Escitalopram oral tablet is a generic prescription drug that’s used to treat depression and anxiety. This drug can interact with alcohol, other medications, and some supplements. For example, escitalopram can interact with ibuprofen and amiodarone.
Escitalopram is used to treat:
- major depressive disorder (depression) in adults and certain children
- generalized anxiety disorder in adults
Escitalopram is available as the brand-name drug Lexapro. It belongs to a group of drugs called selective serotonin reuptake inhibitors (SSRIs).
An interaction can occur because one substance causes another substance to have a different effect than expected. Interactions can also occur if you have certain health conditions.
Keep reading to learn about escitalopram’s possible interactions. And for more information about the drug, including details about its uses, see this in-depth escitalopram article.
Before you start taking escitalopram, tell your doctor and pharmacist about any prescription, over-the-counter, or other drugs you take. Sharing this information with them may help prevent possible interactions. (To learn whether escitalopram interacts with herbs, vitamins, or supplements, see the “Are there other interactions with escitalopram?” section.)
If you have questions about drug interactions that may affect you, talk with your doctor or pharmacist.
The following table lists drugs that may interact with escitalopram. Keep in mind that this table does not include all drugs that may interact with escitalopram. For more information about some of these interactions, see the “Drug interactions explained” section.
| Drug group or drug name | Drug examples | What can happen |
|---|---|---|
| anticoagulants | • apixaban (Eliquis) • warfarin (Jantoven) | can increase the risk of bleeding |
| monoamine oxidase inhibitors (MAOIs)* | • phenelzine (Nardil) • selegiline (Emsam) | can increase the risk of serotonin syndrome |
| nonsteroidal anti-inflammatory drugs (NSAIDs) | • aspirin • ibuprofen (Advil, Aleve) | can increase the risk of bleeding |
| other selective serotonin reuptake inhibitors (SSRIs) | • paroxetine (Paxil) • citalopram (Celexa) | can increase the risk of side effects from escitalopram and the other SSRI drug |
| serotonin-norepinephrine reuptake inhibitors (SNRIs) | • duloxetine (Cymbalta) • venlafaxine (Effexor XR) | can increase the risk of serotonin syndrome |
| triptans | • sumatriptan (Imitrex, others) • rizatriptan (Maxalt) | can increase the risk of serotonin syndrome |
| certain antiarrhythmics | • amiodarone (Pacerone) • sotalol (Betapace, Sorine | can raise the risk of QT prolongation |
| certain antibiotics | • clarithromycin • azithromycin (Zithromax) | can increase the risk of QT prolongation |
| certain antipsychotics | • thioridazine • quetiapine (Seroquel) | can increase the risk of QT prolongation |
| pimozide* | — | can increase the risk of QT prolongation |
* Doctors typically will not prescribe this drug with escitalopram. To learn more, see the “When should I avoid escitalopram?” section.
Optum Now is owned by RVO Health. By clicking on this link, we may receive a commission. Learn more.
Certain health conditions or other factors could raise your risk of harm if you take escitalopram. In such cases, your doctor may not prescribe escitalopram for you. These are known as contraindications. The list below includes contraindications of escitalopram.
If you take pimozide: Doctors typically won’t prescribe escitalopram and pimozide together. (Pimozide is a drug prescribed for treating symptoms of Tourette syndrome.) Taking escitalopram and pimozide together can increase the risk of QT prolongation and the risk of serious consequences caused by this side effect, such as severe arrhythmia. Your doctor can prescribe an alternative to pimozide or escitalopram to avoid these risks.
If you take a monoamine oxidase inhibitor (MAOI) drug: Doctors typically won’t prescribe escitalopram with an MAOI drug, such as phenelzine (Nardil) or linezolid (Zyvox). Taking escitalopram and an MAOI together can increase the risk of serotonin syndrome. This is a potentially serious drug reaction that can cause symptoms that affect the brain, muscles, and other parts of your body.
Instead, your doctor can prescribe an alternative to escitalopram or the MAOI. If you’re currently taking an MAOI, your doctor will likely wait at least 14 days until after your last dose of the MAOI before prescribing escitalopram. And if you’re taking escitalopram, your doctor will likely wait at least 14 days until after your last dose of escitalopram before prescribing an MAOI.
If you’ve had an allergic reaction: If you’ve had an allergic reaction to escitalopram or any of its ingredients, your doctor likely won’t prescribe escitalopram for you. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better options for you.
Before you start taking escitalopram, talk with your doctor if any of the factors above apply to you. Your doctor can determine whether escitalopram is safe for you to take.
Your doctor will likely advise you to avoid consuming alcohol while taking escitalopram. Drinking alcohol during your escitalopram treatment can further increase the risk of certain side effects that escitalopram or alcohol may cause. These include drowsiness, fatigue, and difficulty concentrating.
Consuming alcohol can also worsen symptoms of depression or anxiety, the conditions escitalopram is prescribed to treat.
If you have questions about escitalopram and alcohol, talk with your doctor or pharmacist.
Learn more about certain drug interactions that can occur with escitalopram.
