escitalopram (Rx)

Major Depressive Disorder

Indicated for acute and maintenance treatment of major depressive disorder (MDD)

10 mg PO qDay; may increase to 20 mg/day after 1 week

Generalized Anxiety Disorder

Indicated for acute treatment of generalized anxiety disorder (GAD)

10 mg PO qDay; may increase to 20 mg/day after 1 week; maintain at lowest effective dose and assess need of therapy periodically if extended therapy required

Obsessive-Compulsive Disorder (Off-label)

10 mg PO qDay; may increase to 20 mg/day after 1 week; maintain at lowest effective dose and assess need of therapy periodically if extended therapy required

Insomnia (Off-label)

Secondary to Depression: 5-20 mg PO over 8 week period

Secondary to panic disorder in women: 5-10 mg PO over 8 week period

Vasomotor Symptoms Associated with Menopause (Off-label)

10 mg PO qDay; may increase to 20 mg PO qDay after 4 weeks if symptoms not adequately controlled

Dosage Modifications

Renal impairment

• Mild-to-moderate: No dosage adjustment necessary
• Severe: Use with caution; insufficient number of patients have been evaluated during chronic escitalopram treatment

Hepatic impairment

• Mild-to-severe: 10 mg/day; racemic citalopram clearance decreased resulting in increased plasma concentration

Dosing Considerations

For extended therapy, maintain at lowest effective dose and assess periodically the need for continued therapy

Discontinuation of treatment

• Symptoms associated with discontinuation of SSRIs and SNRIs have been; monitor for symptoms when discontinuing treatment
• Gradual dose reduction rather than abrupt cessation is recommended
• If intolerable symptoms occur following a dose reduction or discontinuation of treatment, then consider resuming the previously prescribed dose; subsequently, continue decreasing the dose at a more gradual rate

Switching to or from a monoamine oxidase inhibitor (MAOI) used to treat for psychiatric disorders

• At least 14 days should elapse between discontinuation of an MAOI and initiation of escitalopram
• Conversely, allow at least 14 days after stopping escitalopram before starting an MAOI

Major Depressive Disorder

<12 years: Safety and efficacy not established

≥12 years: 10 mg PO qDay; may increase dose after at least 3 weeks; not to exceed 20 mg/day

Dosage Modifications

Renal impairment

• Mild-to-moderate: No dosage adjustment necessary
• Severe: Use with caution; insufficient number of patients have been evaluated during chronic escitalopram treatment

Hepatic impairment

• Mild-to-severe: 10 mg/day; clearance of racemic citalopram was decreased and plasma concentration were increased.

Dosing Considerations

For extended therapy, maintain at lowest effective dose and assess periodically the need for continued therapy

Discontinuation of treatment

• Symptoms associated with discontinuation of SSRIs and SNRIs have been; monitor for symptoms when discontinuing treatment
• Gradual dose reduction rather than abrupt cessation is recommended
• If intolerable symptoms occur following a dose reduction or discontinuation of treatment, then consider resuming the previously prescribed dose; subsequently, continue decreasing the dose at a more gradual rate

Switching to or from a monoamine oxidase inhibitor (MAOI) used to treat for psychiatric disorders

• At least 14 days should elapse between discontinuation of an MAOI and initiation of escitalopram
• Conversely, allow at least 14 days after stopping escitalopram before starting an MAOI

Major Depressive Disorders/Generalized Anxiety Disorder

10 mg PO qDay; no additional benefits observed with 20 mg/day

Dosing Considerations

Older patients are more prone to SSRI/SNRI-induced hyponatremia; also, patients taking diuretics or are otherwise volume depleted may be at greater risk

Contraindicated (13)

• cisapride

  escitalopram increases toxicity of cisapride by QTc interval. Contraindicated.

• dronedarone

  escitalopram increases toxicity of dronedarone by QTc interval. Contraindicated.

• goserelin

  goserelin increases toxicity of escitalopram by QTc interval. Contraindicated. Increases risk of torsades de pointes.

• isocarboxazid

  isocarboxazid and escitalopram both increase serotonin levels. Contraindicated.

• lefamulin

  lefamulin will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Lefamulin is contraindicated with CYP3A substrates know to prolong the QT interval.

• leuprolide

  leuprolide increases toxicity of escitalopram by QTc interval. Contraindicated. Increases risk of torsades de pointes.

• phenelzine

  phenelzine and escitalopram both increase serotonin levels. Contraindicated.

• pimozide

  escitalopram and pimozide both increase QTc interval. Contraindicated.

• procarbazine

  procarbazine and escitalopram both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

• selegiline

  selegiline and escitalopram both increase serotonin levels. Contraindicated. At least 14 days should elapse between discontinuation of selegiline and initiation of treatment with a serotonergic drug.

• thioridazine

  escitalopram increases toxicity of thioridazine by QTc interval. Contraindicated.

• tranylcypromine

  tranylcypromine and escitalopram both increase serotonin levels. Contraindicated.

• ziprasidone

  escitalopram and ziprasidone both increase QTc interval. Contraindicated.
  
  ziprasidone and escitalopram both increase QTc interval. Contraindicated.

Serious - Use Alternative (127)

• abametapir

  abametapir will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir.

• alfentanil

  alfentanil, escitalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• amiodarone

  escitalopram increases toxicity of amiodarone by QTc interval. Avoid or Use Alternate Drug.

• amisulpride

  amisulpride and escitalopram both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.

• amitriptyline

  escitalopram and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
  
  escitalopram increases toxicity of amitriptyline by QTc interval. Avoid or Use Alternate Drug.

• amoxapine

  escitalopram and amoxapine both increase serotonin levels. Avoid or Use Alternate Drug.

• apalutamide

  apalutamide will decrease the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP2C19 inducer, with drugs that are CYP2C19 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered.
  
  apalutamide will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.

• arsenic trioxide

  escitalopram increases toxicity of arsenic trioxide by QTc interval. Avoid or Use Alternate Drug.

• artemether

  artemether and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.

• artemether/lumefantrine

  escitalopram increases toxicity of artemether/lumefantrine by QTc interval. Avoid or Use Alternate Drug.

• asenapine

  escitalopram increases toxicity of asenapine by QTc interval. Avoid or Use Alternate Drug.

• azithromycin

  escitalopram increases toxicity of azithromycin by QTc interval. Avoid or Use Alternate Drug.

• bupropion

  escitalopram increases toxicity of bupropion by unspecified interaction mechanism. Avoid or Use Alternate Drug. May lower seizure threshold; keep bupropion dose as low as possible.

• buspirone

  escitalopram and buspirone both increase serotonin levels. Avoid or Use Alternate Drug.

• ceritinib

  ceritinib and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.

• chlorpromazine

  escitalopram increases toxicity of chlorpromazine by QTc interval. Avoid or Use Alternate Drug.

• citalopram

  citalopram and escitalopram both increase serotonin levels. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• clarithromycin

  clarithromycin, escitalopram. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. To monitor for the prolongation of QT/QTc and/or development of ventricular tachyarrhythmias the labeling recommends monitoring QT interval or ECG.
  
  escitalopram increases toxicity of clarithromycin by QTc interval. Avoid or Use Alternate Drug.
  
  clarithromycin will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• clomipramine

  escitalopram and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• crizotinib

  escitalopram increases toxicity of crizotinib by QTc interval. Avoid or Use Alternate Drug.

• cyclobenzaprine

  escitalopram and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

• desflurane

  desflurane and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.

• desipramine

  escitalopram and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• desvenlafaxine

  escitalopram and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.

• dextromethorphan

  escitalopram and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.

• disopyramide

  escitalopram increases toxicity of disopyramide by QTc interval. Avoid or Use Alternate Drug.

• dofetilide

  dofetilide increases toxicity of escitalopram by QTc interval. Avoid or Use Alternate Drug.
  
  escitalopram increases toxicity of dofetilide by QTc interval. Avoid or Use Alternate Drug.

• dosulepin

  escitalopram and dosulepin both increase serotonin levels. Avoid or Use Alternate Drug.

• doxepin

  escitalopram and doxepin both increase serotonin levels. Avoid or Use Alternate Drug.
  
  doxepin and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.

• droperidol

  escitalopram increases toxicity of droperidol by QTc interval. Avoid or Use Alternate Drug.

• encorafenib

  escitalopram increases toxicity of encorafenib by QTc interval. Avoid or Use Alternate Drug.

• entrectinib

  escitalopram and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.

• enzalutamide

  enzalutamide will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• eribulin

  escitalopram increases toxicity of eribulin by QTc interval. Avoid or Use Alternate Drug.

• erythromycin base

  escitalopram increases toxicity of erythromycin base by QTc interval. Avoid or Use Alternate Drug.

• erythromycin ethylsuccinate

  escitalopram increases toxicity of erythromycin ethylsuccinate by QTc interval. Avoid or Use Alternate Drug.

• erythromycin lactobionate

  escitalopram increases toxicity of erythromycin lactobionate by QTc interval. Avoid or Use Alternate Drug.

• erythromycin stearate

  escitalopram increases toxicity of erythromycin stearate by QTc interval. Avoid or Use Alternate Drug.

• fentanyl

  fentanyl, escitalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• fentanyl intranasal

  fentanyl intranasal, escitalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• fentanyl transdermal

  fentanyl transdermal, escitalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• fentanyl transmucosal

  fentanyl transmucosal, escitalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• fexinidazole

  fexinidazole and escitalopram both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.
  
  fexinidazole will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.

• flecainide

  escitalopram increases toxicity of flecainide by QTc interval. Avoid or Use Alternate Drug.

• fluoxetine

  fluoxetine will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug.
  
  escitalopram and fluoxetine both increase serotonin levels. Avoid or Use Alternate Drug.

• fluvoxamine

  fluvoxamine and escitalopram both increase serotonin levels. Avoid or Use Alternate Drug.

• foscarnet

  escitalopram increases toxicity of foscarnet by QTc interval. Avoid or Use Alternate Drug.

• gilteritinib

  gilteritinib will decrease the level or effect of escitalopram by Other (see comment). Avoid or Use Alternate Drug. Coadministration of gilteritinib with drugs that inhibit 5HT2B or sigma nonspecific receptors. Avoid use of these drugs with gilteritinib unless coadministration is necessary.
  
  gilteritinib and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.

• glasdegib

  escitalopram and glasdegib both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, monitor for increased risk of QTc interval prolongation.

• granisetron

  granisetron, escitalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• histrelin

  histrelin increases toxicity of escitalopram by QTc interval. Avoid or Use Alternate Drug. Increases risk of torsades de pointes.

• hydromorphone

  hydromorphone, escitalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• hydroxychloroquine sulfate

  hydroxychloroquine sulfate and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.
  
  escitalopram increases toxicity of hydroxychloroquine sulfate by QTc interval. Avoid or Use Alternate Drug.

• ibutilide

  escitalopram increases toxicity of ibutilide by QTc interval. Avoid or Use Alternate Drug.

• idelalisib

  idelalisib will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates

• iloperidone

  escitalopram increases toxicity of iloperidone by QTc interval. Avoid or Use Alternate Drug.

• imipramine

  escitalopram and imipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• inotuzumab

  escitalopram increases toxicity of inotuzumab by QTc interval. Avoid or Use Alternate Drug.

• isoflurane

  isoflurane and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.

• ivosidenib

  ivosidenib and escitalopram both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.
  
  ivosidenib will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternate therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.

• levomilnacipran

  escitalopram and levomilnacipran both increase serotonin levels. Avoid or Use Alternate Drug.

• linezolid

  linezolid and escitalopram both increase serotonin levels. Avoid or Use Alternate Drug. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first.

• lofepramine

  escitalopram and lofepramine both increase serotonin levels. Avoid or Use Alternate Drug.

• lonafarnib

  lonafarnib will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Lonafarnib may increase the AUC and peak concentration of CYP2C19 substrates. If coadministration unavoidable, monitor for adverse reactions and reduce the CYP2C19 substrate dose in accordance with its approved product labeling.

• lopinavir

  escitalopram increases toxicity of lopinavir by QTc interval. Avoid or Use Alternate Drug.

• lorcaserin

  escitalopram and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• macimorelin

  macimorelin and escitalopram both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.

