Escitalopraminteractions

Table 6 presents clinically important drug interactions with Escitalopram Capsules.

Table 6: Clinically Important Drug Interactions with Escitalopram Capsules Monoamine Oxidase Inhibitors (MAOIs) Prevention or Management Escitalopram Capsules are contraindicated in patients taking MAOIs, including MAOIs such as linezolid or intravenous methylene blue. Mechanism and Clinical Effect(s) Concomitant use of SSRIs, including Escitalopram Capsules, and MAOIs increases the risk of serotonin syndrome. Pimozide Prevention or Management Escitalopram Capsules are contraindicated in patients taking pimozide. Mechanism and Clinical Effect(s) Concomitant use of racemic citalopram with pimozide increases plasma concentrations of pimozide, a drug with a narrow therapeutic index, and may increase the risk of QT prolongation and/or ventricular arrhythmias compared to use of racemic citalopram alone. The mechanism of this pharmacodynamic interaction is not known. Other Serotonergic Drugs Prevention or Management Monitor patients for signs and symptoms of serotonin syndrome, particularly during escitalopram initiation and dosage increases. If serotonin syndrome occurs, consider discontinuation of Escitalopram Capsules and/or concomitant serotonergic drugs. Mechanism and Clinical Effect(s) Concomitant use of Escitalopram Capsules and other serotonergic drugs (including other SSRIs, SNRIs, triptans, tricyclic antidepressants, opioids, lithium, buspirone, amphetamines, tryptophan, and St. John's Wort) increases the risk of serotonin syndrome. Drugs That Interfere With Hemostasis (NSAIDs, Aspirin, Warfarin, etc.) Prevention or Management Inform patients of the increased risk of bleeding associated with the concomitant use of Escitalopram Capsules and antiplatelet agents and anticoagulants. For patients taking warfarin, carefully monitor the international normalized ratio. Mechanism and Clinical Effect(s) Concomitant use of Escitalopram Capsules and an antiplatelet or anticoagulant may potentiate the risk of bleeding. Sumatriptan Prevention or Management If concomitant use of Escitalopram Capsules and sumatriptan is clinically warranted, appropriate observation of the patient is advised. Mechanism and Clinical Effect(s) There have been postmarketing reports of weakness, hyperreflexia, and incoordination following the concomitant use of an SSRI and sumatriptan. Lithium Prevention or Management Monitor plasma lithium levels with appropriate adjustment to the lithium dose in accordance with standard clinical practice. Mechanism and Clinical Effect(s) Because lithium may enhance the serotonergic effects of escitalopram, caution should be exercised when Escitalopram Capsules is used concomitantly with lithium. Alcohol Prevention or Management Concomitant use of Escitalopram Capsules and alcohol is not recommended. Mechanism and Clinical Effect(s) Alcohol may potentiate the psychotropic effects of escitalopram. Drugs Metabolized by CYP2D6 Prevention or Management The clinical significance of this finding is unknown. Exercise caution during coadministration of Escitalopram Capsules and drugs metabolized by CYP2D6. Mechanism and Clinical Effect(s) Coadministration of escitalopram with the tricyclic antidepressant desipramine, a substrate for CYP2D6, resulted in a 40% increase in Cmax and a 100% increase in AUC of desipramine. See full prescribing information for clinically significant drug interactions