escitalopram

AKA

Cipralex®, Lexapro®, Cipralex Meltz®, ACH Escitalopram®, ACT-Escitalopram®, AG-Escitalopram®, Apo-Escitalopram®, Auro-Escitalopram®, Bio-Escitalopram®, JAMP-Escitalopram®, KYE-Escitalopram®, M-Escitalopram®, Mar-Escitalopram®, Mint-Escitalopram®, Mylan-Escitalopram®, Nat-Escitalopram®, NRA-Escitalopram®, PMS-Escitalopram®, PMSC-Escitalopram®, Priva-Escitalopram®, Ran-Escitalopram®, Riva-Escitalopram®, Sandoz-Escitalopram®, Teva-Escitalopram® and others

Purpose [+] Antidepressant, Anxiolytic, Anti-obsessional

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Alcohol

Booze, ethyl or ethanol, adult beverage, brew, brewski, liquor, drink, shot, sauce, rot gut, hooch, giggle juice, moonshine, jello shots, wobbly pop

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Interaction

a) 12 healthy subjects were treated with the related drug citalopram 40 mg daily, amitriptyline 50 mg daily or matching placebo for 1 week in randomized crossover fashion. On the morning of day 8, subjects ingested a dose of ethanol calculated to achieve a blood alcohol content of 80 mg/100 mL (0.8% - the legal intoxication limit in many countries at the time of the study). On a variety of tests measuring cognitive and psychomotor performance, effects of alcohol combined with citalopram were not potentiated compared to subjects receiving alcohol and placebo.

b) 12 healthy subjects were treated with related medication fluoxetine 40 mg daily, amitriptyline 75 mg daily or matching placebo for 1 week in randomized crossover fashion (There was a 28 day washout between administration due to long fluoxetine half-life). On the morning of day 8, subjects ingested a dose of ethanol calculated to achieve a blood alcohol content of 80 mg/100 mL (0.8% - the legal intoxication limit in many countries at the time of the study). On a variety of tests measuring cognitive and psychomotor performance, effects appeared to be mostly due to alcohol, and effects in patients receiving alcohol with fluoxetine were not potentiated compared to subjects receiving alcohol and placebo.

c) The manufacturers of escitalopram state there is no pharmacodynamic interaction noted in clinical studies in which related drug, citalopram was given with alcohol.

d) There are many case reports (at least 93; however, many are anecdotal) in which patients treated with SSRIs developed new or worsened alcohol use disorders. These generally resolved once the medication was discontinued. This occurred in patients who drank minimal alcohol before starting an SSRI as well as patients who already had alcohol use disorders.

e) 265 patients with a diagnosis of alcohol abuse/dependence (per DSM-IV criteria) were titrated up with related drug citalopram 40 mg daily over 2 weeks, which they received for 10 weeks, or were given placebo. They all underwent standard psychotherapy. At 12 weeks the citalopram group had more heavy drinking days and smaller changes in the frequency and amount of alcohol consumption.

f) There are at least 100 case reports describing "pathological intoxication" when SSRIs were taken with alcohol. Patients taking relatively small amounts of alcohol (that were tolerated will before SSRI initiation) have lead to unexpectedly gross disinhibition and even violence or suicide. In at least 4 patient, re-exposure to the same or a related antidepressant reproduced this finding. 32 of these patients reported an increased or altered pattern of alcohol use after SSRI initiation.

g) One case study reports a 26 year old man who developed serotonin syndrome after taking his medications (escitalopram, clomipramine, flunitrazepam) with a can of beer (350 mL).

Mechanism

a,b) Lack of direct potentiation of alcohol effects has been consistently noted with drugs that primarily affect serotonin reuptake (e.g. citalopram and other SSRIs). This class of medications lacks affinity for the histamine H1 receptor, blockade of which is associated with sedation. Many older antidepressant agents (e.g. amitriptyline and other tricyclics) produce strong H1 blockade.

g) Additive serotonergic effects could contribute to an increased risk of serotonin syndrome. Ethanol is a serotonergic agent that has been shown to decrease extracellular serotonin clearance in mice.