• maprotiline

  escitalopram and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• mefloquine

  mefloquine increases toxicity of escitalopram by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

• meperidine

  escitalopram and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.
  
  meperidine, escitalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• methadone

  escitalopram increases toxicity of methadone by QTc interval. Avoid or Use Alternate Drug.

• methylene blue

  methylene blue and escitalopram both increase serotonin levels. Avoid or Use Alternate Drug. Methylene blue may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first.

• metoclopramide

  metoclopramide and escitalopram both increase serotonin levels. Avoid or Use Alternate Drug. Additive effects; increased risk for serotonin syndrome, neuroleptic malignant syndrome, dystonia, or other extrapyramidal reactions

• metoclopramide intranasal

  escitalopram, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

• milnacipran

  escitalopram and milnacipran both increase serotonin levels. Avoid or Use Alternate Drug.

• mirtazapine

  mirtazapine and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.

• mobocertinib

  mobocertinib and escitalopram both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.

• morphine

  morphine, escitalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• nefazodone

  escitalopram and nefazodone both increase serotonin levels. Avoid or Use Alternate Drug.
  
  nefazodone will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• netupitant/palonosetron

  netupitant/palonosetron, escitalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• nilotinib

  escitalopram increases toxicity of nilotinib by QTc interval. Avoid or Use Alternate Drug.

• nortriptyline

  escitalopram and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

• ondansetron

  escitalopram and ondansetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.
  
  ondansetron, escitalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• osimertinib

  escitalopram increases toxicity of osimertinib by QTc interval. Avoid or Use Alternate Drug.

• oxaliplatin

  oxaliplatin and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.

• ozanimod

  ozanimod increases toxicity of escitalopram by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.

• paliperidone

  escitalopram increases toxicity of paliperidone by QTc interval. Avoid or Use Alternate Drug.

• palonosetron

  palonosetron, escitalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• panobinostat

  escitalopram and panobinostat both increase QTc interval. Avoid or Use Alternate Drug. Panobinostat is known to significantly prolong QT interval. Panobinostat prescribing information states use with drugs known to prolong QTc is not recommended.

• paroxetine

  escitalopram and paroxetine both increase serotonin levels. Avoid or Use Alternate Drug.

• pazopanib

  escitalopram increases toxicity of pazopanib by QTc interval. Avoid or Use Alternate Drug.

• pentamidine

  escitalopram increases toxicity of pentamidine by QTc interval. Avoid or Use Alternate Drug.

• phentermine

  escitalopram, phentermine. Either increases toxicity of the other by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of serotonin syndrome.

• pimavanserin

  escitalopram increases toxicity of pimavanserin by QTc interval. Avoid or Use Alternate Drug.

• pitolisant

  escitalopram and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.

• procainamide

  escitalopram increases toxicity of procainamide by QTc interval. Avoid or Use Alternate Drug.

• protriptyline

  escitalopram and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

• quetiapine

  escitalopram increases toxicity of quetiapine by QTc interval. Avoid or Use Alternate Drug.

• quinidine

  escitalopram increases toxicity of quinidine by QTc interval. Avoid or Use Alternate Drug.

• rasagiline

  rasagiline and escitalopram both increase serotonin levels. Avoid or Use Alternate Drug. Severe CNS toxicity associated with hyperpyrexia has been reported with the combined treatment of an antidepressant and rasagiline. Avoid combination within 14 days of MAOI use.

• remifentanil

  remifentanil, escitalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• ribociclib

  ribociclib increases toxicity of escitalopram by QTc interval. Avoid or Use Alternate Drug.
  
  escitalopram increases toxicity of ribociclib by QTc interval. Avoid or Use Alternate Drug.

• ropeginterferon alfa 2b

  ropeginterferon alfa 2b, escitalopram. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Myelosuppressive agents can produce additive myelosuppression. Avoid use and monitor patients receiving the combination for effects of excessive myelosuppression.

• saquinavir

  escitalopram increases toxicity of saquinavir by QTc interval. Avoid or Use Alternate Drug.
  
  saquinavir will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• selegiline transdermal

  selegiline transdermal and escitalopram both increase serotonin levels. Avoid or Use Alternate Drug.

• selinexor

  selinexor, escitalopram. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

• sertraline

  escitalopram and sertraline both increase serotonin levels. Avoid or Use Alternate Drug.
  
  escitalopram increases toxicity of sertraline by QTc interval. Avoid or Use Alternate Drug.

• sevoflurane

  sevoflurane and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.

• sorafenib

  escitalopram increases toxicity of sorafenib by QTc interval. Avoid or Use Alternate Drug.

• sotalol

  escitalopram and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

• St John's Wort

  escitalopram and St John's Wort both increase serotonin levels. Avoid or Use Alternate Drug.

• sufentanil

  sufentanil, escitalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• tedizolid

  tedizolid, escitalopram. Either increases effects of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. both increase serotonin levels; increased risk of serotonin syndrome.

• tetrabenazine

  escitalopram increases toxicity of tetrabenazine by QTc interval. Avoid or Use Alternate Drug.

• toremifene

  escitalopram increases toxicity of toremifene by QTc interval. Avoid or Use Alternate Drug.

• trazodone

  escitalopram and trazodone both increase serotonin levels. Avoid or Use Alternate Drug.

• trimipramine

  escitalopram and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• triptorelin

  triptorelin increases toxicity of escitalopram by QTc interval. Avoid or Use Alternate Drug. Increases risk of torsades de pointes.

• tucatinib

  tucatinib will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.

• umeclidinium bromide/vilanterol inhaled

  escitalopram increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• vandetanib

  escitalopram, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.

• vemurafenib

  vemurafenib and escitalopram both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.
  
  escitalopram increases toxicity of vemurafenib by QTc interval. Avoid or Use Alternate Drug.

• venlafaxine

  escitalopram and venlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.

• vilanterol/fluticasone furoate inhaled

  escitalopram increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• vilazodone

  escitalopram, vilazodone. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug. Concomitant therapy should be discontinued immediately if signs or symptoms of serotonin syndrome emerge and supportive symptomatic treatment should be initiated. .

• vortioxetine

  escitalopram, vortioxetine. Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug.

• voxelotor

  voxelotor will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.

Monitor Closely (240)

• 5-HTP

  escitalopram and 5-HTP both increase serotonin levels. Modify Therapy/Monitor Closely.

• aceclofenac

  escitalopram, aceclofenac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• acemetacin

  escitalopram, acemetacin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• albuterol

  albuterol and escitalopram both increase QTc interval. Use Caution/Monitor.

• alfuzosin

  escitalopram and alfuzosin both increase QTc interval. Use Caution/Monitor.
  
  alfuzosin and escitalopram both increase QTc interval. Use Caution/Monitor.

• almotriptan

  almotriptan, escitalopram. Either increases toxicity of the other by serotonin levels. Modify Therapy/Monitor Closely. Exercise caution when concomitantly using agents that enhance serotonin activity. Monitor for the development of serotonin toxicity/serotonin syndrome during such therapy.

• amifampridine

  escitalopram increases toxicity of amifampridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Amifampridine can cause seizures. Coadministration with drugs that lower seizure threshold may increase this risk.

• amobarbital

  amobarbital will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• amoxapine

  escitalopram increases toxicity of amoxapine by QTc interval. Use Caution/Monitor.

• apixaban

  escitalopram increases effects of apixaban by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

• apomorphine

  escitalopram increases toxicity of apomorphine by QTc interval. Use Caution/Monitor.

• arformoterol

  escitalopram increases toxicity of arformoterol by QTc interval. Use Caution/Monitor.

• aripiprazole

  aripiprazole and escitalopram both increase QTc interval. Use Caution/Monitor.

• aspirin

  escitalopram, aspirin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• aspirin rectal

  escitalopram, aspirin rectal. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• aspirin/citric acid/sodium bicarbonate

  escitalopram, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• atazanavir

  atazanavir increases levels of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased risk of serotonin syndrome.

• atomoxetine

  escitalopram increases levels of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  atomoxetine and escitalopram both increase QTc interval. Use Caution/Monitor.

• azithromycin

  azithromycin increases toxicity of escitalopram by QTc interval. Use Caution/Monitor.

• bedaquiline

  escitalopram and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely

• belzutifan

  belzutifan will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information.

• benzhydrocodone/acetaminophen

  benzhydrocodone/acetaminophen, escitalopram. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

• betrixaban

  escitalopram, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

• buprenorphine subdermal implant

  escitalopram, buprenorphine subdermal implant. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.

• buprenorphine, long-acting injection

  escitalopram, buprenorphine, long-acting injection. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.

• butabarbital

  butabarbital will decrease the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

• butalbital

  butalbital will decrease the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

• cannabidiol

  cannabidiol will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider reducing the dose of sensitive CYP2C19 substrates, as clinically appropriate, when coadministered with cannabidiol.

• carbamazepine

  carbamazepine will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• celecoxib

  escitalopram, celecoxib. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• cenobamate

  cenobamate will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.
  
  cenobamate will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.
  
  cenobamate, escitalopram. Either increases effects of the other by sedation. Use Caution/Monitor.

• chloramphenicol

  chloramphenicol will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• chloroquine

  chloroquine increases toxicity of escitalopram by QTc interval. Use Caution/Monitor.

• choline magnesium trisalicylate

  escitalopram, choline magnesium trisalicylate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• ciprofloxacin

  escitalopram increases toxicity of ciprofloxacin by QTc interval. Use Caution/Monitor.

• clofazimine

  escitalopram increases toxicity of clofazimine by QTc interval. Modify Therapy/Monitor Closely.

• clomipramine

  escitalopram increases toxicity of clomipramine by QTc interval. Use Caution/Monitor.

• clonidine

  clonidine, escitalopram. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration enhances CNS depressant effects.

• clopidogrel

  escitalopram increases effects of clopidogrel by pharmacodynamic synergism. Use Caution/Monitor. SSRIs affect platelet activation; coadministration of SSRIs with clopidogrel may increase the risk of bleeding.

• clozapine

  escitalopram increases levels of clozapine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Plasma levels of clozapine may be increased, resulting in increased pharmacologic and toxic effects. Adjust clozapine dose as needed when initiating or discontinuing certain SSRIs. .
  
  escitalopram increases toxicity of clozapine by QTc interval. Use Caution/Monitor.

• cobicistat

  cobicistat will increase the level or effect of escitalopram by Other (see comment). Use Caution/Monitor. Carefully titrate dose of the antidepressant to the desired effect, including using the lowest feasible initial or maintenance dose, and monitor its response during coadministration with SSRIs and cobicistat.
  
  cobicistat will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• cocaine

  escitalopram and cocaine both increase serotonin levels. Modify Therapy/Monitor Closely.

• crizotinib

  crizotinib increases levels of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Dose reduction may be needed for coadministered drugs that are predominantly metabolized by CYP3A.
  
  crizotinib and escitalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• cyproheptadine

  cyproheptadine decreases effects of escitalopram by pharmacodynamic antagonism. Use Caution/Monitor. Cyproheptadine may diminish the serotonergic effect of SSRIs.

• dabrafenib

  dabrafenib will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

• daridorexant

  escitalopram and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• dasatinib

  escitalopram increases toxicity of dasatinib by QTc interval. Use Caution/Monitor.

• defibrotide

  defibrotide increases effects of escitalopram by Other (see comment). Use Caution/Monitor. Comment: Defibrotide may enhance effects of platelet inhibitors.

• degarelix

  escitalopram increases toxicity of degarelix by QTc interval. Use Caution/Monitor.

• desipramine

  escitalopram increases toxicity of desipramine by QTc interval. Use Caution/Monitor.

• deutetrabenazine

  escitalopram increases toxicity of deutetrabenazine by QTc interval. Use Caution/Monitor.

• dexfenfluramine

  escitalopram and dexfenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• dexmethylphenidate

  dexmethylphenidate increases effects of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• dextroamphetamine

  escitalopram and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.

• dextroamphetamine transdermal

  escitalopram, dextroamphetamine transdermal. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and concomitant serotonergic drug(s).

• diazepam intranasal

  diazepam intranasal, escitalopram. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.

• dichlorphenamide

  dichlorphenamide, escitalopram. sedation. Use Caution/Monitor.

