Interactions with Escitalopram
If you are currently being treated with any of the following medications, you should not use Escitalopram without reading these interactions.
Coadministration with paroxetine, a potent inhibitor of CYP450 2D6, may slightly increase the plasma concentrations of ranolazine, which is metabolized by the isoenzyme secondary to CYP450 3A4. In healthy volunteers, paroxetine (20 mg once a day) increased average steady-state plasma concentrations of ranolazine (1000 mg twice a day) by 1.2-fold. No dosage adjustment of ranolazine is required when used in combination with paroxetine or other CYP450 2D6 inhibitors.
GENERALLY AVOID: Central nervous system (CNS) depressant effects may be additively or synergistically increased in patients using apomorphine in combination with other drugs that can also cause these effects. Apomorphine alone has been frequently associated with somnolence and dizziness. Patients may suddenly fall asleep during activities of daily living.
GENERALLY AVOID: Rasagiline, a monoamine oxidase (MAO)-B inhibitor, may potentiate the pharmacologic activity of selective serotonin reuptake inhibitors (SSRIs) and increase the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5HT1A receptors and characterized by symptoms such as CNS irritability, altered consciousness, confusion, myoclonus, ataxia, abdominal cramping, hyperpyrexia, shivering, pupillary dilation, diaphoresis, hypertension, and tachycardia. The mechanism is an additive pharmacodynamic effect resulting from MAOI inhibition of serotonin metabolism.
GENERALLY AVOID: Several case reports suggest that patients treated with serotonin reuptake inhibitors (SRIs) may exhibit an increased sensitivity to sympathomimetic agents. The mechanism of interaction is unclear. The reaction has been reported when fluoxetine was used concomitantly with phentermine, amphetamine, or phenylpropanolamine. Additionally, some sympathomimetic agents (e.g., amphetamines) may possess serotonergic activity and should generally not be administered with SRIs because of the additive risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A receptors. The interaction occurred in a patient treated with dexamphetamine approximately 2 weeks after the addition of venlafaxine. The medications were discontinued and the patient was given cyproheptadine for suspected serotonin syndrome, whereupon symptoms promptly resolved. A second episode occurred when dexamphetamine was subsequently resumed and citalopram added. The patient improved following cessation of citalopram on his own, and residual symptoms were successfully treated with cyproheptadine.
MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.
MONITOR CLOSELY: Concomitant use of agents with serotonergic activity such as serotonin reuptake inhibitors, monoamine oxidase inhibitors, tricyclic antidepressants, 5-HT1 receptor agonists, ergot alkaloids, lithium, St. John's wort, phenylpiperidine opioids, dextromethorphan, and 5-hydroxytryptophan may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A receptors.
MONITOR: Coadministration with drugs that are inhibitors of CYP450 2D6 and/or 3A4 may increase the plasma concentrations of aripiprazole, which is metabolized by these isoenzymes. According to the manufacturer, ketoconazole (200 mg/day for 14 days), a potent CYP450 3A4 inhibitor, increased the area under the plasma concentration-time curve (AUC) of aripiprazole (15 mg single dose) and its active metabolite, dehydro-aripiprazole, by 63% and 77%, respectively. Quinidine (166 mg/day for 13 days), a potent CYP450 2D6 inhibitor, increased the AUC of aripiprazole (10 mg single dose) by 112% but decreased the AUC of dehydro-aripiprazole by 35%.
MONITOR: Coadministration with inhibitors of CYP450 2D6 and/or 3A4 may increase the plasma concentrations of darifenacin, which is a substrate of these isoenzymes. According to the product labeling, coadministration of darifenacin (30 mg once daily) with the mixed CYP450 inhibitor cimetidine resulted in a 42% increase in the mean darifenacin steady-state peak plasma concentration (Cmax) and a 34% increase in the systemic exposure (AUC) compared to administration of darifenacin alone. The potent CYP450 2D6 inhibitor paroxetine (20 mg) increased steady-state AUC of darifenacin (30 mg once daily) by 33%. Erythromycin, a CYP450 3A4 inhibitor, increased the mean steady-state Cmax and AUC of darifenacin (30 mg once daily) by 128% and 95%, respectively. Fluconazole, another 3A4 inhibitor, increased these values by 88% and 84%, respectively.
MONITOR: Serotonin reuptake inhibitors (SRIs) may potentiate the risk of bleeding in patients treated with agents that affect hemostasis such as anticoagulants, platelet inhibitors, thrombin inhibitors, thrombolytic agents, or agents that commonly cause thrombocytopenia. The tricyclic antidepressant, clomipramine, is also a strong SRI and may interact similarly. Serotonin release by platelets plays an important role in hemostasis, thus SRIs may alter platelet function and induce bleeding. Published case reports have documented the occurrence of bleeding episodes in patients treated with psychotropic agents that interfere with serotonin reuptake. Additional epidemiological studies have confirmed the association between use of these agents and the occurrence of upper gastrointestinal bleeding, and concurrent use of NSAIDs or aspirin was found to potentiate the risk. Preliminary data also suggest that there may be a pharmacodynamic interaction between SSRIs and oral anticoagulants that can cause an increased bleeding diathesis. Concomitant administration of paroxetine and warfarin, specifically, has been associated with an increased frequency of bleeding without apparent changes in the disposition of either drug or changes in the prothrombin time. Bleeding has also been reported with fluoxetine and warfarin, while citalopram and sertraline have been reported to prolong the prothrombin time of patients taking warfarin by about 5% to 8%.
MONITOR: The concomitant administration of agents with hypotensive effects and psychotherapeutic agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics), narcotic analgesics, alcohol, or muscle relaxants may additively increase hypotensive and/or central nervous system depressant effects.
MONITOR: The hypoglycemic effect of insulin may be potentiated by certain drugs, including ACE inhibitors, anabolic steroids, fibrates, monoamine oxidase inhibitors (MAOIs), salicylates, selective serotonin reuptake inhibitors (SSRIs), sulfonamides, disopyramide, propoxyphene, quinine, and quinidine. These drugs may increase the risk of hypoglycemia by enhancing insulin sensitivity (ACE inhibitors, fibrates); stimulating insulin secretion (salicylates, disopyramide, quinine, quinidine, MAOIs); increasing peripheral glucose utilization (SSRIs, insulin-like growth factor); and/or inhibiting gluconeogenesis (SSRIs, MAOIs, insulin-like growth factor). Clinical hypoglycemia has been reported during use of these agents alone or with insulin and/or insulin secretagogues.