From the Guidelines
Combining escitalopram and cannabis (Cannabis indica) is not recommended due to potential interactions and increased risk of side effects. Escitalopram is an antidepressant medication, while cannabis is a psychoactive substance. Using them together can:
- Increase the risk of serotonin syndrome, a potentially dangerous condition.
- Amplify side effects like dizziness, drowsiness, and impaired cognition.
- Potentially reduce the effectiveness of escitalopram.
- Worsen anxiety or mood symptoms in some individuals. If you're prescribed escitalopram, it's crucial to inform your healthcare provider about any cannabis use. They may need to adjust your treatment plan or monitor you more closely. Never start, stop, or change the dose of escitalopram without medical supervision. The interaction occurs because both substances affect neurotransmitter systems in the brain, particularly serotonin. Escitalopram increases serotonin levels, while cannabis can influence various neurotransmitters, potentially leading to unpredictable effects when combined, as noted in a study on the pharmacokinetics and pharmacodynamics of cannabis and cannabinoids 1. Additionally, a clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders highlights the importance of caution when combining serotonergic drugs, such as escitalopram, with other substances that may interact with them 2.
From the Research
Interaction between Escitalopram and Cannabis indica
- The interaction between Escitalopram (Lexapro) and Cannabis indica is complex and involves multiple mechanisms, including pharmacokinetic and pharmacodynamic interactions 3, 4, 5.
- A study found that escitalopram provided no advantage over placebo in either abstinence rates from cannabis or anxiety and depression scores during the withdrawal and abstinent periods 3.
- Another study found that cannabidiol (CBD), a major nonintoxicating constituent of cannabis, significantly inhibited CYP3A4 and CYP2C19-mediated metabolism of citalopram and its stereoisomer escitalopram at physiologically relevant concentrations, suggesting a possible in vivo drug-drug interaction 4.
- The addition of CBD to patients on citalopram or escitalopram significantly increased citalopram plasma concentrations, although it was uncertain whether this also increased selective serotonin reuptake inhibitor-mediated adverse events 4.
- Tetrahydrocannabinol (THC), the primary psychoactive ingredient in cannabis, has potential for drug-drug interactions and adverse drug events due to its conversion by CYP3A4 and CYP2C9, which can be impacted by several common medications 5.
- Escitalopram has been associated with serotonin syndrome, a potentially life-threatening condition, especially when combined with other serotonergic agents 6, 7.
Pharmacokinetic Interactions
- CBD has been shown to inhibit CYP3A4 and CYP2C19-mediated metabolism of citalopram and escitalopram, which may lead to increased plasma concentrations of these medications 4.
- THC is converted by CYP3A4 and CYP2C9, which can be impacted by several common medications, leading to potential drug-drug interactions 5.
Pharmacodynamic Interactions
- The combination of escitalopram and cannabis may lead to increased risk of serotonin syndrome, a potentially life-threatening condition 6, 7.
- THC has broad interactions with drug-metabolizing enzymes and can enhance adverse effects of other medications, including neurological effects, impact on the cardiovascular system, and risk of infection 5.