• diclofenac

  escitalopram, diclofenac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• difelikefalin

  difelikefalin and escitalopram both increase sedation. Use Caution/Monitor.

• diflunisal

  escitalopram, diflunisal. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• dihydroergotamine

  escitalopram and dihydroergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.

• dihydroergotamine intranasal

  escitalopram and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.

• dolasetron

  dolasetron, escitalopram. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Monitor ECG, symptoms of serotonin syndrome especially during initiation/titration.
  
  escitalopram increases toxicity of dolasetron by QTc interval. Use Caution/Monitor.

• donepezil

  donepezil and escitalopram both increase QTc interval. Use Caution/Monitor.

• duloxetine

  duloxetine and escitalopram both increase serotonin levels. Use Caution/Monitor.

• duvelisib

  duvelisib will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration with duvelisib increases AUC of a sensitive CYP3A4 substrate which may increase the risk of toxicities of these drugs. Consider reducing the dose of the sensitive CYP3A4 substrate and monitor for signs of toxicities of the coadministered sensitive CYP3A substrate.

• edoxaban

  escitalopram increases effects of edoxaban by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

• efavirenz

  efavirenz will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
  
  efavirenz will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  efavirenz and escitalopram both increase QTc interval. Use Caution/Monitor.

• elagolix

  elagolix will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak CYP2C19 inhibitor. Caution with sensitive CYP2C19 substrates.
  
  elagolix will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.

• eletriptan

  eletriptan and escitalopram both increase serotonin levels. Modify Therapy/Monitor Closely.

• elvitegravir/cobicistat/emtricitabine/tenofovir DF

  elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

• encorafenib

  encorafenib, escitalopram. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.

• ergotamine

  escitalopram and ergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.

• eslicarbazepine acetate

  eslicarbazepine acetate will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

• esomeprazole

  esomeprazole will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

• etodolac

  escitalopram, etodolac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• etravirine

  etravirine will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
  
  etravirine will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• ezogabine

  ezogabine, escitalopram. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.
  
  escitalopram increases toxicity of ezogabine by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed, particularly when dose titrated to 1200mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.

• fedratinib

  fedratinib will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.
  
  fedratinib will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2C19 substrates as necessary.

• felbamate

  felbamate will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

• fenbufen

  escitalopram, fenbufen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• fenfluramine

  escitalopram and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  fenfluramine, escitalopram. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

• fenoprofen

  escitalopram, fenoprofen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• fexinidazole

  fexinidazole will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

• fingolimod

  fingolimod and escitalopram both increase QTc interval. Use Caution/Monitor.

• fish oil triglycerides

  fish oil triglycerides will increase the level or effect of escitalopram by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

• fluconazole

  fluconazole will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
  
  escitalopram increases toxicity of fluconazole by QTc interval. Use Caution/Monitor.

• fluoxetine

  escitalopram and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.

• fluphenazine

  escitalopram increases toxicity of fluphenazine by QTc interval. Use Caution/Monitor.

• flurbiprofen

  escitalopram, flurbiprofen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• fondaparinux

  escitalopram increases effects of fondaparinux by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

• formoterol

  escitalopram increases toxicity of formoterol by QTc interval. Use Caution/Monitor.

• fosamprenavir

  fosamprenavir increases levels of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. Increased risk of serotonin syndrome.

• fosphenytoin

  fosphenytoin will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• fostemsavir

  escitalopram and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

• frovatriptan

  frovatriptan and escitalopram both increase serotonin levels. Modify Therapy/Monitor Closely.

• gabapentin

  gabapentin, escitalopram. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• gabapentin enacarbil

  gabapentin enacarbil, escitalopram. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• gadobenate

  gadobenate and escitalopram both increase QTc interval. Use Caution/Monitor.

• ganaxolone

  escitalopram and ganaxolone both increase sedation. Use Caution/Monitor.

• gemifloxacin

  escitalopram increases toxicity of gemifloxacin by QTc interval. Use Caution/Monitor.

• gemtuzumab

  escitalopram increases toxicity of gemtuzumab by QTc interval. Use Caution/Monitor.

• granisetron

  granisetron and escitalopram both increase QTc interval. Use Caution/Monitor.

• green tea

  green tea, escitalopram. Other (see comment). Use Caution/Monitor. Comment: Combination may increase risk of bleeding.

• haloperidol

  haloperidol and escitalopram both increase QTc interval. Use Caution/Monitor.
  
  escitalopram increases toxicity of haloperidol by QTc interval. Use Caution/Monitor.

• hydrocodone

  hydrocodone, escitalopram. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

• hydroxyurea

  escitalopram, hydroxyurea. Other (see comment). Use Caution/Monitor. Comment: Combination may increase risk of myelosuppression.

• hydroxyzine

  hydroxyzine and escitalopram both increase QTc interval. Use Caution/Monitor.

• ibrutinib

  ibrutinib will increase the level or effect of escitalopram by anticoagulation. Use Caution/Monitor. Ibrutinib may increase the risk of hemorrhage in patients receiving antiplatelet or anticoagulant therapies and monitor for signs of bleeding.

• ibuprofen

  escitalopram, ibuprofen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• ibuprofen IV

  escitalopram, ibuprofen IV. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• iloperidone

  iloperidone increases levels of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4.

• indacaterol, inhaled

  indacaterol, inhaled, escitalopram. QTc interval. Use Caution/Monitor. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.
  
  escitalopram increases toxicity of indacaterol, inhaled by QTc interval. Use Caution/Monitor.

• indapamide

  escitalopram increases toxicity of indapamide by QTc interval. Use Caution/Monitor.

• indinavir

  indinavir increases levels of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. Increased risk of serotonin syndrome.

• indomethacin

  escitalopram, indomethacin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• ioflupane I 123

  escitalopram decreases effects of ioflupane I 123 by receptor binding competition. Use Caution/Monitor. Drugs that bind to dopamine transporter receptor with high affinity may interfere with the image following ioflupane I 123 administration.

• isoniazid

  isoniazid will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
  
  escitalopram and isoniazid both increase serotonin levels. Modify Therapy/Monitor Closely.

• isradipine

  escitalopram increases toxicity of isradipine by QTc interval. Use Caution/Monitor.

• istradefylline

  istradefylline will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.

• itraconazole

  itraconazole will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  itraconazole and escitalopram both increase QTc interval. Use Caution/Monitor.

• ketoprofen

  escitalopram, ketoprofen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• ketorolac

  escitalopram, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• ketorolac intranasal

  escitalopram, ketorolac intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• L-tryptophan

  escitalopram and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.

• lamotrigine

  lamotrigine increases toxicity of escitalopram by unspecified interaction mechanism. Modify Therapy/Monitor Closely. CNS depressants may increase the toxic effects of selective serotonin reuptake inhibitors; psychomotor impairment may be enhanced.

• lapatinib

  escitalopram increases toxicity of lapatinib by QTc interval. Use Caution/Monitor.

• lasmiditan

  lasmiditan, escitalopram. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.
  
  escitalopram increases effects of lasmiditan by serotonin levels. Use Caution/Monitor. Coadministration may increase risk of serotonin syndrome.

• lemborexant

  lemborexant, escitalopram. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

• lenvatinib

  escitalopram and lenvatinib both increase QTc interval. Use Caution/Monitor. Lenvatinib prescribing information recommends monitoring ECG closely when coadministered with QT prolonging drugs.

• levofloxacin

  escitalopram increases toxicity of levofloxacin by QTc interval. Use Caution/Monitor.

• lisdexamfetamine

  escitalopram, lisdexamfetamine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue along with concomitant serotonergic drug(s).

• lithium

  escitalopram and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  lithium and escitalopram both increase QTc interval. Use Caution/Monitor.

• lofexidine

  escitalopram increases toxicity of lofexidine by QTc interval. Use Caution/Monitor.

• lopinavir

  lopinavir increases levels of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. Increased risk of serotinin syndrome.

• lorlatinib

  lorlatinib will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• lornoxicam

  escitalopram, lornoxicam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• lsd

  escitalopram and lsd both increase serotonin levels. Modify Therapy/Monitor Closely.

• lumacaftor/ivacaftor

  lumacaftor/ivacaftor, escitalopram. affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. In vitro studies suggest that lumacaftor may induce and ivacaftor may inhibit CYP2C19 substrates. .
  
  lumacaftor/ivacaftor will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. A higher dose of escitalopram may be required to obtain desired therapeutic effect. Escitalopram is a CYP3A and CYP2C19 substrate. Lumacaftor/ivacaftor is a strong inducer of CYP3A and has the potential to induce CYP2C19.

• lurasidone

  lurasidone, escitalopram. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

• maprotiline

  escitalopram increases toxicity of maprotiline by QTc interval. Use Caution/Monitor.

• meclofenamate

  escitalopram, meclofenamate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• mefenamic acid

  escitalopram, mefenamic acid. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• mefloquine

  escitalopram increases toxicity of mefloquine by QTc interval. Use Caution/Monitor.

• meloxicam

  escitalopram, meloxicam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• metformin

  escitalopram increases effects of metformin by pharmacodynamic synergism. Use Caution/Monitor.

• midazolam intranasal

  midazolam intranasal, escitalopram. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

• mifepristone

  mifepristone, escitalopram. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
  
  mifepristone will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  escitalopram increases toxicity of mifepristone by QTc interval. Use Caution/Monitor.

• mirtazapine

  escitalopram and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.

• mitotane

  mitotane decreases levels of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.

• modafinil

  modafinil will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely.

• morphine

  escitalopram and morphine both increase serotonin levels. Modify Therapy/Monitor Closely.

• moxifloxacin

  escitalopram and moxifloxacin both increase QTc interval. Modify Therapy/Monitor Closely.
  
  moxifloxacin and escitalopram both increase QTc interval. Modify Therapy/Monitor Closely.

• nabumetone

  escitalopram, nabumetone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• nafcillin

  nafcillin will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• naproxen

  escitalopram, naproxen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• naratriptan

  naratriptan and escitalopram both increase serotonin levels. Modify Therapy/Monitor Closely.

• nelfinavir

  nelfinavir increases levels of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. Increased risk of serotonin syndrome.

• nortriptyline

  escitalopram increases toxicity of nortriptyline by QTc interval. Use Caution/Monitor.

• octreotide

  escitalopram increases toxicity of octreotide by QTc interval. Use Caution/Monitor.

• ofloxacin

  escitalopram increases toxicity of ofloxacin by QTc interval. Use Caution/Monitor.

• olanzapine

  escitalopram increases toxicity of olanzapine by QTc interval. Use Caution/Monitor. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval in rare instances.

• oliceridine

  escitalopram, oliceridine. Either increases toxicity of the other by serotonin levels. Modify Therapy/Monitor Closely.

• olodaterol inhaled

  escitalopram and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. Drugs that prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias

• omeprazole

  omeprazole will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

• osilodrostat

  osilodrostat and escitalopram both increase QTc interval. Use Caution/Monitor.
  
  escitalopram and osilodrostat both increase QTc interval. Use Caution/Monitor. Dose dependent QT prolongation - avoid drugs known to prolong the QT interval

• osimertinib

  osimertinib and escitalopram both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.

• oxaliplatin

  oxaliplatin will increase the level or effect of escitalopram by Other (see comment). Use Caution/Monitor. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval.

• oxaprozin

  escitalopram, oxaprozin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• oxcarbazepine

  oxcarbazepine will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

• oxycodone

  oxycodone increases effects of escitalopram by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Opioids may enhance the serotonergic effects of SSRIs and increase risk for serotonergic syndrome.

• ozanimod

  ozanimod and escitalopram both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.

• parecoxib

  escitalopram, parecoxib. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• pasireotide

  escitalopram and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.

• pentazocine

  escitalopram and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

• pentobarbital

  pentobarbital will decrease the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

• perphenazine

  escitalopram increases toxicity of perphenazine by QTc interval. Use Caution/Monitor.

• phenobarbital

  phenobarbital will decrease the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
  
  phenobarbital will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• phenytoin

  phenytoin will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• piroxicam

  escitalopram, piroxicam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• posaconazole

  escitalopram increases toxicity of posaconazole by QTc interval. Use Caution/Monitor.
  
  posaconazole will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• pregabalin

  pregabalin, escitalopram. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• primaquine

  primaquine and escitalopram both increase QTc interval. Use Caution/Monitor.

