Is it safe to start Lexapro (escitalopram) in a 23-year-old female patient with Attention Deficit Hyperactivity Disorder (ADHD) on Adderall (amphetamine and dextroamphetamine) 10mg Extended Release (XR) for anxiety?

From the Guidelines

Starting Lexapro (escitalopram) in a 23-year-old female patient with ADHD who is currently taking Adderall 10mg XR requires caution but can be done safely with proper medical supervision. The combination of these medications carries a small risk of serotonin syndrome, a potentially serious drug interaction. If prescribed, Lexapro should typically be started at a low dose (5-10mg daily) and gradually increased if needed while monitoring for side effects 1. The patient should be informed about potential symptoms of serotonin syndrome including agitation, confusion, rapid heart rate, dilated pupils, muscle rigidity, and fever. Regular follow-up appointments are essential to assess both the effectiveness of the medication for anxiety and to monitor for any adverse effects.

Some key considerations when combining these medications include:

• Monitoring for increased anxiety, insomnia, or appetite changes
• Adjusting the Adderall dose if necessary
• Considering non-stimulant ADHD medications if anxiety is significantly exacerbated by the stimulant
• Informing the patient about the potential risks and benefits of the combination

It's also important to note that the patient's medical history, current medications, and lifestyle should be taken into account when making this decision. The patient's vital signs, including blood pressure and pulse, should be monitored regularly, especially when starting or adjusting medications 1.

Overall, the combination of Lexapro and Adderall can be beneficial for patients with both ADHD and anxiety, but it requires careful monitoring and management to minimize potential risks.

From the FDA Drug Label

The safety and effectiveness of Escitalopram have been established in adolescents (12 to 17 years of age) for the treatment of major depressive disorder [see Clinical Studies (14. 1)]. Although maintenance efficacy in adolescent patients with major depressive disorder has not been systematically evaluated, maintenance efficacy can be extrapolated from adult data along with comparisons of escitalopram pharmacokinetic parameters in adults and adolescent patients 2.7 Use of Escitalopram with Other MAOIs such as Linezolid or Methylene Blue Do not start Escitalopram tablets in a patient who is being treated with linezolid or intravenous methylene blue because there is an increased risk of serotonin syndrome

The patient in question is a 23-year-old female with ADHD on Adderall 10mg XR, and she wishes to start Lexapro (escitalopram) for anxiety. There is no direct information in the provided drug labels that addresses the safety of concomitantly using Adderall and Lexapro. However, it is known that both medications can increase the risk of serotonin syndrome, especially when used with other medications that affect serotonin levels, such as MAOIs.

• Key Considerations:
  • The patient's age and diagnosis of ADHD and anxiety
  • The potential risk of serotonin syndrome when combining medications that affect serotonin levels
  • The lack of direct information in the provided drug labels regarding the concomitant use of Adderall and Lexapro Given the potential risks and the lack of direct information, it is recommended to exercise caution when considering the initiation of Lexapro in this patient. A thorough evaluation of the patient's medical history, current medications, and potential risks and benefits of concomitant therapy should be conducted before making a decision. 2 2 2

From the Research

Safety of Starting Lexapro in a Patient with ADHD on Adderall

• The patient in question is a 23-year-old female with Attention Deficit Hyperactivity Disorder (ADHD) on Adderall (amphetamine and dextroamphetamine) 10mg Extended Release (XR) for anxiety, and wishes to start Lexapro (escitalopram) 3, 4, 5, 6, 7.
• There is a potential risk of serotonin syndrome when combining serotonergic medications, such as Lexapro, with other psychotropic medications, including stimulants like Adderall 3.
• Lexapro (escitalopram) is a selective serotonin reuptake inhibitor (SSRI) that has been shown to be effective in the treatment of anxiety and major depressive disorder in adults 4, 5.
• The risk of serotonin syndrome can be increased when combining SSRIs with other medications that potentiate serotonin, such as amphetamine salts found in Adderall 3.
• However, Lexapro has been shown to have a low propensity for drug interactions and a predictable tolerability profile with generally mild to moderate and transient adverse events 4, 5.
• There have been reported cases of serotonin syndrome associated with the use of escitalopram, although these are rare 6.
• In the treatment of generalized anxiety disorder, SSRIs, such as Lexapro, are considered a first-line treatment option in adults, while in pediatric patients, SSRIs should be considered the first-line pharmacotherapy 7.

Considerations for Starting Lexapro

• Close monitoring for the triad of altered mental status, neuromuscular abnormalities, and autonomic hyperactivity seen in serotonin syndrome is recommended when starting Lexapro in a patient on Adderall 3.
• The patient's medical history, including any previous experiences with SSRIs or other psychotropic medications, should be carefully reviewed before starting Lexapro 4, 5.
• The potential benefits of starting Lexapro should be weighed against the potential risks, including the risk of serotonin syndrome, and alternative treatment options should be considered if necessary 6, 7.