Can Lexapro Cause Low Blood Sugars and High Blood Pressure?
Lexapro (escitalopram) does not typically cause hypoglycemia or hypertension as direct adverse effects; in fact, research suggests it may improve glycemic control in diabetic patients, while hypertension is primarily seen only in overdose situations.
Blood Sugar Effects of Lexapro
Evidence for Improved Glycemic Control
- Escitalopram appears to improve blood sugar control in diabetic patients with depression, with studies showing significant reductions in fasting glucose, post-prandial glucose, and HbA1c levels after 12 weeks of treatment 1.
- Animal studies demonstrate that escitalopram ameliorates metabolic derangements in type 2 diabetes, potentially through beneficial effects on glycemic control and reduction of advanced glycation end products 2.
Rare Cases of Hyperglycemia
- While uncommon, isolated case reports document escitalopram-induced hyperglycemia in diabetic patients with previously good glycemic control 3.
- One case described an 83-year-old diabetic woman whose blood glucose values significantly increased 5 days after starting escitalopram, returning to normal only after discontinuation despite increased antidiabetic medication doses 3.
- The mechanism of glucose dysregulation with SSRIs, including escitalopram, remains unclear 3.
Hypoglycemia Risk Assessment
- Escitalopram itself does not cause hypoglycemia based on available evidence 4, 3, 1.
- The FDA label for escitalopram does not list hypoglycemia as an adverse effect 4.
- Any hypoglycemia in diabetic patients on escitalopram would more likely result from their diabetes medications (particularly insulin or sulfonylureas) rather than the antidepressant itself 5.
Blood Pressure Effects of Lexapro
Hypertension in Overdose Only
- Hypertension with escitalopram occurs primarily in overdose situations, not at therapeutic doses 4.
- The FDA label specifically notes that hypertension is "most commonly seen" in overdosage, though hypotension can rarely occur with co-ingestants 4.
- Cardiovascular toxicity in overdose may be delayed and can include QRS and QTc interval prolongation, wide complex tachyarrhythmias, and torsade de pointes 4.
Therapeutic Dose Considerations
- At standard therapeutic doses (10-20 mg daily), escitalopram does not typically cause clinically significant blood pressure changes 4.
- The drug label does not list hypertension as a common adverse effect at therapeutic doses 4.
Clinical Monitoring Recommendations
For Diabetic Patients Starting Escitalopram
- Monitor blood glucose levels more closely during the first 4-6 weeks after initiating escitalopram therapy, particularly in patients with pre-existing diabetes 3, 1.
- Check HbA1c at 12 weeks to assess any impact on long-term glycemic control 1.
- Be aware that while improvement in glycemic control is more common, rare cases of hyperglycemia have occurred 3, 1.
For Patients with Hypertension
- Routine blood pressure monitoring is appropriate but not specifically required due to escitalopram, as therapeutic doses do not typically affect blood pressure 4.
- Be vigilant for other SSRI-related complications such as syndrome of inappropriate antidiuretic hormone (SIADH), which can cause hyponatremia and should be monitored in high-risk patients 6.
Important Caveats
Drug Interactions and Comorbidities
- In patients with both diabetes and depression, escitalopram may be a favorable choice as it appears to positively impact glycemic control while treating depression 1, 2.
- One case report documented mania induction with escitalopram at maximum dose (20 mg), particularly when combined with alprazolam, in a patient with diabetes, hypertension, and ischemic heart disease 7.