Can someone take Lexapro (escitalopram) and Strattera (atomoxetine) together?

Lexapro (Escitalopram) and Strattera (Atomoxetine) Combination Safety

Yes, Lexapro (escitalopram) and Strattera (atomoxetine) can be taken together, as there are no significant drug interactions between these medications that would contraindicate their concurrent use. While both medications affect neurotransmitter systems, they primarily target different pathways - escitalopram affects serotonin while atomoxetine targets norepinephrine.

Mechanism of Action and Pharmacology

• Atomoxetine (Strattera) is a selective norepinephrine reuptake inhibitor (SNRI) that primarily inhibits the presynaptic norepinephrine transporter with minimal effect on other neurotransmitters 1, 2
• Escitalopram (Lexapro) is a selective serotonin reuptake inhibitor (SSRI) that specifically targets serotonin reuptake with minimal effect on norepinephrine or dopamine 3, 4
• The different primary mechanisms of action reduce the risk of serious pharmacodynamic interactions 2, 3

Potential Cardiovascular Considerations

• Atomoxetine can cause mild increases in heart rate and blood pressure, though these changes are typically not clinically significant in most patients 1, 5
• Monitoring of cardiovascular parameters is recommended when initiating this combination, particularly during dose adjustments 5
• Patients with pre-existing cardiovascular conditions may require more careful monitoring 5

Metabolism Considerations

• Atomoxetine is primarily metabolized by CYP2D6, resulting in different plasma concentrations in CYP2D6 extensive metabolizers versus poor metabolizers 2
• Escitalopram has less effect on CYP450 isoenzymes compared to many other SSRIs, making it less likely to interfere with atomoxetine metabolism 2, 3
• This pharmacokinetic profile makes escitalopram a relatively safer choice when combining with medications metabolized by CYP450 enzymes 2

Monitoring Recommendations

• Monitor for potential side effects that could be additive:
  • Gastrointestinal disturbances (nausea, decreased appetite) 1
  • Sleep disturbances (somnolence from atomoxetine, insomnia from escitalopram) 1
  • Changes in blood pressure or heart rate 5
• Regular follow-up is recommended, especially during the initial combination period and after any dose adjustments 5

Dosing Considerations

• When initiating combination therapy, consider starting with lower doses of both medications and titrating slowly 1
• For atomoxetine, the usual starting dose is 40 mg daily with titration every 7-14 days up to 80 mg daily (maximum 1.4 mg/kg/day or 100 mg/day) 6
• Monitor closely for side effects during dose adjustments of either medication 1, 5

Important Precautions

• Unlike some other drug combinations with escitalopram, this particular combination does not significantly increase the risk of serotonin syndrome since atomoxetine has minimal effect on serotonin 1, 4
• However, be vigilant for rare adverse events associated with either medication individually:
  • Suicidal ideation (black box warning for atomoxetine) 1
  • Liver injury (rare but reported with atomoxetine) 1
  • Cardiovascular effects (both medications can affect heart rate/blood pressure) 5

This combination is generally considered safe when appropriately prescribed and monitored, with the benefits of treating both conditions often outweighing the potential risks of combined therapy.