What are the common side effects and contraindications of Lexapro (escitalopram)?

Common Side Effects and Contraindications of Lexapro (Escitalopram)

Lexapro (escitalopram) has several common side effects including nausea, sleepiness, weakness, dizziness, anxiety, insomnia, sexual dysfunction, sweating, dry mouth, and constipation, and is contraindicated in patients taking MAOIs, those with QT prolongation, and requires caution in patients with bipolar disorder, liver/kidney problems, or pregnancy. 1

Common Side Effects

Escitalopram, like other SSRIs, has a predictable side effect profile that patients should be aware of before starting treatment:

Frequently Reported Side Effects

• Gastrointestinal effects: Nausea (most common), diarrhea, constipation, dry mouth 1
• Neurological effects: Dizziness, headache, sleepiness/somnolence 1
• Psychiatric effects: Anxiety, insomnia, yawning 1
• Sexual dysfunction: Occurs in approximately 40% of patients 2
• Other common effects:
  • Sweating
  • Weakness/fatigue
  • Loss of appetite 1

Most of these side effects are mild to moderate and often transient, typically resolving within the first few weeks of treatment 3. Nausea, which is one of the most common reasons for discontinuation, is usually mild and temporary 4.

Severe Side Effects

While less common, patients should be monitored for:

• Serotonin syndrome: Characterized by mental status changes, autonomic hyperactivity, and neuromuscular abnormalities 5
• Hyponatremia/SIADH: More common in elderly patients 6
• Increased risk of suicidal thinking: Particularly in young adults aged 18-24 2
• QT interval prolongation: Escitalopram has been associated with QT prolongation 2

Contraindications

Escitalopram is contraindicated in the following situations:

Absolute Contraindications

• Concurrent use of MAOIs: Due to risk of serotonin syndrome 1
• Known hypersensitivity to escitalopram or any component of the formulation 1
• QT prolongation: Use with caution in patients with congenital long QT syndrome or those at high risk 2

Relative Contraindications/Use with Caution

1. Drug Interactions:

   • Triptans (migraine medications)
   • Other serotonergic drugs (SSRIs, SNRIs, triptans, tramadol)
   • St. John's Wort
   • Medications that affect QT interval 1

2. Medical Conditions:

   • Bipolar disorder: Risk of inducing mania 2, 1
   • Seizure disorders: May lower seizure threshold 1
   • Liver impairment: May require dose adjustment 1
   • Kidney problems: May require dose adjustment 1
   • History of bleeding disorders: SSRIs may increase bleeding risk 1
   • Hyponatremia: Risk of worsening 6

3. Special Populations:

   • Pregnancy: Use only if benefits outweigh risks; may cause complications in newborns when used late in pregnancy 1
   • Breastfeeding: Escitalopram passes into breast milk 1
   • Elderly patients: Start with lower doses due to increased risk of side effects, especially hyponatremia 2
   • Children and adolescents: Increased risk of suicidal thinking and behavior 2

Monitoring Recommendations

• Initial period: Close monitoring for suicidal thinking and behavior, especially in patients under 24 years 2
• Regular follow-up: Assessment of side effects and therapeutic response
• Consider dose reduction if side effects are problematic
• Monitor for drug interactions when starting new medications 1

Important Precautions

• Avoid alcohol while taking escitalopram 1
• Do not drive or operate heavy machinery until you know how escitalopram affects you 1
• Do not abruptly discontinue treatment (risk of withdrawal symptoms)
• Be aware of the risk of serotonin syndrome when combining with other serotonergic medications 2

Escitalopram is generally well-tolerated compared to other antidepressants, with a favorable side effect profile that makes it a common first-line choice for depression treatment 7. However, careful consideration of the patient's medical history, current medications, and risk factors is essential before initiating treatment.