Can Lexapro (escitalopram) cause dizziness and gastrointestinal (GI) upset?

Lexapro (Escitalopram) and Side Effects: Dizziness and GI Upset

Yes, Lexapro (escitalopram) commonly causes both dizziness and gastrointestinal upset as side effects. 1 According to the FDA drug label, dizziness occurs in approximately 5% of patients taking escitalopram, while gastrointestinal side effects including nausea (15-18%), diarrhea (8%), constipation (3-5%), indigestion (3%), abdominal pain (2%), and vomiting (3%) are well-documented adverse reactions.

Common Gastrointestinal Side Effects of Lexapro

• Nausea: Affects 15-18% of patients (compared to 7-8% with placebo) 1
• Diarrhea: Affects 8% of patients (compared to 5-6% with placebo) 1
• Constipation: Affects 3-5% of patients (compared to 1-4% with placebo) 1
• Indigestion/Dyspepsia: Affects 3% of patients (compared to 1-2% with placebo) 1
• Abdominal Pain: Affects 2% of patients (compared to 1% with placebo) 1
• Vomiting: Affects 3% of patients (compared to 1% with placebo) 1

Dizziness with Lexapro

• Occurs in approximately 5% of patients (compared to 3% with placebo) 1
• May be more pronounced during the initial treatment period or with dose increases 1
• Can affect a patient's ability to drive or operate machinery 1

Timing and Management of Side Effects

1. Onset and Duration:

   • Most side effects appear within the first few weeks of treatment
   • Many GI side effects are transient and improve with continued use 2
   • Dizziness may persist in some patients or worsen with dose increases

2. Management Strategies:

   • For nausea and GI upset: Taking medication with food may help reduce symptoms 1
   • For dizziness: Changing the timing of medication (e.g., taking at bedtime) may reduce the impact of dizziness on daily activities
   • Dose adjustment: Starting with a lower dose and gradually increasing may reduce the severity of side effects

Risk Factors for Increased Side Effects

• Age: Older adults (≥65 years) may experience more pronounced side effects due to altered drug metabolism 3
• Polypharmacy: Concurrent use of other medications that cause GI upset or dizziness may exacerbate these side effects 3
• Underlying conditions: Pre-existing GI disorders or vestibular issues may increase susceptibility to these side effects

When to Seek Medical Attention

Patients should contact their healthcare provider if:

• GI symptoms are severe, persistent, or worsening
• Dizziness is severe or associated with fainting
• New symptoms develop that interfere with daily functioning
• There are signs of dehydration from persistent vomiting or diarrhea

Comparative Side Effect Profile

Research indicates that escitalopram has a generally favorable side effect profile compared to some other antidepressants, but GI side effects and dizziness remain among the most common complaints 4, 5. A systematic review and meta-analysis of antidepressant side effects found that escitalopram was associated with higher rates of certain GI side effects compared to some other antidepressants 2.

Conclusion

Dizziness and GI upset are well-established side effects of Lexapro (escitalopram) based on clinical trials and post-marketing data. While these side effects are common, they are typically mild to moderate in severity and often improve with continued treatment. Management strategies include taking the medication with food, adjusting the timing of doses, and in some cases, dose modification under medical supervision.