• primidone

  primidone will decrease the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
  
  primidone will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• propafenone

  escitalopram increases toxicity of propafenone by QTc interval. Use Caution/Monitor.

• protriptyline

  escitalopram increases toxicity of protriptyline by QTc interval. Use Caution/Monitor.

• quetiapine

  quetiapine, escitalopram. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT.

• quinine

  escitalopram and quinine both increase QTc interval. Use Caution/Monitor.

• ranolazine

  escitalopram increases toxicity of ranolazine by QTc interval. Use Caution/Monitor.

• remimazolam

  remimazolam, escitalopram. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

• ribociclib

  ribociclib will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rifabutin

  rifabutin will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rifampin

  rifampin will decrease the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
  
  rifampin will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rifapentine

  rifapentine will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rilpivirine

  rilpivirine increases toxicity of escitalopram by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsades de Pointes.
  
  escitalopram increases toxicity of rilpivirine by QTc interval. Use Caution/Monitor.

• risperidone

  escitalopram increases toxicity of risperidone by QTc interval. Use Caution/Monitor.

• ritonavir

  ritonavir increases levels of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. Increased risk of serotonin syndrome.

• rivaroxaban

  escitalopram increases effects of rivaroxaban by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• rizatriptan

  rizatriptan and escitalopram both increase serotonin levels. Modify Therapy/Monitor Closely.

• romidepsin

  escitalopram increases toxicity of romidepsin by QTc interval. Use Caution/Monitor.

• safinamide

  escitalopram, safinamide. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Monitor patients for symptoms of serotonin syndrome if SSRIs are coadministered with safinamide.

• salicylates (non-asa)

  escitalopram, salicylates (non-asa). Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• salsalate

  escitalopram, salsalate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• SAMe

  escitalopram and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.

• secobarbital

  secobarbital will decrease the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
  
  secobarbital will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• selpercatinib

  selpercatinib increases toxicity of escitalopram by QTc interval. Use Caution/Monitor.

• serdexmethylphenidate/dexmethylphenidate

  serdexmethylphenidate/dexmethylphenidate increases effects of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• sodium sulfate/?magnesium sulfate/potassium chloride

  sodium sulfate/?magnesium sulfate/potassium chloride increases effects of escitalopram by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using bowel preps together with drugs that lower the seizure threshold.

• sodium sulfate/potassium sulfate/magnesium sulfate

  sodium sulfate/potassium sulfate/magnesium sulfate increases effects of escitalopram by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using bowel preps together with drugs that lower the seizure threshold.

• sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol

  escitalopram, sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

• solifenacin

  escitalopram increases toxicity of solifenacin by QTc interval. Use Caution/Monitor.

• sorafenib

  sorafenib and escitalopram both increase QTc interval. Use Caution/Monitor.

• stiripentol

  stiripentol will decrease the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider reducing the dose of CYP2C19 substrates, if adverse reactions are experienced when administered concomitantly with stiripentol.

• sufentanil SL

  sufentanil SL, escitalopram. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

• sulfasalazine

  escitalopram, sulfasalazine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• sulindac

  escitalopram, sulindac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• sumatriptan

  sumatriptan and escitalopram both increase serotonin levels. Modify Therapy/Monitor Closely.

• sumatriptan intranasal

  sumatriptan intranasal and escitalopram both increase serotonin levels. Modify Therapy/Monitor Closely.

• sunitinib

  escitalopram increases toxicity of sunitinib by QTc interval. Use Caution/Monitor.

• tacrolimus

  escitalopram increases toxicity of tacrolimus by QTc interval. Use Caution/Monitor.

• tapentadol

  escitalopram and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely.

• tazemetostat

  tazemetostat will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• tecovirimat

  tecovirimat will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Tecovirimat is a weak inhibitor of CYP2C8 and CYP2C19. Monitor for adverse effects if coadministered with sensitive substrates of these enzymes.
  
  tecovirimat will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.

• telavancin

  escitalopram increases toxicity of telavancin by QTc interval. Use Caution/Monitor.

• tipranavir

  tipranavir will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• tizanidine

  tizanidine increases toxicity of escitalopram by pharmacodynamic synergism. Use Caution/Monitor. CNS depressants may enhance the psychomotor impairment of escitalopram.

• tolfenamic acid

  escitalopram, tolfenamic acid. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• tolmetin

  escitalopram, tolmetin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• tramadol

  escitalopram and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.

• triclabendazole

  triclabendazole will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. If plasma concentrations of the CYP2C19 substrates are elevated during triclabendazole, recheck plasma concentration of the CYP2C19 substrates after discontinuation of triclabendazole.

• trimipramine

  escitalopram increases toxicity of trimipramine by QTc interval. Use Caution/Monitor.

• valerian

  valerian and escitalopram both increase sedation. Use Caution/Monitor.

• vardenafil

  escitalopram increases toxicity of vardenafil by QTc interval. Use Caution/Monitor.

• voclosporin

  voclosporin, escitalopram. Either increases effects of the other by QTc interval. Use Caution/Monitor.

• vorapaxar

  escitalopram, vorapaxar. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive antiplatelet effect may occur; SSRIs and SNRIs may cause platelet serotonin depletion .

• voriconazole

  voriconazole will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
  
  escitalopram increases toxicity of voriconazole by QTc interval. Use Caution/Monitor.
  
  voriconazole will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• vorinostat

  escitalopram increases toxicity of vorinostat by QTc interval. Use Caution/Monitor.

• warfarin

  escitalopram, warfarin. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Serotonin release by platelets plays an important role in hemostasis. SSRIs and SNRIs may increase anticoagulation effect of warfarin. .

• zanubrutinib

  escitalopram, zanubrutinib. Either increases effects of the other by anticoagulation. Modify Therapy/Monitor Closely. Zanubrutinib-induced cytopenias increases risk of hemorrhage. Coadministration of zanubritinib with antiplatelets or anticoagulants may further increase this risk.

• zolmitriptan

  zolmitriptan and escitalopram both increase serotonin levels. Modify Therapy/Monitor Closely.

Minor (37)

• acebutolol

  escitalopram increases levels of acebutolol by decreasing metabolism. Minor/Significance Unknown.

• almotriptan

  escitalopram, almotriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.

• atenolol

  escitalopram increases levels of atenolol by decreasing metabolism. Minor/Significance Unknown.

• betaxolol

  escitalopram increases levels of betaxolol by decreasing metabolism. Minor/Significance Unknown.

• bisoprolol

  escitalopram increases levels of bisoprolol by decreasing metabolism. Minor/Significance Unknown.

• bortezomib

  bortezomib will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.

• bumetanide

  bumetanide, escitalopram. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible additive hyponatremia.

• carvedilol

  escitalopram increases levels of carvedilol by decreasing metabolism. Minor/Significance Unknown.

• celiprolol

  escitalopram increases levels of celiprolol by decreasing metabolism. Minor/Significance Unknown.

• darunavir

  darunavir will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown. Coadministration with SSRIs, TCAs, or trazodone may require dose titration of antidepressant to desired effect (eg, using the lowest feasible initial or maintenance dose). Monitor for antidepressant response.

• eletriptan

  escitalopram, eletriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.

• esmolol

  escitalopram increases levels of esmolol by decreasing metabolism. Minor/Significance Unknown.

• ethacrynic acid

  ethacrynic acid, escitalopram. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible additive hyponatremia.

• felodipine

  felodipine will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.

• frovatriptan

  escitalopram, frovatriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.

• furosemide

  furosemide, escitalopram. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible additive hyponatremia.

• labetalol

  escitalopram increases levels of labetalol by decreasing metabolism. Minor/Significance Unknown.

• levoketoconazole

  levoketoconazole will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• lithium

  escitalopram, lithium. Mechanism: unknown. Minor/Significance Unknown. Risk of neurotoxicity.

• metoprolol

  escitalopram increases levels of metoprolol by decreasing metabolism. Minor/Significance Unknown.

• nadolol

  escitalopram increases levels of nadolol by decreasing metabolism. Minor/Significance Unknown.

• naratriptan

  escitalopram, naratriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.

• nebivolol

  escitalopram increases levels of nebivolol by decreasing metabolism. Minor/Significance Unknown.

• panax ginseng

  panax ginseng increases effects of escitalopram by pharmacodynamic synergism. Minor/Significance Unknown.

• parecoxib

  parecoxib will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.

• penbutolol

  escitalopram increases levels of penbutolol by decreasing metabolism. Minor/Significance Unknown.

• pindolol

  escitalopram increases levels of pindolol by decreasing metabolism. Minor/Significance Unknown.

• pleurisy root

  pleurisy root decreases effects of escitalopram by unspecified interaction mechanism. Minor/Significance Unknown. Theoretical interaction.

• propranolol

  escitalopram increases levels of propranolol by decreasing metabolism. Minor/Significance Unknown.

• rizatriptan

  escitalopram, rizatriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.

• serdexmethylphenidate/dexmethylphenidate

  serdexmethylphenidate/dexmethylphenidate increases effects of escitalopram by decreasing metabolism. Minor/Significance Unknown.

• sotalol

  escitalopram increases levels of sotalol by decreasing metabolism. Minor/Significance Unknown.

• sumatriptan

  escitalopram, sumatriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.

• sumatriptan intranasal

  escitalopram, sumatriptan intranasal. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.

• timolol

  escitalopram increases levels of timolol by decreasing metabolism. Minor/Significance Unknown.

• torsemide

  torsemide, escitalopram. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible additive hyponatremia.

• zolmitriptan

  escitalopram, zolmitriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.

• 5-HTP

  Monitor Closely (1)escitalopram and 5-HTP both increase serotonin levels. Modify Therapy/Monitor Closely.

• abametapir

  Serious - Use Alternative (1)abametapir will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir.

• acebutolol

  Minor (1)escitalopram increases levels of acebutolol by decreasing metabolism. Minor/Significance Unknown.

• aceclofenac

  Monitor Closely (1)escitalopram, aceclofenac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• acemetacin

  Monitor Closely (1)escitalopram, acemetacin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• albuterol

  Monitor Closely (1)albuterol and escitalopram both increase QTc interval. Use Caution/Monitor.

• alfentanil

  Serious - Use Alternative (1)alfentanil, escitalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• alfuzosin

  Monitor Closely (2)escitalopram and alfuzosin both increase QTc interval. Use Caution/Monitor.
  
  alfuzosin and escitalopram both increase QTc interval. Use Caution/Monitor.

• almotriptan

  Monitor Closely (1)almotriptan, escitalopram. Either increases toxicity of the other by serotonin levels. Modify Therapy/Monitor Closely. Exercise caution when concomitantly using agents that enhance serotonin activity. Monitor for the development of serotonin toxicity/serotonin syndrome during such therapy.Minor (1)escitalopram, almotriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.

• amifampridine

  Monitor Closely (1)escitalopram increases toxicity of amifampridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Amifampridine can cause seizures. Coadministration with drugs that lower seizure threshold may increase this risk.

• amiodarone

  Serious - Use Alternative (1)escitalopram increases toxicity of amiodarone by QTc interval. Avoid or Use Alternate Drug.

• amisulpride

  Serious - Use Alternative (1)amisulpride and escitalopram both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.

• amitriptyline

  Serious - Use Alternative (2)escitalopram and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
  
  escitalopram increases toxicity of amitriptyline by QTc interval. Avoid or Use Alternate Drug.

• amobarbital

  Monitor Closely (1)amobarbital will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• amoxapine

  Monitor Closely (1)escitalopram increases toxicity of amoxapine by QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)escitalopram and amoxapine both increase serotonin levels. Avoid or Use Alternate Drug.

• apalutamide

  Serious - Use Alternative (2)apalutamide will decrease the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP2C19 inducer, with drugs that are CYP2C19 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered.
  
  apalutamide will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.

• apixaban

  Monitor Closely (1)escitalopram increases effects of apixaban by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

• apomorphine

  Monitor Closely (1)escitalopram increases toxicity of apomorphine by QTc interval. Use Caution/Monitor.