Significance

a-c) It was concluded that in practice, citalopram and fluoxetine interactions with ethanol should be unremarkable in terms of psychomotor impairment. This appears likely to be the case with most other SSRIs (escitalopram) and SNRIs as well, though formal studies with each individual agent have not been conducted.

d) Patients started on escitalopram should be monitored for increased alcohol cravings or consumptions.

e) As an enantiomer of citalopram, escitalopram should not be used in the treatment of alcohol dependence. It should be used very cautiously for other indications in alcohol dependent patients who are in early recovery.

f) It is possible that patients initiating SSRI therapy may experience higher levels of intoxication with amounts of alcohol that they previously tolerated. They should be aware that this may affect their ability to drive or do other activities that require alertness or attention safely.

g) The significance of this case report is unclear as the patient was taking multiple serotonergic medications including clomipramine. Patients taking escitalopram and using alcohol should be educated about the risk of serotonin syndrome and monitored for signs and symptoms.

Serious Risk for Harm

It is possible that taking escitalopram makes it more likely for you to get "drunk" from a smaller amount of alcohol. This means that you may have been able to drink a certain amount before, but now that amount could make it unsafe for you to drive or do other activities that require alertness or attention.

Serious Risk for Harm

There is a medical report of a man who used alcohol and escitalopram together which caused high fever, fast heartbeat, sweating, and confusion. This is ‘serotonin syndrome.’

Think First

It is possible that escitalopram may make you crave alcohol and drink more than you normally would. If this happens you should tell your doctor, pharmacist, or parents.

If you are depressed, blue, or moody, alcohol is a 'downer' and will make you feel worse.

Tobacco

smokes, butts, cigs, cigars, darts, stogies, cancer sticks, chew, dip

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Interaction

a) A study in 130 people found no significant correlation between escitalopram serum levels and smoking.

b) In a retrospective analysis of 124 patients (including 36 smokers), smokers had significantly lower escitalopram serum concentrations compared to non-smokers despite taking higher daily doses of escitalopram.

Mechanism

b) It is speculated that the mechanism of the interaction may be due to induction of enzymatic pathways (CYP3A4, CYP2C19) by polycyclic aromatic hydrocarbons in cigarette smoke. Escitalopram is a CYP3A4 and CYP2C19 substrate.

Significance

b) Smokers may require higher escitalopram dosages. Additionally, when patients are taking escitalopram and then quit smoking, escitalopram dosage may need to be reduced to prevent emergent adverse effects.

Think First

Cigarette smoking can speed up the removal of escitalopram from your body. Tell your doctor if you change your smoking habits as your escitalopram dose may need to change.

Caffeine

coffee, java, joe, soda, pop, tea, energy drinks (Red Bull®, Monster®, Rock Star®, Amp®, NOS®, Full Throttle®, 5-hour Energy Drink®, Beaver Buzz®), chocolate, cocoa

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Interaction

No information currently available.

Think First

Taking large amounts of caffeine may cause shaking hands, fast heart beat, trouble sleeping at night, edgy or irritable feelings. If you are taking escitalopram to help with anxiety, this may work against the helpful effects of escitalopram.

Cannabis/ Hash

Marijuana, mary jane, BC bud, blunt, chronic, J, jay, joint, hemp, pot, grass, herb, 420, dope, THC, weed, reefer, ganja, gangster, skunk, hydro, hash oil, weed oil, hash brownies, grease, boom, honey oil, K2, spice, poppers, shatter, budder

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Interaction
a) As a CNS depressant, escitalopram has the potential to enhance the adverse or toxic effects of other CNS depressants, such as cannabis.

b) Cannabis may theoretically result in reduced escitalopram metabolism.

Mechanism
a) The exact mechanism of increased CNS depression is unknown, but it appears that the effects are mainly additive.

b) Cannabidiol (CBD) inhibits CYP2C19 and CYP3A4, although this has not yet been proven at doses used in human studies. Escitalopram is a substrate for CYP2C19 and CYP3A4.

Significance
a) It is important to warn patients of the potential for a reduction in psychomotor function when these drugs are taken concurrently. They may or may not be aware of their deterioration in skill level and response will vary between individuals. They will likely experience a deterioration in their abilities to operate a vehicle and/or carry out tasks that require mental alertness.

b) Patients taking escitalopram and using cannabis may experience increased adverse effects from escitalopram.

Serious Risk for Harm

Escitalopram can cause sleepiness, dizziness and confusion. Cannabis use can make this worse, and make it more dangerous to drive or do activities that require alertness and attention.

Think First

Cannabis might slow down the removal of escitalopram from your body. This might give you more side effects from escitalopram.

