Escitalopram

MAOI with potential to increase serotonin syndrome risk. Escitalopram is contraindicated in patients taking linezolid.

Concomitant use with MAOIs is contraindicated. See Dosage and Administration, Contraindications, and Warnings and Precautions.

MAOI with potential to increase serotonin syndrome risk. Escitalopram is contraindicated in patients taking intravenous methylene blue.

MAOIs are contraindicated with escitalopram due to risk of serotonin syndrome.

Concomitant use increases plasma concentrations of pimozide and may increase risk of QT prolongation and ventricular arrhythmias. Escitalopram is contraindicated.

Concurrent use may potentiate risk of upper gastrointestinal bleeding due to interference with hemostasis.

Concomitant use increases risk of serotonin syndrome. Monitor for signs and symptoms, particularly during initiation and dosage increases.

Concomitant use increases risk of serotonin syndrome. Monitor for signs and symptoms, particularly during initiation and dosage increases.

Concomitant use increases risk of serotonin syndrome. Monitor for signs and symptoms, particularly during initiation and dosage increases.

Concurrent use may potentiate risk of upper gastrointestinal bleeding due to interference with hemostasis.

Concomitant use increases the risk of serotonin syndrome. Monitor patients for signs and symptoms, particularly during initiation and dosage increases.

Concomitant use with other SSRIs is not recommended; risk of serotonin syndrome.

Concomitant use increases risk of serotonin syndrome. Monitor for signs and symptoms, particularly during initiation and dosage increases.

Postmarketing reports describe weakness, hyperreflexia, and incoordination with concurrent SSRI and sumatriptan use, consistent with serotonin syndrome.

Rare postmarketing reports of serotonin syndrome with SSRIs and triptans. Careful observation advised if concomitant use clinically warranted.

Concomitant use with tryptophan is not recommended due to risk of serotonin syndrome.

Altered anticoagulant effects including increased bleeding reported. Patients receiving warfarin should be carefully monitored when escitalopram is initiated or discontinued.

Use of alcohol by patients taking escitalopram is not recommended, although escitalopram did not potentiate cognitive and motor effects in clinical trials.

Carbamazepine may increase clearance of escitalopram due to enzyme-inducing properties. Monitor effectiveness of escitalopram.

Combined administration resulted in 43% increase in citalopram AUC and 39% increase in Cmax. Clinical significance unknown.

CYP2D6 or CYP3A4 inhibitor that can increase clozapine levels and lead to adverse reactions. Close monitoring and dose reduction may be necessary.

Caution should be used when escitalopram is combined with other centrally acting drugs due to primary CNS effects.

Coadministration resulted in 40% increase in desipramine Cmax. Desipramine is a CYP2D6 substrate metabolized by escitalopram.

SSRI that inhibits CYP2D6, may increase plasma concentration of doxepin hydrochloride. Caution advised in coadministration; monitor plasma levels.

Gilteritinib may reduce the effects of escitalopram. Avoid concomitant use unless essential for patient care.

NSAIDs with escitalopram may potentiate bleeding risk; inform patients of increased bleeding risk.

Combined administration did not significantly affect pharmacokinetics of either drug; no significant interaction expected.

7.16 Ketoconazole Combined administration of racemic citalopram (40 mg) and ketoconazole (200 mg), a potent CYP3A4 inhibitor, decreased the C max and AUC of ketoconazole by 21% and 10%, respectively, and did not significantly affect the pharmacokinetics of citalopram.

7.20 Metoprolol Administration of 20 mg/day escitalopram oxalate for 21 days in healthy volunteers resulted in a 50% increase in C max and 82% increase in AUC of the beta-adrenergic blocker metoprolol (given in a single dose of 100 mg). Increased metoprolol plasma levels have been associated with decreased cardioselectivity. Coadministration of escitalopram oxalate and metoprolol had no clinically significant effects on blood pressure or heart rate.

7.17 Ritonavir Combined administration of a single dose of ritonavir (600 mg), both a CYP3A4 substrate and a potent inhibitor of CYP3A4, and escitalopram (20 mg) did not affect the pharmacokinetics of either ritonavir or escitalopram. However, coadministration of escitalopram (20 mg) and ritonavir (600 mg), a potent inhibitor of CYP3A4, did not significantly affect the pharmacokinetics of escitalopram.

7.15 Triazolam Combined administration of racemic citalopram (titrated to 40 mg/day for 28 days) and the CYP3A4 substrate triazolam (single dose of 0.25 mg) did not significantly affect the pharmacokinetics of either citalopram or triazolam.