Eslo Drug Interactions

Contra-indicated MAOIs: Cases of serious reactions have been reported in patients receiving an SSRI in combination with a non-selective monoamine oxidase inhibitor (MAOI), and in patients who have recently discontinued SSRI treatment and have been started on MAOI treatment. In some cases, the patient developed serotonin syndrome.
Escitalopram is contra-indicated in combination with non-selective MAOIs. Escitalopram may be started 14 days after discontinuing treatment with an irreversible MAOI and at least one day after discontinuing treatment with the reversible MAOI (RIMA), moclobemide. At least 7 days should elapse after discontinuing Escitalopram treatment, before starting a non-selective MAOI.
Inadvisable combination: Reversible, selective MAO A inhibitor (moclobemide): Due to the risk of serotonin syndrome, the combination of Escitalopram with a MAO A inhibitor is not recommended. If the combination proves necessary, it should be started at the minimum recommended dosage and clinical monitoring is strongly recommended.
Combination requiring precautions for use: Selegiline: In combination with selegiline (irreversible MAO B inhibitor), caution is required due to the risk of developing serotonin syndrome.
Serotonergic medicinal products: Co-administration with serotonergic medicinal products (e.g. tramadol, sumatriptan and other triptans) may lead to serotonin syndrome.
Medicinal product lowering the seizure threshold: SSRIs can lower the seizure threshold. Caution is advised when concomitantly using other medicinal product capable of lowering the seizure threshold (e.g. antidepressants tricyclics, SSRIs) neuroleptics (phenothiazines, thioxanthenes, butyrophenones) mefloquine, bupropion and tramadol).
Lithium, tryptophan: There have been reports of enhanced effects when SSRIs have been given together with lithium or tryptophan, therefore concomitant use of SSRIs with these medicinal products should be undertaken with caution.
St. John's Wort: Concomitant use of SSRIs and herbal remedies containing St. John's Wort (Hypericum perforatum) may result in an increased incidence of adverse reactions.
Haemorrhage: Altered anti-coagulant effects may occur when Escitalopram is combined with oral anticoagulants. Patients receiving oral anticoagulant therapy should receive careful coagulations monitoring when Escitalopram is started or stopped.
Alcohol: No pharmacodynamics or pharmacokinetics interactions are expected between Escitalopram and alcohol. However, as with other psychotropic medicinal products the combination with alcohol is not advisable.
NSAIDs: Concomitant use of non-steroidal anti-inflammatory drugs (NSAIDs) may increase bleeding-tendency.
Pharmacokinetics interactions: Influence of other medicinal products on the pharmacokinetics of Escitalopram: The metabolism of escitalopram is mainly mediated by CYP2C19, CYP3A4 and CYP2D6 may also contribute to the metabolism although to a smaller extent. The metabolism of the major metabolite S DCT (demethylated Escitalopram) seems to be partly catalyzed by CYP2D6.
Co-administration of Escitalopram with omeprazole (a CYP2C19 inhibitor) resulted in moderate (approximately 50%) increase in the plasma concentrations of Escitalopram.
Co-administration of Escitalopram with cimetidine (moderately potent general enzyme-inhibitor) resulted in moderate (approximately 70%) increase in the plasma concentrations of Escitalopram.
Caution should be thus be exercised at the upper end of the dose range of Escitalopram when used concomitantly with CYP2C19 inhibitors (e.g. Omeprazole, fluoxetine, fluvoxamine, lansoprazole, ticlopidine) and with cimetidine.
A reduction in the dose of Escitalopram may be necessary based on clinical judgement.
Effect of Escitalopram on the pharmacokinetics of other medicinal products: Escitalopram is an inhibitor of the enzyme CYP2D6. Caution is recommended when Escitalopram is co-administered with medicinal products are mainly by this enzyme, and that have a narrow therapeutics index, e.g. flecainide, propafenone and metoprolol (when used in cardiac failure), or some CNS acting medicinal products that are mainly metabolized by CYP2D6, e.g. antidepressants such as desipramine, clomipramine and nortriptyline or antipsychotics like risperidone, thioridazine and haloperidol. Dosage adjustments may be warranted.
Co-administered with desipramine or metoprolol resulted in a two-fold increase in the plasma levels of these two CYP2D6 substrates.
Escitalopram may also cause weak inhibition of CYP2C19. Caution is recommended with concomitant use of medicinal products that are metabolized by CYP2C19.