Think First

Cannabis, especially in high doses, can cause anxiety. If you are taking escitalopram for anxiety, cannabis could work against the helpful effects of escitalopram.

Cocaine/ Crack

coke, snow, flake, nose candy, blow, lady white, stardust, rock, crystal, bazooka, moon rock, tar

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Interaction
a) A 47-year old male with a history of drug abuse and suicide attempts was found dead at home. The investigation found evidence of cocaine abuse and multiple drug ingestion (citalopram (related to escitalopram), cocaine, oxycodone, promethazine, propoxyphene) in post-mortem samples by gas chromatography- mass spectrometry. The possibility of multiple drug interactions, including citalopram was evident. Citalopram concentrations were consistent with those reported in fatal cases involving multiple drug use. The death was ruled accidental. The man was taking omeprazole which is a potent inhibitor of CYP2C19, one of the enzymes involved in metabolizing citalopram. This may have contributed to the toxicity.

b) Two studies investigated the addition of escitalopram to modafanil with the goal of attenuating the euphoric effects of cocaine. The combination did not reduce cocaine's effects or working memory in cocaine users more than modafanil alone.

c) On day 1-5, compared to placebo, escitalopram resulted in a significant decrease in attentional bias to cocaine-related words. This effect was not found after day 5.

d) Concomitant use of cocaine and escitalopram may theoretically lead to development of serotonin syndrome.

e) Concomitant use of escitalopram with cocaine may result in QTc interval prolongation and an arrhythmia with the potential to develop Torsades de Pointes

Mechanism
a)Escitalopram is the active S-enantiomer of racemic citalopram, and is metabolized similarly to citalopram.

Cocaine and escitalopram both bind to the serotonin transporter. Cocaine has the ability to block the reuptake of norepinephrine, dopamine, and serotonin.

c) It is hypothesized that this may be due to activation of 5-HT2C receptors due to the increased levels of 5-HT when escitalopram is administered.

d) Cocaine and escitalopram both bind to the serotonin transporter. Cocaine has the ability to block the reuptake of norepinephrine, dopamine, and serotonin.

e) Additive QTc prolongation.

Significance
a) Concomitant use of cocaine and escitalopram may theoretically have additive inhibition of serotonin reuptake and could lead to serotonin syndrome.

b) Escitalopram does not appear to reduce the effects of cocaine.

c) No long-term effects of escitalopram on attentional-bias to cocaine related words was found. This indicates that SSRIs would not be effective as treatment for cocaine dependence.

d) Patients taking escitalopram and using cocaine should be educated on the risk of serotonin syndrome and monitored for signs and symptoms.

e) Due to increased risk of QTc interval prolongation, cocaine use should be avoided while taking escitalopram.

Serious Risk for Harm

If you are taking escitalopram, using cocaine may increase the risk for side effects from both drugs and you could get: very high fever, really sick, dangerously high blood pressure, a very fast heart beat, heart problems and even die. This is 'serotonin syndrome'.

Serious Risk for Harm

Cocaine and escitalopram can both affect heart rhythm. When cocaine is combined with escitalopram, it could lead to a severe abnormal heart rhythm that is very dangerous and can even cause death.

Opioids

codeine, Tylenol #3®, cody, meperidine, Demerol®, DXM, dextromethorphan, robo, skittles, morphine, morph, monkey, methadone, bupe, sub, or dollies, oxycodone, Oxycontin®, hillbilly heroin, OxyNeo®, OC, oxy, roxy, percs, fentanyl, Sublimaze®, Duragesic®, china white, hydrocodone, Hycodan®, Vicodin®, suboxone®, buprenorphine, vike, heroin, H, horse, junk, smack, brown sugar, black tar, down, china white, purple drank, W18, carfentanil, elephant tranquilizer, loperamide, lope, lean

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Interaction
ALL OPIOIDS: As a CNS depressant, escitalopram has the potential to enhance the adverse or toxic effects of other CNS depressants such as opioids.

DEXTROMETHORPHAN: a) One case study reports a 20-year-old man who developed serotonin syndrome after ingesting dextromethorphan overdoses, while receiving escitalopram.

b) One case study reports that a 6-year-old patient developed serotonin syndrome after ingesting dextromethorphan overdoses while receiving a related drug, sertraline.

