Can Lexapro (Escitalopram) Cause Facial Swelling?
Yes, Lexapro (escitalopram) can cause facial swelling as part of a severe allergic reaction, though this is rare and requires immediate medical attention.
Mechanism and Clinical Presentation
Facial swelling from escitalopram occurs as part of a severe allergic (hypersensitivity) reaction 1. The FDA-approved prescribing information explicitly lists this as a serious side effect requiring emergency evaluation 1.
Key Warning Signs to Recognize
The facial swelling associated with escitalopram typically presents alongside other allergic symptoms 1:
- Swelling of the face, tongue, eyes, or mouth 1
- Difficulty breathing or trouble breathing 1
- Rash, itchy welts (hives), or blisters 1
- May occur with fever or joint pain 1
When to Seek Emergency Care
Call 911 or go to the emergency department immediately if facial swelling develops 1. This represents a potentially life-threatening allergic reaction that requires urgent medical intervention 1. The American Heart Association guidelines confirm that facial and lip swelling are cardinal signs of anaphylaxis requiring emergency response system activation 2.
Clinical Evidence
A documented case report describes a patient who developed tongue swelling along with other symptoms after escitalopram ingestion, with features consistent with an allergic-type reaction 3. While this case had additional dystonic features, it demonstrates that escitalopram can trigger swelling of facial structures 3.
Differential Considerations
Facial swelling can occur from multiple medication classes and conditions 2. However, when it develops after starting or changing the dose of escitalopram, the medication should be considered the likely culprit until proven otherwise 1.
Management Algorithm
- Stop escitalopram immediately if facial swelling develops 1
- Activate emergency medical services (call 911) 1
- Do not restart escitalopram - patients with this reaction are allergic to escitalopram oxalate and should avoid it permanently 1
- Inform the prescribing healthcare provider about the allergic reaction for documentation and alternative treatment planning 1
Critical Pitfall to Avoid
Do not dismiss mild facial swelling as benign - even if symptoms seem minor initially, allergic reactions can progress rapidly to involve the airway, causing life-threatening respiratory compromise 2, 1. The presence of any facial or tongue swelling warrants immediate medical evaluation 2.