Interaction with serotonin-norepinephrine reuptake inhibitors (SNRIs)
Escitalopram can interact with SNRIs. Like escitalopram, SNRIs are used to treat certain mental health conditions such as depression. Some are also prescribed for other uses, such as treating nerve pain.
Examples of SNRI medications include:
- duloxetine (Cymbalta)
- venlafaxine (Effexor XR)
- milnacipran (Savella)
- desvenlafaxine (Pristiq)
- levomilnacipran (Fetzima)
What could happen
Taking escitalopram with an SNRI can raise your risk of serotonin syndrome. Both escitalopram and SNRIs increase the level of serotonin in your body, which can lead to serotonin syndrome. So taking these drugs together further raises this risk.
What you can do
Doctors typically won’t prescribe escitalopram with an SNRI. These medications are prescribed for similar conditions, so doctors typically prescribe either escitalopram or an SNRI. There isn’t evidence that indicates prescribing them together works better to treat depression or other mental health conditions. But taking these drugs together does increase the risk of side effects.
Because of this, your doctor will prescribe either escitalopram or an SNRI to treat your condition. They can provide more information on how escitalopram and SNRI drugs compare for treating your condition.
Interaction with certain antiarrhythmics
Escitalopram can interact with certain antiarrhythmic drugs, which are prescribed to treat arrhythmia.
Examples of antiarrhythmic medications that can interact with escitalopram include:
- amiodarone (Pacerone)
- disopyramide (Norpace)
- dronedarone (Multaq)
- quinidine
- sotalol (Betapace, Sorine)
What could happen
Both escitalopram and certain antiarrhythmics can cause QT prolongation. So taking these drugs together raises the risk of QT prolongation and serious consequences caused by this side effect, such as severe arrhythmia. In rare cases, these risks can be life threatening.
What you can do
Certain antiarrhythmics have a stronger effect on the QT interval (a certain part of your heartbeat) than others. If you’re taking escitalopram and need to take an antiarrhythmic, your doctor will likely try to prescribe an antiarrhythmic with a lower risk of prolonging the QT interval.
Your doctor will also likely closely monitor your heart rhythm for signs of QT prolongation during your treatment. They can provide more information on this, such as how often you’ll need to have testing done.
Interaction with nonsteroidal anti-inflammatory drugs (NSAIDs)
Escitalopram can interact with nonsteroidal anti-inflammatory drugs (NSAIDs). These medications are used to treat mild to moderate pain, including pain caused by osteoarthritis and other forms of arthritis.
Examples of NSAIDs medications include:
- aspirin
- diclofenac (Cataflam, others)
- ibuprofen (Advil, Aleve)
- nabumetone
- naproxen (Aleve, Naprosyn)
What could happen
When taken on their own, both escitalopram and NSAIDs increase your risk of bleeding. Taking these medications together can further increase this risk.
What you can do
Although escitalopram and NSAIDs interact, doctors may still sometimes prescribe them together.
If you take escitalopram and an NSAID, your doctor may want to monitor you closely for symptoms of bleeding during your treatment. This is more likely if you’ll take an NSAID long term, such as to treat osteoarthritis.
Escitalopram may have other interactions. They could occur with supplements, foods, vaccines, or even lab tests. See the following section for details. Note that this information does not include all other possible interactions with escitalopram.
Does escitalopram interact with supplements?
Before you start taking escitalopram, talk with your doctor and pharmacist about any herbs, vitamins, or supplements you take. Sharing this information with them may help you avoid possible interactions.
If you have questions about interactions that may affect you, talk with your doctor or pharmacist.
Escitalopram interactions with herbs
Escitalopram can interact with St. John’s wort, which is used to help ease symptoms of depression. Taking escitalopram and St. John’s wort together can cause serotonin syndrome. Due to this risk, your doctor will likely advise that you do not take St. John’s wort during your escitalopram treatment.
Escitalopram can also interact with valerian (also called valerian root) supplements, which may be used to aid sleep. Taking escitalopram and valerian together can increase your risk of certain side effects, such as drowsiness and fatigue.
This interaction doesn’t necessarily mean you have to avoid taking escitalopram and valerian together. But if you experience drowsiness, fatigue, or other side effects, your doctor may advise you to stop taking valerian root during your escitalopram treatment.
Talk with your doctor or pharmacist if you have other questions about taking escitalopram with herbal supplements.
Escitalopram interactions with vitamins
There are currently no reports of escitalopram interacting with vitamins. But this doesn’t mean that vitamin interactions won’t be recognized in the future.
For this reason, it’s still important to check with your doctor or pharmacist before taking any of these products while taking escitalopram.
Does escitalopram interact with food?
Escitalopram can interact with grapefruit and grapefruit juice. Grapefruit can affect how well your body breaks down escitalopram. This can increase the level of escitalopram in your body, which can raise your risk of side effects from escitalopram.
Due to this risk, your doctor may recommend that you do not consume grapefruit products while you’re taking escitalopram.
Does escitalopram interact with vaccines?