FENTANYL/OXYCODONE: a) A case report describes a 59 year old woman who was taking escitalopram and oxycodone and received fentanyl 250 mcg and morphine during surgery. The patient developed symptoms of serotonin syndrome the following morning.

b) A case report describes a 66 year old male who was taking oxycodone 120 mg daily and fentanyl 200 mcg intranasally up to QID. Escitalopram 5 mg/day was initiated and he developed serotonin syndrome. The majority of his symptoms resolved in 2 days but he continued to suffer from blurred vision.

HYDROCODONE: A 90 year old woman was taking hydrocodone and her citalopram 10 mg daily was changed to escitalopram 10 mg daily. She developed hallucinations, and hydrocodone was discontinued due to improved pain. The hallucinations resolved. She had previously taken paroxetine with the same dose of hydrocodone with no hallucinations or signs of serotonin-syndrome.

HYDROMORPHONE: An 81 year old woman who took related drug fluoxetine 20 mg daily and other medications for several years developed abnormal movements, confusion, incoherent speech, sweating, redness, tremor, hyperreflexia and muscle spasm 2 days after starting hydromorphone 12 mg daily. Fluoxetine was stopped and the symptoms resolved.

LOPERAMIDE: QTc prolongation has been observed with escitalopram. Concomitant use with high-dose loperamide (>100 mg/day) may result in an arrhythmia with the potential to develop Torsades de Pointes.

MEPERIDINE: Taking meperidine and escitalopram together increases the risk of serotonin syndrome.

MORPHINE: A patient, who had been taking related drug paroxetine prior to surgery, was given morphine and ondansetron during the surgery. She experienced post-operative delirium (agitation, confusion, uncontrolled limb movements, abnormal ocular function, hypertension, pyrexia, brisk reflexes, ankle clonus, elevated creatinine phosphokinase (CPK)) during the following 2 days.

METHADONE: QTc interval prolongation has been observed with escitalopram, thus concomitant use with methadone may result in an arrhythmia with the potential to develop Torsades de Pointes.

OXYCODONE: Symptoms of serotonin syndrome occurred in a patient taking escitalopram and extended release oxycodone after the oxycodone dose was increased.

TRAMADOL: a) A placebo-controlled crossover study was preformed where 15 healthy volunteers were given escitalopram 20 mg daily and tramadol 150 mg. The median AUC of (+)-O-desmethyltramadol (tramadol metabolite) was decreased by 29% in those taking escitalopram. The analgesic effect was assessed by the cold pressor test; it was unaffected.

b) An increase in seizure risk was noted by the manufacturer of tramadol when used with SSRIs.

c) There are multiple case reports of patients experiencing serotonin syndrome due to a combination of tramadol and related drug citalopram.

d) A 58 year old male patient was taking escitalopram 20 mg daily as well as quetiapine 300 mg daily, oxazepam 60 mg daily, alprazolam 2 mg daily, and zolpidem 12.5 mg daily. He was also treated with baclofen for 5 months for alcohol dependence. He was also on various other medications for non-psychiatric conditions (diabetes, cardiovascular disease, benign prostatic hyperplasia and urinary incontinence). Tramadol 50 mg BID was prescribed, although the patient may have taken more than prescribed. One month later the patient was arrested and diagnosed with a manic episode. He also had a positive urinary screen for tetrahydrocannabinol. Tramadol was discontinued on admission and escitalopram was discontinued 1 week later, but the patient wasn't able to be discharged for 3 months due to his symptoms, despite treatment with quetiapine, oxazepam, and lithium.

OTHER OPIOIDS: The serotonergic effects of SSRIs may be enhanced by concomitant use with serotonergic opioids.

Mechanism
ALL OPIOIDS: b) The exact mechanism of increased CNS depression is unknown, but it appears that the effects are mainly additive.

DEXTROMETHORPHAN: Serotonin syndrome is a dose-related response to the use of serotonergic drugs, often in combination. Genetic polymorphism in CYP2D6 function leads to differences in the ability to metabolize dextromethorphan which may explain the differences in clinical experiences reported by those who abuse dextromethorphan for its dissociative effects.

FENTANYL: a,b) Additive serotonergic effects could contribute to an increased risk of serotonin syndrome.

LOPERAMIDE: Both escitalopram and high dose loperamide can cause QTc interval prolongation. When used together, these effects may be additive.

MEPERIDINE: Additive serotonergic effects could contribute to an increased risk of serotonin syndrome.

