Can Escitalopram Cause Vomiting?
Yes, escitalopram can cause vomiting as a side effect, with clinical trials showing a 3% incidence rate in patients with generalized anxiety disorder, which is three times higher than placebo (1%).1
Gastrointestinal Side Effects of Escitalopram
Incidence of Vomiting
- Vomiting is specifically listed as a treatment-emergent adverse reaction in the FDA drug label for escitalopram, occurring in 3% of patients treated for generalized anxiety disorder compared to 1% in placebo-treated patients 1
- Nausea is more common than vomiting, occurring in 15% of patients with major depressive disorder and 18% of patients with generalized anxiety disorder 1
- Gastrointestinal side effects, including nausea and vomiting, are among the most common reasons for discontinuation in escitalopram efficacy studies 1
Timing and Severity
- Gastrointestinal side effects like nausea and vomiting typically occur during initial treatment or dose increases 2
- These side effects are usually transient and often resolve with continued treatment at the same dose 2
- In a 2023 study of escitalopram in functional gastrointestinal disorders, nausea/vomiting was reported in 21.57% of patients, though most side effects were classified as mild 3
Risk Factors and Management
Dose Dependency
- Higher doses of escitalopram are associated with increased incidence of adverse effects 1
- In fixed-dose trials, the overall incidence of adverse events was 66% in 10 mg escitalopram-treated patients (similar to placebo at 61%), but increased to 86% in 20 mg/day escitalopram-treated patients 1
Management Approaches
- For patients experiencing breakthrough nausea or vomiting, clinicians should re-evaluate medications and consider other contributing factors 4
- If vomiting persists and appears to be psychogenic in nature, continuing escitalopram may actually help resolve symptoms over time, as demonstrated in case reports where escitalopram (10-20 mg/day) reduced episodes of psychogenic nausea and vomiting 5
- For intolerable symptoms, a gradual reduction in dose rather than abrupt cessation is recommended to avoid discontinuation symptoms 1
Special Considerations
- Patients with functional gastrointestinal disorders may benefit from escitalopram despite initial side effects like nausea and vomiting 3
- In a meta-analysis comparing antidepressants, escitalopram and sertraline were shown to be the least tolerated antidepressants on the gastrointestinal tract 6
Clinical Recommendations
- Monitor patients starting escitalopram for gastrointestinal side effects, particularly during the first few weeks of treatment 2, 3
- Consider starting at lower doses and titrating slowly to minimize gastrointestinal side effects 2
- If vomiting occurs and is intolerable, evaluate for other potential causes before attributing solely to escitalopram 4
- For persistent vomiting that appears psychogenic in nature, continuing escitalopram at an appropriate dose may actually help resolve symptoms over time 5