• arformoterol

  Monitor Closely (1)escitalopram increases toxicity of arformoterol by QTc interval. Use Caution/Monitor.

• aripiprazole

  Monitor Closely (1)aripiprazole and escitalopram both increase QTc interval. Use Caution/Monitor.

• arsenic trioxide

  Serious - Use Alternative (1)escitalopram increases toxicity of arsenic trioxide by QTc interval. Avoid or Use Alternate Drug.

• artemether

  Serious - Use Alternative (1)artemether and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.

• artemether/lumefantrine

  Serious - Use Alternative (1)escitalopram increases toxicity of artemether/lumefantrine by QTc interval. Avoid or Use Alternate Drug.

• asenapine

  Serious - Use Alternative (1)escitalopram increases toxicity of asenapine by QTc interval. Avoid or Use Alternate Drug.

• aspirin

  Monitor Closely (1)escitalopram, aspirin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• aspirin rectal

  Monitor Closely (1)escitalopram, aspirin rectal. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• aspirin/citric acid/sodium bicarbonate

  Monitor Closely (1)escitalopram, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• atazanavir

  Monitor Closely (1)atazanavir increases levels of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased risk of serotonin syndrome.

• atenolol

  Minor (1)escitalopram increases levels of atenolol by decreasing metabolism. Minor/Significance Unknown.

• atomoxetine

  Monitor Closely (2)atomoxetine and escitalopram both increase QTc interval. Use Caution/Monitor.
  
  escitalopram increases levels of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• azithromycin

  Monitor Closely (1)azithromycin increases toxicity of escitalopram by QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)escitalopram increases toxicity of azithromycin by QTc interval. Avoid or Use Alternate Drug.

• bedaquiline

  Monitor Closely (1)escitalopram and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely

• belzutifan

  Monitor Closely (1)belzutifan will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information.

• benzhydrocodone/acetaminophen

  Monitor Closely (1)benzhydrocodone/acetaminophen, escitalopram. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

• betaxolol

  Minor (1)escitalopram increases levels of betaxolol by decreasing metabolism. Minor/Significance Unknown.

• betrixaban

  Monitor Closely (1)escitalopram, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

• bisoprolol

  Minor (1)escitalopram increases levels of bisoprolol by decreasing metabolism. Minor/Significance Unknown.

• bortezomib

  Minor (1)bortezomib will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.

• bumetanide

  Minor (1)bumetanide, escitalopram. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible additive hyponatremia.

• buprenorphine subdermal implant

  Monitor Closely (1)escitalopram, buprenorphine subdermal implant. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.

• buprenorphine, long-acting injection

  Monitor Closely (1)escitalopram, buprenorphine, long-acting injection. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.

• bupropion

  Serious - Use Alternative (1)escitalopram increases toxicity of bupropion by unspecified interaction mechanism. Avoid or Use Alternate Drug. May lower seizure threshold; keep bupropion dose as low as possible.

• buspirone

  Serious - Use Alternative (1)escitalopram and buspirone both increase serotonin levels. Avoid or Use Alternate Drug.

• butabarbital

  Monitor Closely (1)butabarbital will decrease the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

• butalbital

  Monitor Closely (1)butalbital will decrease the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

• cannabidiol

  Monitor Closely (1)cannabidiol will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider reducing the dose of sensitive CYP2C19 substrates, as clinically appropriate, when coadministered with cannabidiol.

• carbamazepine

  Monitor Closely (1)carbamazepine will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• carvedilol

  Minor (1)escitalopram increases levels of carvedilol by decreasing metabolism. Minor/Significance Unknown.

• celecoxib

  Monitor Closely (1)escitalopram, celecoxib. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• celiprolol

  Minor (1)escitalopram increases levels of celiprolol by decreasing metabolism. Minor/Significance Unknown.

• cenobamate

  Monitor Closely (3)cenobamate, escitalopram. Either increases effects of the other by sedation. Use Caution/Monitor.
  
  cenobamate will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.
  
  cenobamate will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.

• ceritinib

  Serious - Use Alternative (1)ceritinib and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.

• chloramphenicol

  Monitor Closely (1)chloramphenicol will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• chloroquine

  Monitor Closely (1)chloroquine increases toxicity of escitalopram by QTc interval. Use Caution/Monitor.

• chlorpromazine

  Serious - Use Alternative (1)escitalopram increases toxicity of chlorpromazine by QTc interval. Avoid or Use Alternate Drug.

• choline magnesium trisalicylate

  Monitor Closely (1)escitalopram, choline magnesium trisalicylate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• ciprofloxacin

  Monitor Closely (1)escitalopram increases toxicity of ciprofloxacin by QTc interval. Use Caution/Monitor.

• cisapride

  Contraindicated (1)escitalopram increases toxicity of cisapride by QTc interval. Contraindicated.

• citalopram

  Serious - Use Alternative (1)citalopram and escitalopram both increase serotonin levels. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• clarithromycin

  Serious - Use Alternative (3)clarithromycin, escitalopram. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. To monitor for the prolongation of QT/QTc and/or development of ventricular tachyarrhythmias the labeling recommends monitoring QT interval or ECG.
  
  escitalopram increases toxicity of clarithromycin by QTc interval. Avoid or Use Alternate Drug.
  
  clarithromycin will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• clofazimine

  Monitor Closely (1)escitalopram increases toxicity of clofazimine by QTc interval. Modify Therapy/Monitor Closely.

• clomipramine

  Monitor Closely (1)escitalopram increases toxicity of clomipramine by QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)escitalopram and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• clonidine

  Monitor Closely (1)clonidine, escitalopram. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration enhances CNS depressant effects.

• clopidogrel

  Monitor Closely (1)escitalopram increases effects of clopidogrel by pharmacodynamic synergism. Use Caution/Monitor. SSRIs affect platelet activation; coadministration of SSRIs with clopidogrel may increase the risk of bleeding.

• clozapine

  Monitor Closely (2)escitalopram increases levels of clozapine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Plasma levels of clozapine may be increased, resulting in increased pharmacologic and toxic effects. Adjust clozapine dose as needed when initiating or discontinuing certain SSRIs. .
  
  escitalopram increases toxicity of clozapine by QTc interval. Use Caution/Monitor.

• cobicistat

  Monitor Closely (2)cobicistat will increase the level or effect of escitalopram by Other (see comment). Use Caution/Monitor. Carefully titrate dose of the antidepressant to the desired effect, including using the lowest feasible initial or maintenance dose, and monitor its response during coadministration with SSRIs and cobicistat.
  
  cobicistat will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• cocaine

  Monitor Closely (1)escitalopram and cocaine both increase serotonin levels. Modify Therapy/Monitor Closely.

• crizotinib

  Monitor Closely (2)crizotinib and escitalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.
  
  crizotinib increases levels of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Dose reduction may be needed for coadministered drugs that are predominantly metabolized by CYP3A.Serious - Use Alternative (1)escitalopram increases toxicity of crizotinib by QTc interval. Avoid or Use Alternate Drug.

• cyclobenzaprine

  Serious - Use Alternative (1)escitalopram and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

• cyproheptadine

  Monitor Closely (1)cyproheptadine decreases effects of escitalopram by pharmacodynamic antagonism. Use Caution/Monitor. Cyproheptadine may diminish the serotonergic effect of SSRIs.

• dabrafenib

  Monitor Closely (1)dabrafenib will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

• daridorexant

  Monitor Closely (1)escitalopram and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• darunavir

  Minor (1)darunavir will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown. Coadministration with SSRIs, TCAs, or trazodone may require dose titration of antidepressant to desired effect (eg, using the lowest feasible initial or maintenance dose). Monitor for antidepressant response.

• dasatinib

  Monitor Closely (1)escitalopram increases toxicity of dasatinib by QTc interval. Use Caution/Monitor.

• defibrotide

  Monitor Closely (1)defibrotide increases effects of escitalopram by Other (see comment). Use Caution/Monitor. Comment: Defibrotide may enhance effects of platelet inhibitors.

• degarelix

  Monitor Closely (1)escitalopram increases toxicity of degarelix by QTc interval. Use Caution/Monitor.

• desflurane

  Serious - Use Alternative (1)desflurane and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.

• desipramine

  Monitor Closely (1)escitalopram increases toxicity of desipramine by QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)escitalopram and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• desvenlafaxine

  Serious - Use Alternative (1)escitalopram and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.

• deutetrabenazine

  Monitor Closely (1)escitalopram increases toxicity of deutetrabenazine by QTc interval. Use Caution/Monitor.

• dexfenfluramine

  Monitor Closely (1)escitalopram and dexfenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• dexmethylphenidate

  Monitor Closely (1)dexmethylphenidate increases effects of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• dextroamphetamine

  Monitor Closely (1)escitalopram and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.

• dextroamphetamine transdermal

  Monitor Closely (1)escitalopram, dextroamphetamine transdermal. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and concomitant serotonergic drug(s).

• dextromethorphan

  Serious - Use Alternative (1)escitalopram and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.

• diazepam intranasal

  Monitor Closely (1)diazepam intranasal, escitalopram. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.

• dichlorphenamide

  Monitor Closely (1)dichlorphenamide, escitalopram. sedation. Use Caution/Monitor.

• diclofenac

  Monitor Closely (1)escitalopram, diclofenac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• difelikefalin

  Monitor Closely (1)difelikefalin and escitalopram both increase sedation. Use Caution/Monitor.

• diflunisal

  Monitor Closely (1)escitalopram, diflunisal. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• dihydroergotamine

  Monitor Closely (1)escitalopram and dihydroergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.

• dihydroergotamine intranasal

  Monitor Closely (1)escitalopram and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.

• disopyramide

  Serious - Use Alternative (1)escitalopram increases toxicity of disopyramide by QTc interval. Avoid or Use Alternate Drug.

• dofetilide

  Serious - Use Alternative (2)dofetilide increases toxicity of escitalopram by QTc interval. Avoid or Use Alternate Drug.
  
  escitalopram increases toxicity of dofetilide by QTc interval. Avoid or Use Alternate Drug.

• dolasetron

  Monitor Closely (2)dolasetron, escitalopram. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Monitor ECG, symptoms of serotonin syndrome especially during initiation/titration.
  
  escitalopram increases toxicity of dolasetron by QTc interval. Use Caution/Monitor.

• donepezil

  Monitor Closely (1)donepezil and escitalopram both increase QTc interval. Use Caution/Monitor.

• dosulepin

  Serious - Use Alternative (1)escitalopram and dosulepin both increase serotonin levels. Avoid or Use Alternate Drug.

• doxepin

  Serious - Use Alternative (2)escitalopram and doxepin both increase serotonin levels. Avoid or Use Alternate Drug.
  
  doxepin and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.

• dronedarone

  Contraindicated (1)escitalopram increases toxicity of dronedarone by QTc interval. Contraindicated.

• droperidol

  Serious - Use Alternative (1)escitalopram increases toxicity of droperidol by QTc interval. Avoid or Use Alternate Drug.

• duloxetine

  Monitor Closely (1)duloxetine and escitalopram both increase serotonin levels. Use Caution/Monitor.

• duvelisib

  Monitor Closely (1)duvelisib will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration with duvelisib increases AUC of a sensitive CYP3A4 substrate which may increase the risk of toxicities of these drugs. Consider reducing the dose of the sensitive CYP3A4 substrate and monitor for signs of toxicities of the coadministered sensitive CYP3A substrate.

• edoxaban

  Monitor Closely (1)escitalopram increases effects of edoxaban by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

• efavirenz

  Monitor Closely (3)efavirenz will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
  
  efavirenz will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  efavirenz and escitalopram both increase QTc interval. Use Caution/Monitor.

• elagolix

  Monitor Closely (2)elagolix will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak CYP2C19 inhibitor. Caution with sensitive CYP2C19 substrates.
  
  elagolix will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.

• eletriptan

  Monitor Closely (1)eletriptan and escitalopram both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)escitalopram, eletriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.

• elvitegravir/cobicistat/emtricitabine/tenofovir DF

  Monitor Closely (1)elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

• encorafenib

  Monitor Closely (1)encorafenib, escitalopram. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.Serious - Use Alternative (1)escitalopram increases toxicity of encorafenib by QTc interval. Avoid or Use Alternate Drug.

