Escitalopram drug interactions

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Contents 1 Drug-drug interactions 2 Drug-food/drug-herb interactions 3 References

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Drug-drug interactions

Severity level	Drug and description of interaction
4	dexfenfluramine, fenfluramine, monoamine oxidase inhibitor (MAOI), nefazodone, phentermine, procarbazine, selective serotonin reuptake inhibitor (SSRI), venlafaxine: The risk of serotonin syndrome is increased when escitalopram is co-administered with these drugs.[1][2][3][4][5][6][7][8] phenothiazines: Escitalopram can increase the effect or toxicity of phenothiazines by mild inhibition of CYP 2D6.[9]
3	amphetamine, buspirone, cocaine, dextroamphetamine, furazolidone, isoniazid, linezolid, metoclopamide, pentazocine, selective norepinephrine reuptake inhibitor (SNRI), selective serotonin reuptake inhibitor (SSRI), sibutramine, trazodone, triptans: The risk of serotonin syndrome is increased when escitalopram is co-administered with these drugs.[3][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] aripiprazole, atomoxetine, thiothixene, tricyclic antidepressant (TCA): Escitalopram can increase the effect or toxicity of these drugs by mild inhibition of CYP 2D6.[3][9][25][26][27] protease inhibitor: Protease inhibitors can theoretically impair the metabolism of escitalopram. The exact mechanism is unknown.[9][28] tramadol: The risk of serotonin syndrome and seizure is increased when escitalopram is co-administered with tramadol.[29]
2	alosetron, lithium: The risk of serotonin syndrome is increased when escitalopram is co-administered with these drugs.[3] aprepitant, clarithromycin, erythromycin, itraconazole, voriconazole: These drugs can theoretically impair the metabolism of escitalopram. The exact mechanisms are unknown.[9][30] aspirin, nonsteroidal antiinflammatory drug (NSAID): The risk of an upper GI bleed is increased when escitalopram is co-administered with these drugs.[9][31] barbiturates, carbamazepine, phenytoin, primidone, rifabutin, rifampin: CYP 3A4 inducers may decrease the plasma concentrations of escitalopram due to induction of the CYP3A4 isoenzyme.[9] clozapine, cyproheptadine, darifenacin, dextromethorphan, encainide, flecainide, haloperidol, mexiletine, opiate agonists, propafenone, ranolazine, risperidone: Escitalopram can increase the effect or toxicity of these drugs by mild inhibition of CYP 2D6.[3][9][26][32][33] doxercalciferol: Escitalopram decreases the efficacy of doxercalciferol by inhibiting 25-hydroxylation.[9][34] ethanol: Co-administration of ethanol and escitalopram can cause additive CNS effects.[3] ketoconazole: Escitalopram may have some CYP 3A4 inducer property which reduces the Cmax and AUC of ketoconazole.[26] warfarin: The risk of bleeding is increased when escitalopram is co-administered with warfarin.[3][35] zolpidem: Cases of hallucinations have been reported when escitalopram was co-administered with zolpidem.[36]
1	carvedilol, cevimeline, metoprolol, propranolol, timolol: Escitalopram can increase the effect or toxicity of these drugs by mild inhibition of CYP 2D6.[9] cimetidine: The AUC of citalopram increases by 43% and the Cmax increases by 39% when citalopram is coadministered with escitalopram.[26] dexamethasone: Increases the metabolism of escitalopram through CYP 2D6 induction. diltiazem, modafinil, nicardipine, troleandomycin, verapamil: These drugs can theoretically impair the metabolism of escitalopram. The exact mechanisms are unknown.[9]

Drug-food/drug-herb interactions

Severity level	Drug and description of interaction
4	St. John's Wort, tryptophan: The risk of serotonin syndrome is increased when escitalopram is co-administered with St. John's Wort or tryptophan.[37][38][39]
3	None known
2	Grapefruit juice: Grapefruit juice components are known inhibitors of intestinal CYP 3A4. Co-administration of grapefruit juice with escitalopram may cause an increase in Cmax and AUC, which can lead to adverse reactions or overdose toxicity.[9] kava kava, valerian: The CNS side effects of escitalopram may increase when it is coadministered with kava kava or valerian.[40][41]
1	None known

