome can result, leading to symptoms such as agitation, hallucinations, fever, rapid heart rate, and severe muscle stiffness. A wash-out period of at least 14 days is required when switching between an MAOI and Lexapro.
- Pimozide: This antipsychotic medication, used to treat Tourette syndrome, should not be combined with Lexapro. The combination can increase the risk of serious heart rhythm abnormalities, including QT prolongation.
Special Precautions and Conditions
For individuals with certain health conditions, Lexapro may be prescribed with caution, often at a lower dose and with close monitoring. However, in some cases, a healthcare provider may decide against using it entirely due to the heightened risks.
Caution in Younger Adults and Adolescents
Antidepressants, including Lexapro, have a boxed warning from the FDA concerning an increased risk of suicidal thoughts and behaviors, particularly in those aged 24 and younger. This risk is highest during the first few months of treatment or following a dosage change. Close friends, family, and patients should monitor for changes in mood or behavior, including new or worsening anxiety, agitation, and restlessness.
Managing Chronic Health Conditions
Patients with certain pre-existing conditions need a thorough medical evaluation before starting Lexapro:
- Bipolar Disorder or Mania: Taking Lexapro alone can trigger a manic or hypomanic episode in people with bipolar disorder. A healthcare provider must screen for a history of mania before starting treatment.
- Seizure Disorders (Epilepsy): Lexapro can cause seizures, and the risk is higher for those with a pre-existing seizure disorder. It should be used with care in these patients.
- Severe Kidney or Liver Disease: The body relies on the kidneys and liver to process and eliminate medication. Impairment can lead to increased drug levels and a higher risk of side effects. A lower dose is often recommended for those with liver problems, while its safety in severe kidney problems is unknown.
- Heart Problems: People with heart conditions, such as a history of irregular heartbeat, should use Lexapro with caution, as it can affect heart rhythm.
- Bleeding Disorders: Lexapro can affect blood clotting, increasing the risk of bleeding or bruising. This risk is compounded in individuals with pre-existing bleeding problems like hemophilia.
- Narrow-Angle Glaucoma: The medication can cause pupil dilation, which may trigger an acute, painful eye pressure increase (angle-closure glaucoma) in those with anatomically narrow eye angles.
- Low Sodium (Hyponatremia): Lexapro can cause dangerously low sodium levels, particularly in older adults, those taking diuretics, or who are dehydrated.
Potentially Dangerous Drug Interactions
In addition to MAOIs and pimozide, several other medications and substances can interact harmfully with Lexapro, necessitating careful review by a healthcare provider. The risk of serotonin syndrome is particularly high when Lexapro is combined with other serotonergic drugs.
Interactions that increase risk of Serotonin Syndrome:
- Other Serotonergic Drugs: Including other SSRIs (e.g., Zoloft, Prozac), SNRIs (e.g., Effexor), triptans for migraines (e.g., sumatriptan), opioids (e.g., tramadol), and the herbal supplement St. John's wort.
- Lithium and Buspirone: When combined with Lexapro, these drugs also increase the risk of serotonin syndrome.
Interactions that increase risk of bleeding:
- NSAIDs and Blood Thinners: Taking Lexapro with NSAIDs (like ibuprofen, naproxen, aspirin) or anticoagulants (like warfarin) significantly raises the risk of abnormal bleeding or bruising.
Other notable interactions:
- Alcohol: Avoid alcohol while taking Lexapro, as it can worsen symptoms of depression and increase sedative side effects.
Pregnancy, Breastfeeding, and Other Considerations
Pregnancy
Studies have shown conflicting results regarding the safety of Lexapro during pregnancy, and it is categorized as Pregnancy Category C by the FDA. Use during the last trimester may increase the risk of complications in newborns, such as persistent pulmonary hypertension (a severe lung condition) and withdrawal symptoms. The decision to use Lexapro during pregnancy involves weighing the potential risks and benefits with a doctor.
Breastfeeding
Lexapro can pass into breast milk and has been linked to side effects in breastfed infants, such as excessive sleepiness, agitation, restlessness, and poor feeding. While some research suggests low levels in breast milk, especially in older infants, careful monitoring is needed, and alternatives may be considered.
Comparison of Key Precautions and Interactions
| Condition / Drug Category | Caution Level | Primary Risk | Management Consideration |
|---|---|---|---|
| MAOIs & Pimozide | Absolute Contraindication | Serotonin Syndrome, Heart Arrhythmia | Avoid completely; respect wash-out periods. |
| Bipolar Disorder | High Caution | Triggering Manic Episodes | Screen thoroughly before treatment; monitor closely. |
| Bleeding Disorders | High Caution | Increased Bleeding Risk | Use with care, especially with NSAIDs or blood thinners. |
| Seizure Disorders | High Caution | Increased Seizure Risk | Monitor carefully; consider alternative medication. |
| Severe Kidney/Liver Disease | High Caution | Increased Side Effects | Dose adjustment may be necessary; monitor closely. |
| Other Serotonergic Drugs | High Caution | Serotonin Syndrome | Avoid or use with extreme caution under medical supervision. |
| Pregnancy/Breastfeeding | Caution; Risk vs. Benefit | Harm to Fetus/Infant | Individualized medical advice is essential. |
| Alcohol | Avoid | Worsened Side Effects | Do not consume alcohol while on Lexapro. |
Conclusion
While Lexapro is an effective treatment for many, it is not suitable for everyone. Individuals with specific medical conditions such as a history of seizures, bipolar disorder, severe kidney or liver problems, or certain heart issues should approach its use with extreme caution or avoid it entirely. The combination of Lexapro with other serotonergic medications, MAOIs, or pimozide can lead to life-threatening complications. Moreover, pregnant or breastfeeding individuals must discuss the potential risks and benefits thoroughly with a healthcare provider. It is imperative to always inform your doctor of your complete medical history and all other medications, including supplements and over-the-counter drugs, to ensure treatment safety. Discontinuation should always be managed with a healthcare professional to avoid withdrawal symptoms.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. You should always consult a healthcare professional for diagnosis and treatment. For information on the FDA's boxed warning for antidepressants and suicidal risk, please refer to the FDA website.