• entrectinib

  Serious - Use Alternative (1)escitalopram and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.

• enzalutamide

  Serious - Use Alternative (1)enzalutamide will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• ergotamine

  Monitor Closely (1)escitalopram and ergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.

• eribulin

  Serious - Use Alternative (1)escitalopram increases toxicity of eribulin by QTc interval. Avoid or Use Alternate Drug.

• erythromycin base

  Serious - Use Alternative (1)escitalopram increases toxicity of erythromycin base by QTc interval. Avoid or Use Alternate Drug.

• erythromycin ethylsuccinate

  Serious - Use Alternative (1)escitalopram increases toxicity of erythromycin ethylsuccinate by QTc interval. Avoid or Use Alternate Drug.

• erythromycin lactobionate

  Serious - Use Alternative (1)escitalopram increases toxicity of erythromycin lactobionate by QTc interval. Avoid or Use Alternate Drug.

• erythromycin stearate

  Serious - Use Alternative (1)escitalopram increases toxicity of erythromycin stearate by QTc interval. Avoid or Use Alternate Drug.

• eslicarbazepine acetate

  Monitor Closely (1)eslicarbazepine acetate will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

• esmolol

  Minor (1)escitalopram increases levels of esmolol by decreasing metabolism. Minor/Significance Unknown.

• esomeprazole

  Monitor Closely (1)esomeprazole will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

• ethacrynic acid

  Minor (1)ethacrynic acid, escitalopram. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible additive hyponatremia.

• etodolac

  Monitor Closely (1)escitalopram, etodolac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• etravirine

  Monitor Closely (2)etravirine will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
  
  etravirine will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• ezogabine

  Monitor Closely (2)escitalopram increases toxicity of ezogabine by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed, particularly when dose titrated to 1200mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.
  
  ezogabine, escitalopram. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.

• fedratinib

  Monitor Closely (2)fedratinib will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.
  
  fedratinib will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2C19 substrates as necessary.

• felbamate

  Monitor Closely (1)felbamate will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

• felodipine

  Minor (1)felodipine will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.

• fenbufen

  Monitor Closely (1)escitalopram, fenbufen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• fenfluramine

  Monitor Closely (2)fenfluramine, escitalopram. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.
  
  escitalopram and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• fenoprofen

  Monitor Closely (1)escitalopram, fenoprofen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• fentanyl

  Serious - Use Alternative (1)fentanyl, escitalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• fentanyl intranasal

  Serious - Use Alternative (1)fentanyl intranasal, escitalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• fentanyl transdermal

  Serious - Use Alternative (1)fentanyl transdermal, escitalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• fentanyl transmucosal

  Serious - Use Alternative (1)fentanyl transmucosal, escitalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• fexinidazole

  Monitor Closely (1)fexinidazole will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.Serious - Use Alternative (2)fexinidazole and escitalopram both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.
  
  fexinidazole will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.

• fingolimod

  Monitor Closely (1)fingolimod and escitalopram both increase QTc interval. Use Caution/Monitor.

• fish oil triglycerides

  Monitor Closely (1)fish oil triglycerides will increase the level or effect of escitalopram by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

• flecainide

  Serious - Use Alternative (1)escitalopram increases toxicity of flecainide by QTc interval. Avoid or Use Alternate Drug.

• fluconazole

  Monitor Closely (2)fluconazole will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
  
  escitalopram increases toxicity of fluconazole by QTc interval. Use Caution/Monitor.

• fluoxetine

  Monitor Closely (1)escitalopram and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (2)escitalopram and fluoxetine both increase serotonin levels. Avoid or Use Alternate Drug.
  
  fluoxetine will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug.

• fluphenazine

  Monitor Closely (1)escitalopram increases toxicity of fluphenazine by QTc interval. Use Caution/Monitor.

• flurbiprofen

  Monitor Closely (1)escitalopram, flurbiprofen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• fluvoxamine

  Serious - Use Alternative (1)fluvoxamine and escitalopram both increase serotonin levels. Avoid or Use Alternate Drug.

• fondaparinux

  Monitor Closely (1)escitalopram increases effects of fondaparinux by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

• formoterol

  Monitor Closely (1)escitalopram increases toxicity of formoterol by QTc interval. Use Caution/Monitor.

• fosamprenavir

  Monitor Closely (1)fosamprenavir increases levels of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. Increased risk of serotonin syndrome.

• foscarnet

  Serious - Use Alternative (1)escitalopram increases toxicity of foscarnet by QTc interval. Avoid or Use Alternate Drug.

• fosphenytoin

  Monitor Closely (1)fosphenytoin will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• fostemsavir

  Monitor Closely (1)escitalopram and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

• frovatriptan

  Monitor Closely (1)frovatriptan and escitalopram both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)escitalopram, frovatriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.

• furosemide

  Minor (1)furosemide, escitalopram. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible additive hyponatremia.

• gabapentin

  Monitor Closely (1)gabapentin, escitalopram. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• gabapentin enacarbil

  Monitor Closely (1)gabapentin enacarbil, escitalopram. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• gadobenate

  Monitor Closely (1)gadobenate and escitalopram both increase QTc interval. Use Caution/Monitor.

• ganaxolone

  Monitor Closely (1)escitalopram and ganaxolone both increase sedation. Use Caution/Monitor.

• gemifloxacin

  Monitor Closely (1)escitalopram increases toxicity of gemifloxacin by QTc interval. Use Caution/Monitor.

• gemtuzumab

  Monitor Closely (1)escitalopram increases toxicity of gemtuzumab by QTc interval. Use Caution/Monitor.

• gilteritinib

  Serious - Use Alternative (2)gilteritinib will decrease the level or effect of escitalopram by Other (see comment). Avoid or Use Alternate Drug. Coadministration of gilteritinib with drugs that inhibit 5HT2B or sigma nonspecific receptors. Avoid use of these drugs with gilteritinib unless coadministration is necessary.
  
  gilteritinib and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.

• glasdegib

  Serious - Use Alternative (1)escitalopram and glasdegib both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, monitor for increased risk of QTc interval prolongation.

• goserelin

  Contraindicated (1)goserelin increases toxicity of escitalopram by QTc interval. Contraindicated. Increases risk of torsades de pointes.

• granisetron

  Monitor Closely (1)granisetron and escitalopram both increase QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)granisetron, escitalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• green tea

  Monitor Closely (1)green tea, escitalopram. Other (see comment). Use Caution/Monitor. Comment: Combination may increase risk of bleeding.

• haloperidol

  Monitor Closely (2)escitalopram increases toxicity of haloperidol by QTc interval. Use Caution/Monitor.
  
  haloperidol and escitalopram both increase QTc interval. Use Caution/Monitor.

• histrelin

  Serious - Use Alternative (1)histrelin increases toxicity of escitalopram by QTc interval. Avoid or Use Alternate Drug. Increases risk of torsades de pointes.

• hydrocodone

  Monitor Closely (1)hydrocodone, escitalopram. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

• hydromorphone

  Serious - Use Alternative (1)hydromorphone, escitalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• hydroxychloroquine sulfate

  Serious - Use Alternative (2)hydroxychloroquine sulfate and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.
  
  escitalopram increases toxicity of hydroxychloroquine sulfate by QTc interval. Avoid or Use Alternate Drug.

• hydroxyurea

  Monitor Closely (1)escitalopram, hydroxyurea. Other (see comment). Use Caution/Monitor. Comment: Combination may increase risk of myelosuppression.

• hydroxyzine

  Monitor Closely (1)hydroxyzine and escitalopram both increase QTc interval. Use Caution/Monitor.

• ibrutinib

  Monitor Closely (1)ibrutinib will increase the level or effect of escitalopram by anticoagulation. Use Caution/Monitor. Ibrutinib may increase the risk of hemorrhage in patients receiving antiplatelet or anticoagulant therapies and monitor for signs of bleeding.

• ibuprofen

  Monitor Closely (1)escitalopram, ibuprofen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• ibuprofen IV

  Monitor Closely (1)escitalopram, ibuprofen IV. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• ibutilide

  Serious - Use Alternative (1)escitalopram increases toxicity of ibutilide by QTc interval. Avoid or Use Alternate Drug.

• idelalisib

  Serious - Use Alternative (1)idelalisib will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates

• iloperidone

  Monitor Closely (1)iloperidone increases levels of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4.Serious - Use Alternative (1)escitalopram increases toxicity of iloperidone by QTc interval. Avoid or Use Alternate Drug.

• imipramine

  Serious - Use Alternative (1)escitalopram and imipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• indacaterol, inhaled

  Monitor Closely (2)indacaterol, inhaled, escitalopram. QTc interval. Use Caution/Monitor. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.
  
  escitalopram increases toxicity of indacaterol, inhaled by QTc interval. Use Caution/Monitor.

• indapamide

  Monitor Closely (1)escitalopram increases toxicity of indapamide by QTc interval. Use Caution/Monitor.

• indinavir

  Monitor Closely (1)indinavir increases levels of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. Increased risk of serotonin syndrome.

• indomethacin

  Monitor Closely (1)escitalopram, indomethacin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• inotuzumab

  Serious - Use Alternative (1)escitalopram increases toxicity of inotuzumab by QTc interval. Avoid or Use Alternate Drug.

• ioflupane I 123

  Monitor Closely (1)escitalopram decreases effects of ioflupane I 123 by receptor binding competition. Use Caution/Monitor. Drugs that bind to dopamine transporter receptor with high affinity may interfere with the image following ioflupane I 123 administration.

• isocarboxazid

  Contraindicated (1)isocarboxazid and escitalopram both increase serotonin levels. Contraindicated.

• isoflurane

  Serious - Use Alternative (1)isoflurane and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.

• isoniazid

  Monitor Closely (2)isoniazid will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
  
  escitalopram and isoniazid both increase serotonin levels. Modify Therapy/Monitor Closely.

• isradipine

  Monitor Closely (1)escitalopram increases toxicity of isradipine by QTc interval. Use Caution/Monitor.

• istradefylline

  Monitor Closely (1)istradefylline will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.

• itraconazole

  Monitor Closely (2)itraconazole will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  itraconazole and escitalopram both increase QTc interval. Use Caution/Monitor.

• ivosidenib

  Serious - Use Alternative (2)ivosidenib and escitalopram both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.
  
  ivosidenib will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternate therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.

• ketoprofen

  Monitor Closely (1)escitalopram, ketoprofen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• ketorolac

  Monitor Closely (1)escitalopram, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• ketorolac intranasal

  Monitor Closely (1)escitalopram, ketorolac intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• L-tryptophan

  Monitor Closely (1)escitalopram and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.

• labetalol

  Minor (1)escitalopram increases levels of labetalol by decreasing metabolism. Minor/Significance Unknown.

• lamotrigine

  Monitor Closely (1)lamotrigine increases toxicity of escitalopram by unspecified interaction mechanism. Modify Therapy/Monitor Closely. CNS depressants may increase the toxic effects of selective serotonin reuptake inhibitors; psychomotor impairment may be enhanced.

• lapatinib

  Monitor Closely (1)escitalopram increases toxicity of lapatinib by QTc interval. Use Caution/Monitor.

• lasmiditan

  Monitor Closely (2)lasmiditan, escitalopram. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.
  
  escitalopram increases effects of lasmiditan by serotonin levels. Use Caution/Monitor. Coadministration may increase risk of serotonin syndrome.

• lefamulin

  Contraindicated (1)lefamulin will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Lefamulin is contraindicated with CYP3A substrates know to prolong the QT interval.

• lemborexant

  Monitor Closely (1)lemborexant, escitalopram. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

• lenvatinib

  Monitor Closely (1)escitalopram and lenvatinib both increase QTc interval. Use Caution/Monitor. Lenvatinib prescribing information recommends monitoring ECG closely when coadministered with QT prolonging drugs.

• leuprolide

  Contraindicated (1)leuprolide increases toxicity of escitalopram by QTc interval. Contraindicated. Increases risk of torsades de pointes.

• levofloxacin

  Monitor Closely (1)escitalopram increases toxicity of levofloxacin by QTc interval. Use Caution/Monitor.