References

1. ↑ Redux™ (dexfenfluramine) package insert. Philadelphia PA: Wyeth-Ayerst Laboratories; 1997. NOTE: Dexfenfluramine was removed voluntarily from the US market in response to FDA concerns in September 1997.
2. ↑ Brosen K, Naranjo CA.Review of pharmacokinetic and pharmacodynamic interaction studies with citalopram.Eur Neuropsychopharmacol. 2001 Aug;11(4):275-83.
3. ↑ ^{3.0 3.1 3.2 3.3 3.4 3.5 3.6} Lexapro® (escitalopram oxalate) package insert. St. Louis, MO; Forest Laboratories; 2003 Dec.
4. ↑ Serzone®(nefazodone)package insert. Princeton, NJ: Bristol-Myers Squibb Company; 2003 Sep.
5. ↑ Vivero LE, Anderson PO, Clark RF. A close look at fenfluramine and dexfenfluramine. J Emerg Med. 1998;16:197—205.
6. ↑ Matulane® (procarbazine) package insert.Gaithersburg, MD: sigma-tau Pharmaceuticals, Inc.; 2002 July.
7. ↑ Mackay FJ, Dunn NR, Mann RD. Antidepressants and the serotonin syndrome in general practice. Br J Gen Pract 1999;49:871—4.
8. ↑ Effexor® (venlafaxine) package insert. Philadelphia, PA;Wyeth Pharmaceuticals, Inc.;2005 Dec.
9. ↑ ^{9.00 9.01 9.02 9.03 9.04 9.05 9.06 9.07 9.08 9.09 9.10} Hansten PD, Horn JR. Cytochrome P450 Enzymes and Drug Interactions, Table of Cytochrome P450 Substrates, Inhibitors, Inducers and P-glycoprotein, with Footnotes. In: The Top 100 Drug Interactions - A guide to Patient Management. 2006 Edition. Edmonds, WA: H&H Publications; 2006:160—174.
10. ↑ Buspar® (buspirone)package insert. Princeton, NJ: Bristol-Myers Squibb Company; 2003 Nov.
11. ↑ Spigset O, Adielsson G. Combined serotonin syndrome and hyponatraemia caused by a citalopram-buspirone interaction. Int Clin Psychopharmacol. 1997;12:61—3.
12. ↑ Muller CP, Carey RJ, Huston JP. Serotonin as an important mediator of cocaine's behavioral effects. Drugs Today (Barc). 2003;39:497—511.
13. ↑ Pettinger WA, Soyangco FG, Oates JA. Inhibition of monoamine oxidase in man by furazolidone. Clin Pharmacol Ther 1968;9:442—7.
14. ↑ Furoxone® (furazolidone) package insert. Eatontown, NJ: Roberts Pharmaceutical Corporation; No date
15. ↑ Nydrazid® Injection (isoniazid, INH)package insert. Princeton, NJ: Apothecon; 1997 Aug.
16. ↑ Zyvox™ (linezolid) package insert. Kalamazoo, MI: Pharmacia & Upjohn Company; 2005 Feb.
17. ↑ Fisher AA, Davis MW. Serotonin syndrome caused by selective serotonin reuptake-inhibitors-metoclopramide interaction. Ann Pharmacother 2002;36:67—71.
18. ↑ Christensen RC, Byerly MJ. Mandibular dystonia associated with the combination of sertraline and metoclopramide. J Clin Psychiatry 1996;57:596.
19. ↑ Bowdle TA. Adverse effects of opioid agonists and agonist-antagonists in anaesthesia. Drug Saf 1998;19:173—89.
20. ↑ U.S. Food and Drug Administration (FDA). Combined use of 5-hydroxytryptamine receptor agonists (triptans), selective serotonin reuptake inhibitors (SSRIs) or selective serotonin/norepinephrine reuptake inhibitors (SNRIs) may result in life-threatening serotonin syndrome. FDA Public Health Advisory. Accessed July 26, 2006. Available on the World Wide Web at: http://www.fda.gov/cder/drug/advisory/SSRI_SS200607.htm.
