Can Lexapro (escitalopram) and hydroxyzine cause nausea?

Can Lexapro and Hydroxyzine Cause Nausea?

Yes, both Lexapro (escitalopram) and hydroxyzine can cause nausea, though the mechanisms and clinical significance differ between these medications.

Lexapro (Escitalopram) and Nausea

Nausea is a well-established adverse effect of escitalopram, occurring as a mild and transient side effect in clinical trials. 1

• Escitalopram, like other SSRIs, can cause nausea as one of the expected adverse events during treatment 1
• The nausea associated with escitalopram is typically mild and transient, meaning it often resolves with continued use 1
• In clinical trials, nausea was one of the few adverse events that occurred more frequently than placebo (along with ejaculatory problems), though other SSRI-related side effects like diarrhea and insomnia were generally no more frequent than placebo 1

Clinical Context

• Interestingly, escitalopram has also been reported as an effective treatment for psychogenic nausea and vomiting in patients with depression or anxiety disorders, suggesting its effects on nausea are complex and context-dependent 2
• SSRIs in general have been linked to neonatal withdrawal symptoms when used during pregnancy, with nausea being among the potential signs 3

Hydroxyzine and Nausea

Hydroxyzine is actually used as an antiemetic agent and is more likely to prevent nausea than cause it.

• Hydroxyzine is specifically mentioned as useful for managing pruritus and has antiemetic properties when administered orally or intramuscularly 3
• A recent study demonstrated that prophylactic hydroxyzine 25 mg significantly reduced postoperative nausea and vomiting incidence (34.8% vs 57.0% without prophylaxis, p=0.002) 4
• Hydroxyzine is classified as a first-generation H1 antihistamine with sedating, anxiolytic, and antiemetic properties 3

Important Caveat

• While hydroxyzine itself is antiemetic, one case report documented neonatal withdrawal symptoms including nausea when the mother received multiple drug therapy including hydroxyzine, though this was in the context of polypharmacy 3
• First-generation antihistamines like hydroxyzine can cause sedation and cognitive decline, particularly in elderly patients, which should be considered when prescribing 3

Clinical Management Recommendations

If nausea develops while taking escitalopram:

• Reassure the patient that nausea is typically mild and transient with SSRIs 1
• Consider starting with lower doses and titrating slowly to minimize initial adverse effects 3
• Monitor for the first 1-2 weeks, as nausea often resolves spontaneously with continued treatment 1

If using hydroxyzine for other indications:

• Hydroxyzine is more likely to help prevent nausea than cause it, making it potentially useful as adjunctive therapy 3, 4
• The antiemetic properties of hydroxyzine may actually be beneficial if the patient is experiencing nausea from other medications 4

Key Pitfall to Avoid

Do not discontinue escitalopram prematurely due to initial nausea, as this side effect is typically self-limiting and the medication may provide significant benefit for the underlying psychiatric condition 1. However, if nausea persists beyond 1-2 weeks or is severe, reassess for other causes and consider alternative SSRI options 3.