• levoketoconazole

  Minor (1)levoketoconazole will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• levomilnacipran

  Serious - Use Alternative (1)escitalopram and levomilnacipran both increase serotonin levels. Avoid or Use Alternate Drug.

• linezolid

  Serious - Use Alternative (1)linezolid and escitalopram both increase serotonin levels. Avoid or Use Alternate Drug. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first.

• lisdexamfetamine

  Monitor Closely (1)escitalopram, lisdexamfetamine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue along with concomitant serotonergic drug(s).

• lithium

  Monitor Closely (2)lithium and escitalopram both increase QTc interval. Use Caution/Monitor.
  
  escitalopram and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)escitalopram, lithium. Mechanism: unknown. Minor/Significance Unknown. Risk of neurotoxicity.

• lofepramine

  Serious - Use Alternative (1)escitalopram and lofepramine both increase serotonin levels. Avoid or Use Alternate Drug.

• lofexidine

  Monitor Closely (1)escitalopram increases toxicity of lofexidine by QTc interval. Use Caution/Monitor.

• lonafarnib

  Serious - Use Alternative (1)lonafarnib will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Lonafarnib may increase the AUC and peak concentration of CYP2C19 substrates. If coadministration unavoidable, monitor for adverse reactions and reduce the CYP2C19 substrate dose in accordance with its approved product labeling.

• lopinavir

  Monitor Closely (1)lopinavir increases levels of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. Increased risk of serotinin syndrome.Serious - Use Alternative (1)escitalopram increases toxicity of lopinavir by QTc interval. Avoid or Use Alternate Drug.

• lorcaserin

  Serious - Use Alternative (1)escitalopram and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• lorlatinib

  Monitor Closely (1)lorlatinib will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• lornoxicam

  Monitor Closely (1)escitalopram, lornoxicam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• lsd

  Monitor Closely (1)escitalopram and lsd both increase serotonin levels. Modify Therapy/Monitor Closely.

• lumacaftor/ivacaftor

  Monitor Closely (2)lumacaftor/ivacaftor will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. A higher dose of escitalopram may be required to obtain desired therapeutic effect. Escitalopram is a CYP3A and CYP2C19 substrate. Lumacaftor/ivacaftor is a strong inducer of CYP3A and has the potential to induce CYP2C19.
  
  lumacaftor/ivacaftor, escitalopram. affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. In vitro studies suggest that lumacaftor may induce and ivacaftor may inhibit CYP2C19 substrates. .

• lurasidone

  Monitor Closely (1)lurasidone, escitalopram. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

• macimorelin

  Serious - Use Alternative (1)macimorelin and escitalopram both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.

• maprotiline

  Monitor Closely (1)escitalopram increases toxicity of maprotiline by QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)escitalopram and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• meclofenamate

  Monitor Closely (1)escitalopram, meclofenamate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• mefenamic acid

  Monitor Closely (1)escitalopram, mefenamic acid. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• mefloquine

  Monitor Closely (1)escitalopram increases toxicity of mefloquine by QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)mefloquine increases toxicity of escitalopram by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

• meloxicam

  Monitor Closely (1)escitalopram, meloxicam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• meperidine

  Serious - Use Alternative (2)escitalopram and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.
  
  meperidine, escitalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• metformin

  Monitor Closely (1)escitalopram increases effects of metformin by pharmacodynamic synergism. Use Caution/Monitor.

• methadone

  Serious - Use Alternative (1)escitalopram increases toxicity of methadone by QTc interval. Avoid or Use Alternate Drug.

• methylene blue

  Serious - Use Alternative (1)methylene blue and escitalopram both increase serotonin levels. Avoid or Use Alternate Drug. Methylene blue may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first.

• metoclopramide

  Serious - Use Alternative (1)metoclopramide and escitalopram both increase serotonin levels. Avoid or Use Alternate Drug. Additive effects; increased risk for serotonin syndrome, neuroleptic malignant syndrome, dystonia, or other extrapyramidal reactions

• metoclopramide intranasal

  Serious - Use Alternative (1)escitalopram, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

• metoprolol

  Minor (1)escitalopram increases levels of metoprolol by decreasing metabolism. Minor/Significance Unknown.

• midazolam intranasal

  Monitor Closely (1)midazolam intranasal, escitalopram. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

• mifepristone

  Monitor Closely (3)mifepristone will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  escitalopram increases toxicity of mifepristone by QTc interval. Use Caution/Monitor.
  
  mifepristone, escitalopram. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.

• milnacipran

  Serious - Use Alternative (1)escitalopram and milnacipran both increase serotonin levels. Avoid or Use Alternate Drug.

• mirtazapine

  Monitor Closely (1)escitalopram and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)mirtazapine and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.

• mitotane

  Monitor Closely (1)mitotane decreases levels of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.

• mobocertinib

  Serious - Use Alternative (1)mobocertinib and escitalopram both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.

• modafinil

  Monitor Closely (1)modafinil will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely.

• morphine

  Monitor Closely (1)escitalopram and morphine both increase serotonin levels. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)morphine, escitalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• moxifloxacin

  Monitor Closely (2)escitalopram and moxifloxacin both increase QTc interval. Modify Therapy/Monitor Closely.
  
  moxifloxacin and escitalopram both increase QTc interval. Modify Therapy/Monitor Closely.

• nabumetone

  Monitor Closely (1)escitalopram, nabumetone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• nadolol

  Minor (1)escitalopram increases levels of nadolol by decreasing metabolism. Minor/Significance Unknown.

• nafcillin

  Monitor Closely (1)nafcillin will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• naproxen

  Monitor Closely (1)escitalopram, naproxen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• naratriptan

  Monitor Closely (1)naratriptan and escitalopram both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)escitalopram, naratriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.

• nebivolol

  Minor (1)escitalopram increases levels of nebivolol by decreasing metabolism. Minor/Significance Unknown.

• nefazodone

  Serious - Use Alternative (2)escitalopram and nefazodone both increase serotonin levels. Avoid or Use Alternate Drug.
  
  nefazodone will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• nelfinavir

  Monitor Closely (1)nelfinavir increases levels of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. Increased risk of serotonin syndrome.

• netupitant/palonosetron

  Serious - Use Alternative (1)netupitant/palonosetron, escitalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• nilotinib

  Serious - Use Alternative (1)escitalopram increases toxicity of nilotinib by QTc interval. Avoid or Use Alternate Drug.

• nortriptyline

  Monitor Closely (1)escitalopram increases toxicity of nortriptyline by QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)escitalopram and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

• octreotide

  Monitor Closely (1)escitalopram increases toxicity of octreotide by QTc interval. Use Caution/Monitor.

• ofloxacin

  Monitor Closely (1)escitalopram increases toxicity of ofloxacin by QTc interval. Use Caution/Monitor.

• olanzapine

  Monitor Closely (1)escitalopram increases toxicity of olanzapine by QTc interval. Use Caution/Monitor. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval in rare instances.

• oliceridine

  Monitor Closely (1)escitalopram, oliceridine. Either increases toxicity of the other by serotonin levels. Modify Therapy/Monitor Closely.

• olodaterol inhaled

  Monitor Closely (1)escitalopram and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. Drugs that prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias

• omeprazole

  Monitor Closely (1)omeprazole will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

• ondansetron

  Serious - Use Alternative (2)escitalopram and ondansetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.
  
  ondansetron, escitalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• osilodrostat

  Monitor Closely (2)osilodrostat and escitalopram both increase QTc interval. Use Caution/Monitor.
  
  escitalopram and osilodrostat both increase QTc interval. Use Caution/Monitor. Dose dependent QT prolongation - avoid drugs known to prolong the QT interval

• osimertinib

  Monitor Closely (1)osimertinib and escitalopram both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.Serious - Use Alternative (1)escitalopram increases toxicity of osimertinib by QTc interval. Avoid or Use Alternate Drug.

• oxaliplatin

  Monitor Closely (1)oxaliplatin will increase the level or effect of escitalopram by Other (see comment). Use Caution/Monitor. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval.Serious - Use Alternative (1)oxaliplatin and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.

• oxaprozin

  Monitor Closely (1)escitalopram, oxaprozin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• oxcarbazepine

  Monitor Closely (1)oxcarbazepine will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

• oxycodone

  Monitor Closely (1)oxycodone increases effects of escitalopram by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Opioids may enhance the serotonergic effects of SSRIs and increase risk for serotonergic syndrome.

• ozanimod

  Monitor Closely (1)ozanimod and escitalopram both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.Serious - Use Alternative (1)ozanimod increases toxicity of escitalopram by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.

• paliperidone

  Serious - Use Alternative (1)escitalopram increases toxicity of paliperidone by QTc interval. Avoid or Use Alternate Drug.

• palonosetron

  Serious - Use Alternative (1)palonosetron, escitalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• panax ginseng

  Minor (1)panax ginseng increases effects of escitalopram by pharmacodynamic synergism. Minor/Significance Unknown.

• panobinostat

  Serious - Use Alternative (1)escitalopram and panobinostat both increase QTc interval. Avoid or Use Alternate Drug. Panobinostat is known to significantly prolong QT interval. Panobinostat prescribing information states use with drugs known to prolong QTc is not recommended.

• parecoxib

  Monitor Closely (1)escitalopram, parecoxib. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.Minor (1)parecoxib will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.

• paroxetine

  Serious - Use Alternative (1)escitalopram and paroxetine both increase serotonin levels. Avoid or Use Alternate Drug.

• pasireotide

  Monitor Closely (1)escitalopram and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.

• pazopanib

  Serious - Use Alternative (1)escitalopram increases toxicity of pazopanib by QTc interval. Avoid or Use Alternate Drug.

• penbutolol

  Minor (1)escitalopram increases levels of penbutolol by decreasing metabolism. Minor/Significance Unknown.

• pentamidine

  Serious - Use Alternative (1)escitalopram increases toxicity of pentamidine by QTc interval. Avoid or Use Alternate Drug.

• pentazocine

  Monitor Closely (1)escitalopram and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

• pentobarbital

  Monitor Closely (1)pentobarbital will decrease the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

• perphenazine

  Monitor Closely (1)escitalopram increases toxicity of perphenazine by QTc interval. Use Caution/Monitor.

• phenelzine

  Contraindicated (1)phenelzine and escitalopram both increase serotonin levels. Contraindicated.

• phenobarbital

  Monitor Closely (2)phenobarbital will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  phenobarbital will decrease the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

• phentermine

  Serious - Use Alternative (1)escitalopram, phentermine. Either increases toxicity of the other by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of serotonin syndrome.

• phenytoin

  Monitor Closely (1)phenytoin will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• pimavanserin

  Serious - Use Alternative (1)escitalopram increases toxicity of pimavanserin by QTc interval. Avoid or Use Alternate Drug.

• pimozide

  Contraindicated (1)escitalopram and pimozide both increase QTc interval. Contraindicated.

• pindolol

  Minor (1)escitalopram increases levels of pindolol by decreasing metabolism. Minor/Significance Unknown.

• piroxicam

  Monitor Closely (1)escitalopram, piroxicam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• pitolisant

  Serious - Use Alternative (1)escitalopram and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.

• pleurisy root

  Minor (1)pleurisy root decreases effects of escitalopram by unspecified interaction mechanism. Minor/Significance Unknown. Theoretical interaction.

• posaconazole

  Monitor Closely (2)posaconazole will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  escitalopram increases toxicity of posaconazole by QTc interval. Use Caution/Monitor.

• pregabalin

  Monitor Closely (1)pregabalin, escitalopram. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• primaquine

  Monitor Closely (1)primaquine and escitalopram both increase QTc interval. Use Caution/Monitor.

• primidone

  Monitor Closely (2)primidone will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  primidone will decrease the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

• procainamide

  Serious - Use Alternative (1)escitalopram increases toxicity of procainamide by QTc interval. Avoid or Use Alternate Drug.

• procarbazine

  Contraindicated (1)procarbazine and escitalopram both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

• propafenone

  Monitor Closely (1)escitalopram increases toxicity of propafenone by QTc interval. Use Caution/Monitor.

• propranolol

  Minor (1)escitalopram increases levels of propranolol by decreasing metabolism. Minor/Significance Unknown.