METHADONE: Additive QTc prolongation.

TRAMADOL: a) The analgesic effect of tramadol is thought to be mediated mainly by the (+)-O-desmethyltramadol metabolite.

b) Tramadol can cause seizures, and SSRIs can lower the seizure threshold.

c) Additive serotonergic effects could contribute to an increased risk of serotonin syndrome.

d) The parent compound is an inhibitor of serotonin and norepinephrine reuptake (structural analog of venlafaxine).

OTHER OPIOIDS: Additive serotonergic effects.

Significance
ALL OPIOIDS: It is important to warn patients of the potential for a reduction in psychomotor function when these drugs are taken concurrently. They may or may not be aware of their deterioration in skill level and response will vary between individuals. They will likely experience a deterioration in their abilities to operate a vehicle and/or carry out tasks that require mental alertness.

DEXTROMETHORPHAN: If therapeutic doses of dextromethorphan and an SSRI are enough to elicit serotonin syndrome, then the combination of these drugs should be avoided. One case study suggests that supra-therapeutic doses of dextromethorphan are a risk factor for the development of serotonin syndrome.

FENTANYL, MEPERIDINE, TRAMADOL: Fentanyl, meperidine, and tramadol may not be the best choice for analgesic therapy in patients currently maintained on escitalopram due to increased risk of serotonin syndrome. If these combinations cannot be avoided patients should be monitored for signs of serotonin syndrome.

LOPERAMIDE:Due to increased risk of QTc interval prolongation, it is recommended to avoid concomitant use of high-dose loperamide (>100 mg/day) and escitalopram.

METHADONE: Due to increased risk of QTc interval prolongation, caution is recommended with concomitant use of methadone and escitalopram.

TRAMADOL: a) The change in metabolism of tramadol does not appear to affect analgesic efficacy.

b) Caution with concomitant use of tramadol and SSRIs is recommended in patients who already have increased risks of seizures.

d) As the exact dose taken is unknown, tramadol abuse is possible. The significance of this case report is unclear, but the mechanism of action of tramadol makes it possible for it to induce mania.

OTHER OPIOIDS: While there is the potential for increased risk of serotonin syndrome with the concomitant use of SSRIs and opioids, it appears to be relatively rare. Little evidence exists to suggests a contraindication to concomitant use; however, it is recommended to monitor for serotonin syndrome-like symptoms if used in patients with altered mental status, autonomic dysfunction, or those experiencing neuromuscular adverse effects.

Serious Risk for Harm

ALL OPIOIDS: Escitalopram can cause sleepiness, dizziness and confusion. Opioid use can make this worse, and make it more dangerous to drive or do activities that require alertness and attention.

Serious Risk for Harm

LOPERAMIDE: Use of both escitalopram and very high doses of loperamide (more than 100 mg in one day) can cause abnormal heart rhythm. Mixing these two medications could make the chance of having a deadly abnormal heart beat more likely, so this cocktail should be avoided.

METHADONE: Methadone and escitalopram can both affect heart rhythm. When methadone is combined with escitalopram, it could lead to a severe abnormal heart rhythm that is very dangerous and can even cause death.

Serious Risk for Harm

DEXTROMETHORPHAN: When high doses of dextromethorphan are combined with escitalopram, you could get: very high fever, really sick, dangerously high blood pressure, heart problems and even die. This is 'serotonin syndrome'.

FENTANYL: When combined with escitalopram, you could get: very high fever, really sick, dangerously high blood pressure, heart problems and even die. This is 'serotonin syndrome'.

HYDROMORPHONE: When combined with escitalopram, you could get: very high fever, really sick, dangerously high blood pressure, heart problems and even die. This is 'serotonin syndrome'.

MEPERIDINE: When combined with escitalopram, you could get: very high fever, really sick, dangerously high blood pressure, heart problems and even die. This is 'serotonin syndrome'.

MORPHINE: When combined with escitalopram, you could get: very high fever, really sick, dangerously high blood pressure, heart problems and even die. This is 'serotonin syndrome'.

TRAMADOL: When combined with escitalopram, you could get: very high fever, really sick, dangerously high blood pressure, heart problems and even die. This is 'serotonin syndrome'.

If you have epilepsy, taking tramadol with escitalopram could make you have seizures more often.