There are currently no reports of escitalopram interacting with vaccines. If you have questions about getting certain vaccines during your escitalopram treatment, talk with your doctor.
Does escitalopram interact with lab tests?
There are currently no reports of escitalopram interacting with lab tests. If you have questions about having certain lab tests done during your treatment with escitalopram, talk with the healthcare professional ordering the test.
Does escitalopram interact with cannabis or CBD?There are currently no reports of escitalopram specifically interacting with cannabis (commonly called marijuana) or cannabis products such as cannabidiol (CBD). But as with any drug or supplement, talk with your doctor before using cannabis with escitalopram.
Before you start treatment with escitalopram, tell your doctor and pharmacist if you use cannabis. By sharing this information with them, you may help prevent possible interactions.
Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.
Certain medical conditions or other health factors may raise the risk of interactions with escitalopram. Before taking escitalopram, talk with your doctor about your health history. They’ll determine whether escitalopram is right for you.
Health conditions or other factors that might interact with escitalopram include:
Bleeding condition: Taking escitalopram increases your risk of bleeding. If you have a condition that also increases your risk of bleeding, such as hemophilia, your doctor can help determine if escitalopram is safe for you to take.
Bipolar disorder or mania: If you have bipolar disorder or mania, taking escitalopram could worsen the symptoms of your condition. Due to this, your doctor may prefer to prescribe a different treatment for depression or anxiety than escitalopram.
Long QT syndrome or other arrhythmia: Escitalopram can cause QT prolongation as a side effect. If you already have long QT syndrome or another arrhythmia, taking escitalopram could worsen your condition. Your doctor may decide to prescribe a different treatment besides escitalopram. Or, if they prescribe escitalopram, they’ll likely want to closely monitor your heart rhythm for any changes during treatment.
Severe kidney condition: It’s not known if it’s safe to take escitalopram if you have a severe kidney condition, such as severe chronic kidney disease (CKD). Studies of escitalopram did not include people with severe kidney conditions. Your doctor can provide more information on the risks and benefits of taking escitalopram with a severe kidney condition.
Liver condition: Your liver plays a major role in breaking down escitalopram after you take a dose. If you have a liver condition, such as hepatitis, your body may not break down escitalopram properly. This can increase the level of escitalopram in your system, which raises the risk of side effects. Due to this, your doctor may prescribe a lower escitalopram dosage if you have a liver condition.
Low blood sodium: Escitalopram can cause hyponatremia (low level of sodium in the blood). If you already have this condition, taking escitalopram may worsen it. Your doctor may want to treat your low blood sodium first before prescribing escitalopram.
Seizures due to epilepsy or another condition: In rare cases, escitalopram can cause seizures. If you already experience seizures, taking escitalopram could worsen your symptoms or cause seizures to occur more frequently. If your doctor prescribes escitalopram for you, they may need to adjust your current treatment plan for seizures. For example, they may prescribe additional seizure drugs for you or increase the dosage of any that you currently take.
Pregnancy: There are risks to taking escitalopram during pregnancy, but there are also risks involved with having untreated depression while pregnant. If you’re pregnant or planning a pregnancy, talk with your doctor before taking escitalopram. They can help determine the best way to treat your depression during pregnancy.
Breastfeeding: It’s not known whether escitalopram is safe to take while breastfeeding. The drug passes into breast milk and may cause side effects in a child who’s breastfed. These side effects can include:
- excess sleepiness
- agitation
- difficulty gaining weight or eating
- restlessness
If you’re breastfeeding or planning to do so, talk with your doctor about your options.
Allergic reaction: If you’ve had an allergic reaction to escitalopram or any of its ingredients, your doctor will likely not prescribe escitalopram. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better choices for you.
Risk of suicidal thoughts and behaviors: Escitalopram has a boxed warning about the risk of suicidal thoughts and behaviors. To learn more, see the “Boxed warning” section.
Help is out there
If you or someone you know is in crisis and considering suicide or self-harm, please seek support:
- Call or text the 988 Suicide and Crisis Lifeline at 988 or chat at 988lifeline.org. Caring counselors are available to listen and provide free and confidential support 24/7.
- Text HOME to the Crisis Text Line at 741741 to connect with a volunteer crisis counselor for free and confidential support 24/7.
- Not in the United States? Find a helpline in your country with Befrienders Worldwide.
- Call 911 or your local emergency services number if you feel safe to do so.
If you’re calling on behalf of someone else, stay with them until help arrives. You may remove weapons or substances that can cause harm if you can do so safely.
If you’re not in the same household, stay on the phone with them until help arrives.
Taking certain steps can help you avoid interactions with escitalopram. Before starting treatment, talk with your doctor and pharmacist. Things to discuss with them include:
- whether you drink alcohol or use cannabis
- other medications you take, as well as any vitamins, supplements, and herbs (they can also help you fill out a
medication list ) - what to do if you start taking a new drug during your escitalopram treatment
It’s also important to understand escitalopram’s
If you have trouble reading or understanding this information, your doctor or pharmacist can help.
Taking escitalopram exactly as prescribed can also help prevent interactions.
Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.