• protriptyline

  Monitor Closely (1)escitalopram increases toxicity of protriptyline by QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)escitalopram and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

• quetiapine

  Monitor Closely (1)quetiapine, escitalopram. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT.Serious - Use Alternative (1)escitalopram increases toxicity of quetiapine by QTc interval. Avoid or Use Alternate Drug.

• quinidine

  Serious - Use Alternative (1)escitalopram increases toxicity of quinidine by QTc interval. Avoid or Use Alternate Drug.

• quinine

  Monitor Closely (1)escitalopram and quinine both increase QTc interval. Use Caution/Monitor.

• ranolazine

  Monitor Closely (1)escitalopram increases toxicity of ranolazine by QTc interval. Use Caution/Monitor.

• rasagiline

  Serious - Use Alternative (1)rasagiline and escitalopram both increase serotonin levels. Avoid or Use Alternate Drug. Severe CNS toxicity associated with hyperpyrexia has been reported with the combined treatment of an antidepressant and rasagiline. Avoid combination within 14 days of MAOI use.

• remifentanil

  Serious - Use Alternative (1)remifentanil, escitalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• remimazolam

  Monitor Closely (1)remimazolam, escitalopram. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

• ribociclib

  Monitor Closely (1)ribociclib will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (2)ribociclib increases toxicity of escitalopram by QTc interval. Avoid or Use Alternate Drug.
  
  escitalopram increases toxicity of ribociclib by QTc interval. Avoid or Use Alternate Drug.

• rifabutin

  Monitor Closely (1)rifabutin will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rifampin

  Monitor Closely (2)rifampin will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  rifampin will decrease the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

• rifapentine

  Monitor Closely (1)rifapentine will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rilpivirine

  Monitor Closely (2)escitalopram increases toxicity of rilpivirine by QTc interval. Use Caution/Monitor.
  
  rilpivirine increases toxicity of escitalopram by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsades de Pointes.

• risperidone

  Monitor Closely (1)escitalopram increases toxicity of risperidone by QTc interval. Use Caution/Monitor.

• ritonavir

  Monitor Closely (1)ritonavir increases levels of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. Increased risk of serotonin syndrome.

• rivaroxaban

  Monitor Closely (1)escitalopram increases effects of rivaroxaban by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• rizatriptan

  Monitor Closely (1)rizatriptan and escitalopram both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)escitalopram, rizatriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.

• romidepsin

  Monitor Closely (1)escitalopram increases toxicity of romidepsin by QTc interval. Use Caution/Monitor.

• ropeginterferon alfa 2b

  Serious - Use Alternative (1)ropeginterferon alfa 2b, escitalopram. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Myelosuppressive agents can produce additive myelosuppression. Avoid use and monitor patients receiving the combination for effects of excessive myelosuppression.

• safinamide

  Monitor Closely (1)escitalopram, safinamide. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Monitor patients for symptoms of serotonin syndrome if SSRIs are coadministered with safinamide.

• salicylates (non-asa)

  Monitor Closely (1)escitalopram, salicylates (non-asa). Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• salsalate

  Monitor Closely (1)escitalopram, salsalate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• SAMe

  Monitor Closely (1)escitalopram and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.

• saquinavir

  Serious - Use Alternative (2)saquinavir will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  escitalopram increases toxicity of saquinavir by QTc interval. Avoid or Use Alternate Drug.

• secobarbital

  Monitor Closely (2)secobarbital will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  secobarbital will decrease the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

• selegiline

  Contraindicated (1)selegiline and escitalopram both increase serotonin levels. Contraindicated. At least 14 days should elapse between discontinuation of selegiline and initiation of treatment with a serotonergic drug.

• selegiline transdermal

  Serious - Use Alternative (1)selegiline transdermal and escitalopram both increase serotonin levels. Avoid or Use Alternate Drug.

• selinexor

  Serious - Use Alternative (1)selinexor, escitalopram. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

• selpercatinib

  Monitor Closely (1)selpercatinib increases toxicity of escitalopram by QTc interval. Use Caution/Monitor.

• serdexmethylphenidate/dexmethylphenidate

  Monitor Closely (1)serdexmethylphenidate/dexmethylphenidate increases effects of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Minor (1)serdexmethylphenidate/dexmethylphenidate increases effects of escitalopram by decreasing metabolism. Minor/Significance Unknown.

• sertraline

  Serious - Use Alternative (2)escitalopram and sertraline both increase serotonin levels. Avoid or Use Alternate Drug.
  
  escitalopram increases toxicity of sertraline by QTc interval. Avoid or Use Alternate Drug.

• sevoflurane

  Serious - Use Alternative (1)sevoflurane and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.

• sodium sulfate/?magnesium sulfate/potassium chloride

  Monitor Closely (1)sodium sulfate/?magnesium sulfate/potassium chloride increases effects of escitalopram by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using bowel preps together with drugs that lower the seizure threshold.

• sodium sulfate/potassium sulfate/magnesium sulfate

  Monitor Closely (1)sodium sulfate/potassium sulfate/magnesium sulfate increases effects of escitalopram by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using bowel preps together with drugs that lower the seizure threshold.

• sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol

  Monitor Closely (1)escitalopram, sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

• solifenacin

  Monitor Closely (1)escitalopram increases toxicity of solifenacin by QTc interval. Use Caution/Monitor.

• sorafenib

  Monitor Closely (1)sorafenib and escitalopram both increase QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)escitalopram increases toxicity of sorafenib by QTc interval. Avoid or Use Alternate Drug.

• sotalol

  Serious - Use Alternative (1)escitalopram and sotalol both increase QTc interval. Avoid or Use Alternate Drug.Minor (1)escitalopram increases levels of sotalol by decreasing metabolism. Minor/Significance Unknown.

• St John's Wort

  Serious - Use Alternative (1)escitalopram and St John's Wort both increase serotonin levels. Avoid or Use Alternate Drug.

• stiripentol

  Monitor Closely (1)stiripentol will decrease the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider reducing the dose of CYP2C19 substrates, if adverse reactions are experienced when administered concomitantly with stiripentol.

• sufentanil

  Serious - Use Alternative (1)sufentanil, escitalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• sufentanil SL

  Monitor Closely (1)sufentanil SL, escitalopram. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

• sulfasalazine

  Monitor Closely (1)escitalopram, sulfasalazine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• sulindac

  Monitor Closely (1)escitalopram, sulindac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• sumatriptan

  Monitor Closely (1)sumatriptan and escitalopram both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)escitalopram, sumatriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.

• sumatriptan intranasal

  Monitor Closely (1)sumatriptan intranasal and escitalopram both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)escitalopram, sumatriptan intranasal. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.

• sunitinib

  Monitor Closely (1)escitalopram increases toxicity of sunitinib by QTc interval. Use Caution/Monitor.

• tacrolimus

  Monitor Closely (1)escitalopram increases toxicity of tacrolimus by QTc interval. Use Caution/Monitor.

• tapentadol

  Monitor Closely (1)escitalopram and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely.

• tazemetostat

  Monitor Closely (1)tazemetostat will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• tecovirimat

  Monitor Closely (2)tecovirimat will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Tecovirimat is a weak inhibitor of CYP2C8 and CYP2C19. Monitor for adverse effects if coadministered with sensitive substrates of these enzymes.
  
  tecovirimat will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.

• tedizolid

  Serious - Use Alternative (1)tedizolid, escitalopram. Either increases effects of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. both increase serotonin levels; increased risk of serotonin syndrome.

• telavancin

  Monitor Closely (1)escitalopram increases toxicity of telavancin by QTc interval. Use Caution/Monitor.

• tetrabenazine

  Serious - Use Alternative (1)escitalopram increases toxicity of tetrabenazine by QTc interval. Avoid or Use Alternate Drug.

• thioridazine

  Contraindicated (1)escitalopram increases toxicity of thioridazine by QTc interval. Contraindicated.

• timolol

  Minor (1)escitalopram increases levels of timolol by decreasing metabolism. Minor/Significance Unknown.

• tipranavir

  Monitor Closely (1)tipranavir will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• tizanidine

  Monitor Closely (1)tizanidine increases toxicity of escitalopram by pharmacodynamic synergism. Use Caution/Monitor. CNS depressants may enhance the psychomotor impairment of escitalopram.

• tolfenamic acid

  Monitor Closely (1)escitalopram, tolfenamic acid. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• tolmetin

  Monitor Closely (1)escitalopram, tolmetin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• toremifene

  Serious - Use Alternative (1)escitalopram increases toxicity of toremifene by QTc interval. Avoid or Use Alternate Drug.

• torsemide

  Minor (1)torsemide, escitalopram. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible additive hyponatremia.

• tramadol

  Monitor Closely (1)escitalopram and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.

• tranylcypromine

  Contraindicated (1)tranylcypromine and escitalopram both increase serotonin levels. Contraindicated.

• trazodone

  Serious - Use Alternative (1)escitalopram and trazodone both increase serotonin levels. Avoid or Use Alternate Drug.

• triclabendazole

  Monitor Closely (1)triclabendazole will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. If plasma concentrations of the CYP2C19 substrates are elevated during triclabendazole, recheck plasma concentration of the CYP2C19 substrates after discontinuation of triclabendazole.

• trimipramine

  Monitor Closely (1)escitalopram increases toxicity of trimipramine by QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)escitalopram and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• triptorelin

  Serious - Use Alternative (1)triptorelin increases toxicity of escitalopram by QTc interval. Avoid or Use Alternate Drug. Increases risk of torsades de pointes.

• tucatinib

  Serious - Use Alternative (1)tucatinib will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.

• umeclidinium bromide/vilanterol inhaled

  Serious - Use Alternative (1)escitalopram increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• valerian

  Monitor Closely (1)valerian and escitalopram both increase sedation. Use Caution/Monitor.

• vandetanib

  Serious - Use Alternative (1)escitalopram, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.

• vardenafil

  Monitor Closely (1)escitalopram increases toxicity of vardenafil by QTc interval. Use Caution/Monitor.

• vemurafenib

  Serious - Use Alternative (2)escitalopram increases toxicity of vemurafenib by QTc interval. Avoid or Use Alternate Drug.
  
  vemurafenib and escitalopram both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.

• venlafaxine

  Serious - Use Alternative (1)escitalopram and venlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.

• vilanterol/fluticasone furoate inhaled

  Serious - Use Alternative (1)escitalopram increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• vilazodone

  Serious - Use Alternative (1)escitalopram, vilazodone. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug. Concomitant therapy should be discontinued immediately if signs or symptoms of serotonin syndrome emerge and supportive symptomatic treatment should be initiated. .

• voclosporin

  Monitor Closely (1)voclosporin, escitalopram. Either increases effects of the other by QTc interval. Use Caution/Monitor.

• vorapaxar

  Monitor Closely (1)escitalopram, vorapaxar. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive antiplatelet effect may occur; SSRIs and SNRIs may cause platelet serotonin depletion .

• voriconazole

  Monitor Closely (3)voriconazole will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
  
  voriconazole will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  escitalopram increases toxicity of voriconazole by QTc interval. Use Caution/Monitor.

• vorinostat

  Monitor Closely (1)escitalopram increases toxicity of vorinostat by QTc interval. Use Caution/Monitor.

• vortioxetine

  Serious - Use Alternative (1)escitalopram, vortioxetine. Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug.

• voxelotor

  Serious - Use Alternative (1)voxelotor will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.

• warfarin

  Monitor Closely (1)escitalopram, warfarin. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Serotonin release by platelets plays an important role in hemostasis. SSRIs and SNRIs may increase anticoagulation effect of warfarin. .

• zanubrutinib

  Monitor Closely (1)escitalopram, zanubrutinib. Either increases effects of the other by anticoagulation. Modify Therapy/Monitor Closely. Zanubrutinib-induced cytopenias increases risk of hemorrhage. Coadministration of zanubritinib with antiplatelets or anticoagulants may further increase this risk.

• ziprasidone

  Contraindicated (2)escitalopram and ziprasidone both increase QTc interval. Contraindicated.
  
  ziprasidone and escitalopram both increase QTc interval. Contraindicated.

• zolmitriptan

  Monitor Closely (1)zolmitriptan and escitalopram both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)escitalopram, zolmitriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.