Amphetamines/ Stimulants

uppers, ecstasy, E, X, Molly, mesc, XTC, love drug, MDA, MDE, Eve, MDMA, adam, disco biscuit, bennies, black beauties, Dexedrine®, Adderall®, dexies, Ritalin®, speed, crystal, meth, ice, glass, crank, tweak, cat, qat, kat, khat, bath salts, Ivory Wave, Vanilla Sky, Cloud 9

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Interaction
ALL AMPHETAMINES:a) Concomitant use of psychostimulants (amphetamine derivatives or methylphenidate) and SSRIs may increase a patient's risk of serotonin syndrome.

b) SSRIs may have amphetamine-like effects if abused.

e) It is possible that the combination of amphetamines and escitalopram may lead to neurotoxicity.

ECSTASY/MDMA: a) A male taking the related drug citalopram at a dose of 50 mg/day took an unknown amount of MDMA and became aggressive, agitated, severely grandiose, restless, and performed peculiar compulsive movements. The patient lacked normal movement control and had visual hallucinations of seeing little bugs everywhere. The patient was treated with haloperidol and chlordiazepoxide and improved within 2 days of replacing citalopram with promazine.

b) The effects of the related drug citalopram pre-treatment (40 mg IV) on vegetative and cardiovascular effects of MDMA (1.5 mg/kg orally) was investigated in a double-blind, placebo-controlled study involving 16 healthy volunteers. MDMA moderately increased blood pressure and heart rate, slightly elevated body temperature and produced a broad range of acute and short-term side effects. Citalopram reduced all these MDMA-induced physiological changes except for body temperature. MDMA produced an emotional state with heightened mood, increased self-confidence and extroversion, moderate derealization, and an intensification of sensory perception. Most of these effects were markedly reduced by citalopram.

c) A case report describes a patient who was taking related drug citalopram 20 mg daily and then took ecstasy, and experienced no effects from ecstasy.

d) The combination of related medication citalopram and ecstasy may increase the risk of the syndrome of inappropriate antidiuretic hormone excretion (SIADH) and hyponatremia.

e) It is possible that the combination of ecstasy and escitalopram may lead to neurotoxicity.

Mechanism
ALL AMPHETAMINES: a) Additive effects of serotonin reuptake inhibition by psychostimulants (amphetamine derivatives or methylphenidate) and SSRIs could contribute to an increased risk of serotonin syndrome.

ECSTASY/MDMA: c) These findings suggest that physiological and psychological effects of MDMA in humans are partially due to an interaction of MDMA with the serotonin transporter and a subsequent release of serotonin. This could theoretically be blocked by SSRIs.

d) The effects may be additive.

e) One possible effect of ecstasy is serotonin reuptake inhibition. The increased serotonergic effects could result in neurotoxicity.

Significance
ALL AMPHETAMINES: a) Patients should be monitored closely for signs and symptoms of serotonin syndrome (e.g. agitation, myoclonus, increased sweating, tachycardia, etc) if psychostimulants are used concurrently with SSRIs.

ECSTASY/MDMA: b) The effects of ecstasy may be decreased while taking escitalopram.

d) Escitalopram should be avoided in patients who are known to take ecstasy due to this risk.

Serious Risk for Harm

When street doses of amphetamines or other stimulants are taken with medicines in the same family as escitalopram, it can cause: very high fever, sickness, dangerously high blood pressure, heart problems and even death. This is 'serotonin syndrome'.

It can also cause you to get very dehydrated which can be dangerous.

Serious Risk for Harm

There are some reports of people who take medicines from the same family as escitalopram having a milder 'high' when they use ecstasy. This might make you think it is ok to take more ecstacy than normal, but that could result in an overdose.

Think First

Doctors will sometimes prescribe small amounts of medical amphetamines to patients taking escitalopram, to help treat certain illnesses, but this is done very carefully.

Taking amphetamines without your doctor knowing is a risk.

Phencyclidine/ Ketamine

PCP, angel dust, PeaCe Pill, rocket fuel, love boat, embalming fluid, elephant tranquilizer, hog, illy, wet, wet stick, dipper, toe tag, cadillac, snorts, or surfer, Special K, vitamin K, CVR, cat tranquilizer, cat valium, jet, kit kat, Ketalar®

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Interaction
KETAMINE: a) As a CNS depressant, escitalopram has the potential to enhance the adverse or toxic effects of other CNS depressants, such as ketamine.

b) Patients receiving escitalopram for depression had either ketamine 0.5mg/kg IV over 40min or a placebo added on. The ketamine group had significantly higher response and remission rates, and the time to response and remission was decreased. The superiority of ketamine over placebo was not sustained on certain questionnaires at week 3 and 4, at week 4 more patients in the ketamine group were remitted. There were no differences in psychotic or dissociative symptoms between groups. YMRS (young mania rating scale) scores were higher with IV ketamine at 1 and 2 hour assessment points.

