7 Escitalopram (Lexapro) Interactions to Watch Out for

Escitalopram (Lexapro) is an antidepressant that treats mental health conditions like anxiety and depression. It’s a selective serotonin reuptake inhibitor (SSRI).

Compared to other SSRIs, escitalopram tends to have fewer interactions. But, there are still some potentially serious ones you should be aware of. Let’s review seven escitalopram interactions you should be aware of.

Keep in mind this isn’t a complete list. So if you take other medications, it’s important to share your complete medication list with your healthcare team. This can help them spot possible interactions ahead of time.

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1. Monoamine oxidase inhibitors

Monoamine oxidase inhibitors (MAOIs) treat conditions such as depression and Parkinson’s disease. Some examples of MAOIs include rasagiline (Azilect) or selegiline (Zelapar, Emsam). These medications have been around for a while. But they aren't prescribed often because of their side effects and stringent diet requirements. In addition, MAOIs interact with many other medications.

Escitalopram and MAOIs can each increase serotonin levels in the brain. Taking them together can cause there to be too much serotonin. This may lead to a potentially dangerous condition called serotonin syndrome.

Symptoms of serotonin syndrome can range from mild to severe. Some mild symptoms include sweating, a rapid heart rate, and tremors. More serious symptoms include rigid muscles, confusion, and a high fever. If you believe you’re experiencing serotonin syndrome, contact your prescriber for next steps. More serious cases may require medical care in a hospital.

Taking escitalopram along with an MAOI is a contraindication. This means it’s not recommended because the potential harm of the combination outweighs the benefits for most people. So it’s unlikely that your prescriber would have you take both. If you’re switching between medications, it’s recommended to separate them by at least 14 days (2 weeks).

2. Other medications that raise serotonin levels

There are many other medications besides escitalopram and MAOIs that raise serotonin levels. Taking any of them with escitalopram also increases the risk of serotonin syndrome.

Examples include:

• Tricyclic antidepressants, like amitriptyline

• Some opioids, like tramadol (Conzip, Qdolo)

• Triptans, like sumatriptan (Imitrex, Tosmyra)

• Serotonin and norepinephrine reuptake inhibitors (SNRIs) like venlafaxine (Effexor XR)

• Other SSRIs, like paroxetine (Paxil)

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These aren’t the only medications that can raise serotonin levels. Talk to a healthcare professional if you’re concerned about this escitalopram interaction. They can make sure your medications are safe to take together.

3. St. John’s wort

The herbal supplement St. John's wort has been researched for treating depression. But it also interacts with many medications. St. John’s wort can increase serotonin levels. Taking escitalopram alongside St. John's wort raises your risk of serotonin syndrome.

Carefully discuss taking St. John's wort with your healthcare team. Since it’s available without a prescription, they may not be aware that you’re taking it. In most cases, it’s best to avoid taking St. John’s wort and escitalopram together.

4. Blood thinners

Blood thinners help treat and prevent unwanted blood clots. They treat conditions like atrial fibrillation and can help prevent strokes. But when you take these medications, you have a higher chance of bleeding problems. Escitalopram can also slightly raise your risk of bleeding. And, when you combine escitalopram with blood thinners, this risk is even greater.

Examples of blood thinners that interact with escitalopram include anticoagulants and antiplatelet medications, such as:

• Warfarin (Coumadin, Jantoven)

• Rivaroxaban (Xarelto)

• Apixaban (Eliquis)

• Ticagrelor (Brilinta)

• Clopidogrel (Plavix)

If you’re taking a blood thinner, you may still be able to take escitalopram. Your healthcare team will help weigh the risks and benefits of taking both medications for you. If you’re taking both escitalopram and a blood thinner, watch for new or unusual bleeding. Let your prescriber know if you notice excessive bruising or blood in your urine or stool.

5. Pimozide

Pimozide is an antipsychotic medication prescribed for Tourette syndrome. It can cause a heart rhythm issue known as a prolonged QT interval (also called long QT syndrome). This can lead to a serious arrhythmia (abnormal heart rhythm) called torsades de pointes. Symptoms include lightheadedness, blurred vision, and fainting. In severe cases, seizures and death are possible.

Taking escitalopram with pimozide is considered a contraindication. The combination raises the risk of developing long QT syndrome. You shouldn’t take these medications together.

Information about this interaction is based on studies of taking pimozide with citalopram. But escitalopram and citalopram are very similar in structure. So experts conclude that escitalopram could have the same interaction.

6. Alcohol

When you consume alcohol, it can cause harmful effects on the body. Because of this, there’s no safe amount of alcohol to drink. And if you drink while taking escitalopram, it can cause even more issues.

Drinking on escitalopram can worsen side effects. This includes dizziness, drowsiness, and changes in sleep patterns. It’s also possible to experience worsening depression.

There’s not much research on how an occasional serving of alcohol might interact with escitalopram. So it’s best to avoid alcohol altogether if you take this antidepressant. Your healthcare team can give you more information about your unique risks when it comes to escitalopram and alcohol.

7. NSAIDs, such as ibuprofen

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a group of medications that can help with pain, fever, and inflammation. Popular NSAIDs include ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and aspirin.

NSAIDs can raise your risk of bleeding. Escitalopram can also slightly increase this risk. Occasionally taking an NSAID for minor aches and pains may be OK for some people. But it’s a good idea to speak with a healthcare professional before taking both escitalopram and an NSAID. They can let you know if you should completely avoid combining them.

Can you take Tylenol and Lexapro together?

Yes, you can safely combine acetaminophen (Tylenol) and escitalopram. These two medications don’t interact with each other. In fact, it’s common for people to take Tylenol instead of NSAIDs to help avoid an interaction with escitalopram.

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Written by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

Edited by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

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