What are the side effects of Escitalopram (Lexapro)?

From the Guidelines

Lexapro (escitalopram) is associated with several common side effects, including gastrointestinal bleeding, hepatotoxicity, hyponatremia, QT prolongation, and sexual effects, as reported in a 2015 study published in the American Family Physician 1.

Common Side Effects

The most frequent side effects of escitalopram include:

• Gastrointestinal bleeding, with an odds ratio of 1.2 to 1.5, especially when used concurrently with antiplatelet or nonsteroidal anti-inflammatory drugs 1
• Hepatotoxicity, affecting 0.5% to 3% of users, typically presenting as asymptomatic mild elevation in transaminase levels within six months of treatment 1
• Hyponatremia, occurring in 0.5% to 12% of older adults, particularly within the first month of treatment 1
• QT prolongation, a dose-dependent effect, which led to a 2012 boxed warning not to exceed doses of citalopram > 40 mg per day or > 20 mg per day in adults older than 60 years 1
• Sexual effects, with a weighted mean incidence of 40% across observational studies, often manifesting within the first week of treatment 1

Serious Side Effects

More severe but rare side effects may include:

• Suicidality, with a slightly increased risk in adults 18 to 24 years of age, but a neutral or protective effect in older adults 1
• Serotonin syndrome, characterized by confusion, rapid heart rate, and high fever
• Severe allergic reactions
• Unusual bleeding
• Seizures It is essential to monitor patients for these side effects, especially when initiating or increasing the dose of escitalopram, and to consult a healthcare provider if any concerns arise.

From the FDA Drug Label

Escitalopram tablets may cause serious side effects, including all of those described in the section entitled “What is the most important information I should know about Escitalopram tablets? ” Common possible side effects in people who take Escitalopram tablets include: • Nausea • Sleepiness • Weakness • Dizziness • Feeling anxious • Trouble sleeping • Sexual problems • Sweating • Shaking • Not feeling hungry • Dry mouth • Constipation • Infection • Yawning Other side effects in children and adolescents include: • increased thirst • abnormal increase in muscle movement or agitation • nose bleed • difficult urination • heavy menstrual periods • possible slowed growth rate and weight change.

The possible side effects of Escitalopram (Lexapro) include:

• Common side effects: nausea, sleepiness, weakness, dizziness, feeling anxious, trouble sleeping, sexual problems, sweating, shaking, not feeling hungry, dry mouth, constipation, infection, yawning
• Side effects in children and adolescents: increased thirst, abnormal increase in muscle movement or agitation, nose bleed, difficult urination, heavy menstrual periods, possible slowed growth rate and weight change 2

From the Research

Side Effects of Escitalopram (Lexapro)

• The tolerability profile of escitalopram is predictable and similar to that of RS-citalopram, with adverse events such as nausea, ejaculatory problems, diarrhea, and insomnia being expected 3.
• However, with the exception of ejaculatory problems and nausea, which is mild and transient, these adverse events were generally no more frequent than with placebo in fully published clinical trials 3.
• Sexual dysfunction with escitalopram treatment appeared to occur to a similar or lower extent to that with paroxetine, to a similar or greater extent to that with the SNRI duloxetine, and to a greater extent than that with the aminoketone bupropion 4.
• Discontinuation symptoms were milder with escitalopram than with paroxetine 5.
• Associated adverse events were generally mild and temporary 5.
• The most common adverse events associated with escitalopram include:
  • Nausea
  • Ejaculatory problems
  • Diarrhea
  • Insomnia
  • Sexual dysfunction

Comparison with Other Antidepressants

• Escitalopram has a low propensity for drug interactions, similar to other SSRIs 3, 6.
• Compared with other antidepressants, escitalopram is generally better tolerated, with a relatively fast onset of action, and may have cost-effectiveness and cost-utility advantages 6.
• Escitalopram is at least as effective in the treatment of depression and anxiety as other SSRIs, as well as venlafaxine, bupropion, and duloxetine 6.