PHENCYCLIDINE: No information currently available.

Mechanism
KETAMINE: Additive CNS depression.

Significance
KETAMINE: a) It is important to warn patients of the potential for a reduction in psychomotor function when these drugs are taken concurrently. They may or may not be aware of their deterioration in skill level and response will vary between individuals. They will likely experience a deterioration in their abilities to operate a vehicle and/or carry out tasks that require mental alertness.

b) The significance of this study is unclear. The authors believe this shows promise for the use of ketamine for speeding up the efficacy of antidepressants.

Serious Risk for Harm

KETAMINE: Esitalopram can cause sleepiness, dizziness and confusion. Ketamine can make this worse, and make it more dangerous to drive or do activities that require alertness and attention.

Unknown Dangers

PHENCYCLIDINE: Unknown dangers.

LSD/ Hallucinogens

acid, blotter, cartoon acid, hit, purple haze, trip, white lightning, raggedy ann, sunshine, window-pane, microdot, boomers, buttons, mesc, peyote, salvia, morning glory seeds, flying saucers, licorice drops, pearly gates, magic mushrooms, shrooms

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Interaction
In one study, 28 out of 32 subjects (88%) who had taken an antidepressant with inhibitory effects on serotonin reuptake (fluoxetine, paroxetine, sertraline, trazodone) for over 3 weeks had a subjective decrease or virtual elimination of their responses to LSD. These data are in contrast with a previous study that reported increased responses to LSD during chronic administration of tricyclic antidepressants or lithium.

3 case reports discuss patients with a history of LSD abuse who experienced onset or worsening of LSD flashbacks when given related SSRIs (fluoxetine, paroxetine or sertraline).

Mechanism
The mechanism is not well understood. Increased levels of serotonin may lead to increased stimulation of 5-HT2 and 5-HT1A receptors, changes in extracellular brain serotonin concentrations, and changes in brain catecholamine systems.

Significance
There is limited information on the potential interactions between LSD and escitalopram. The authors of the case studies recommended warning patients with a history of LSD use of the potential for flashbacks or hallucinations.

Serious Risk for Harm

Mixing medicines in the same family as escitalopram with LSD can cause a bad trip, flashbacks of previous trips (even if it has been a while since you took LSD), or hallucinations. And sometimes, people have very 'mild' trips on LSD when they are taking these types of medicines. This may make you think it is safe to take more LSD than normal, but that could make you overdose.

Benzodiazepines

benzos, downers, tranquilizers, tranks, Ativan®, Halcion®, Klonopin®, Rivotril®, Restoril®, Serax®, Valium®, Xanax®, Rohypnol® (roofies, rope, the forget or date rape pill)

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Interaction
ALL BENZODIAZEPINES: As a CNS depressant, escitalopram has the potential to enhance the adverse or toxic effects of other CNS depressants, such as benzodiazepines.

Mechanism
ALL BENZODIAZEPINES: Additive CNS depression.

Unlike some other SSRIs, escitalopram only has weak inhibitory effects on CYP enzymes. Benzodiazepines that are not metabolized via CYP enzymes (e.g. lorazepam, oxazepam, and temazepam) are likely not affected by SSRIs.

Significance
It is important to warn patients of the potential for a reduction in psychomotor function when these drugs are taken concurrently. They may or may not be aware of their deterioration in skill level and response will vary between individuals. They will likely experience a deterioration in their abilities to operate a vehicle and/or carry out tasks that require mental alertness.

While the risk of clinically relevant interactions between benzodiazepines and escitalopram appears to be low compared to other SSRIs, patients should be advised that the potential for interactions still exists and they should be monitored for any increases in adverse or toxic effects when starting, stopping or changing doses of either escitalopram or a benzodiazepine.

Serious Risk for Harm

Escitalopram can cause sleepiness, dizziness and confusion. Benzodiazepines can make this worse, and make it more dangerous to drive or do activities that require alertness and attention.