21. ↑ Chan BSH, Graudins A, Whyte IM, et al. Serotonin syndrome resulting from drug interactions. Med J Aust 1998;169:523—5.
22. ↑ Mackay FJ, Dunn NR, Mann RD. Antidepressants and the serotonin syndrome in general practice. Br J Gen Pract 1999;49:871—4.
23. ↑ Desyrel® (trazodone) package insert. Princeton, NJ: Bristol-Myers Squibb; 2005 Jan.
24. ↑ Chan BSH, Graudins A, Whyte IM, et al. Serotonin syndrome resulting from drug interactions. Med J Aust 1998;169:523—5.
25. ↑ Abilify® (aripiprazole) tablets,discmelt orally-disintegrating tablets, oral solution, and intramuscular injection. Rockville, MD: Otsuka America Pharmaceutical, Inc.; 2006 Sept.
26. ↑ ^{26.0 26.1 26.2 26.3} Celexa® (citalopram) package insert. St. Louis, MO; Forest Pharmaceuticals, Inc.;2004 Jan.
27. ↑ Tofranil®-PM (imipramine) package insert. St. Louis, MO; Mallinckrodt Inc.;2001 Apr.
28. ↑ Gutierrez MM, Rosenberg J, Abramowitz W.An evaluation of the potential for pharmacokinetic interaction between escitalopram and the cytochrome P450 3A4 inhibitor ritonavir.Clin Ther. 2003 Apr;25(4):1200-10.
29. ↑ Kesavan S, Sobala GM. Serotonin syndrome with fluoxetine plus tramadol. J R Soc Med. 1999;92:474—5.
30. ↑ Emend® (aprepitant) package insert. Whitehouse Station, NJ: Merck & Co., Inc.; 2006 Aug.
31. ↑ Dalton, SO, Johansen C, Mellemkjaer L, et al. Use of selective serotonin reuptake inhibitors and the risk of upper gastrointestinal tract bleeding: a population-based cohort study. Arch Intern Med 2003;163:59—64.
32. ↑ Periactin® (cyproheptadine) package insert. West Point, PA: Merck and Company, Inc.;1999 Jan.
33. ↑ Ranexa™ (ranolazine extended-release tablets) package insert. Palo Alto, CA: CV Therapeutics, Inc.; 2006 Jan.
34. ↑ Hectorol® (doxercalciferol) package insert. Middleton, WI: Bone Care International, Inc.; 2005 Jun.
35. ↑ Coumadin® (warfarin)package insert. Princeton, NJ: Bristol-Myers Squibb Company; 2006 Oct.
36. ↑ Elko CJ, Burgess JL, Robertson WO. Zolpidem-associated hallucinations and serotonin reuptake inhibition: a possible interaction. J Toxicol Clin Toxicol 1998;36:195-203.
37. ↑ Henderson L, Yue QY, Bergquist C, et al. St John's wort (Hypericum perforatum): drug interactions and clinical outcomes. Br J Clin Pharmacol 2002;54:349—56.
38. ↑ Prozac® (fluoxetine hydrochloride). Indianapolis, IN: Eli Lilly and Company; 2003 Nov.
39. ↑ Steiner W, Fontaine R. Toxic reaction following the combined administration of fluoxetine and L-tryptophan: five case reports. Biol Psychiatry. 1986;21:1067—71.
40. ↑ German Commission E. Kava Kava, Piperis methystici rhizoma, monograph Published June 1, 1990. In: Blumenthal, M et al ., eds. The complete German Commission E Monographs -Therapeutic Guide to Alternative Medicines. Boston MA: Integrative Medicine Communications for the American Botanical Council; 1998:156—7.
41. ↑ Leuschner J, Muller J, Rudmann M. Characterisation of the central nervous depressant activity of a commercially available valerian root extract. Arzneimittelforschung 1993;43:638—41.