Think First

Benzodiazepines are 'downers'. If you are depressed, blue, or moody, benzodiazepines can make this worse.

References

[+]

also see CITALOPRAM

also see FLUOXETINE

Allen D, Lader M, Curran HV. A comparative study of the interactions of alcohol with amitriptyline, fluoxetine and placebo in normal subjects. Prog Neuropsychopharmacol Biol Psychiatry. 1988; 12: 63-80.

Ansermot N, Chocron O, Herrera F, et al. Severe Manic Episode Associated With Tramadol in a Patient With Recurrent Depressive Disorder. J Clin Psychopharmacol 2015; 35: 203-4.

Atigari O, Kelley AM, Jabeen Q, et al. New onset alcohol dependence linked to treatment with selective serotonin reuptake inhibitors. Int J Risk Saf Med 2013; 25: 105-9.

Bonson KR, Buckholtz JW, Murphy DL. Chronic administration of serotonergic antidepressants attenuates the subjective effects of LSD in humans. Neuropsychopharmacology 1996; 14: 425-36.

Brookwell L, Hogan C, Healy D, et al. Ninety-three cases of alcohol dependence following SSRI treatment. Int J Risk Saf Med 2014; 26: 99-107.

Dunlop BW, Davis PG. Combination treatment with benzodiazepines and SSRIs for comorbid anxiety and depression: a review. Prim Care Companion J Clin Psychiatry 2008; 10: 222-8.

Gnanadesigan N, Espinoza RT, Smith R et al. Interaction of serotonergic antidepressants and opioid analgesics: Is serotonin syndrome going undetected? J Am Med Dir Assoc 2005; 6: 265-9.

Hu Y, Xiang Y, Fang J, et al. Single IV ketamine augmentation of newly initiated escitalopram for major depression: results from a randomized, placebo-controlled 4-week study. Psychol Med 2016; 46: 623-35.

Lader M, Melhuish A, Frcka G et al. The effects of citalopram in single and repeated doses and with alcohol on physiological and psychological measures in healthy subjects. Eur J Clin Pharmacol. 1986; 31: 183-90.

Lexi-Comp ONLINE, Lexi-Comp ONLINE Interaction Analysis, Hudson, Ohio: Lexi-Comp, Inc.; 2021; Aug 10, 2021.

Liechti ME, Baumann C, Gamma A et al. Acute psychological effects of 3,4-methylenedioxymethamphetamine (MDMA, 'Ecstasy') are attenuated by the serotonin uptake inhibitor citalopram. Neuropsychopharmacology 2000; 22: 513-21.

Liechti ME, Vollenweider FX. The serotonin uptake inhibitor citalopram reduces acute cardiovascular and vegetative effects of 3,4-methylenedioxymethamphetamine ('Ecstasy') in healthy volunteers. J Psychopharmacol 2000; 14: 269-74.

Markel H, Lee A, Holmes RD et al. LSD flashback syndrome exacerbated by selective serotonin reuptake inhibitor antidepressants in adolescents. J Pediatr 1994; 125: 817-9.

Menkes D, Herxheimer A. Interaction between antidepressants and alcohol: Signal amplification by multiple case reports. Int J Risk Saf Med 2014: 26; 163-70.

Noehr-Jensen L, Zwisler ST, Larsen F et al. Escitalopram is a weak inhibitor of the CYP2D6-catalyzed O-demethylation of (+)-tramadol but does not reduce the hypoalgesic effect in experimental pain. Clin Pharmacol Ther 2009; 86: 626-33.

Nolting A, Abramowitz W. Lack of interaction between citalopram and the CYP3A4 substrate triazolam. Pharmacotherapy 2000; 20: 750-5.

Preston CL (Ed), Stockley’s Interactions Checker. [online] London: Pharmaceutical Press. (accessed on Aug 10, 2021).

Scherf-Clavel M, Deckert J, Menke A, et al. Smoking Is Associated With Lower Dose-Corrected Serum Concentrations of Escitalopram. J Clin Psychopharmacol 2019; 39: 485-88.

Suzuki A, Otani K. Serotonin Syndrome After an Alcohol Intake in a Patient Treated With Escitalopram and Clomipramine. Clin Neuropharmacol 2019; 42: 103-4.

Therapeutic Research Center. Natural Medicines [Internet]. Somerville (MA): Escitalopram; [cited Aug 30, 2021].

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escitalopram

References

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