Can Lexapro Cause Nausea, Vomiting, and Diarrhea?
Yes, escitalopram (Lexapro) commonly causes nausea, diarrhea, and less frequently vomiting, particularly during the first 1-2 weeks of treatment. 1
Frequency of Gastrointestinal Side Effects
According to FDA labeling data, gastrointestinal side effects occur at the following rates in patients taking escitalopram compared to placebo:
- Nausea: 15-18% (versus 7-8% with placebo) 1
- Diarrhea: 8% (versus 5-6% with placebo) 1
- Vomiting: 3% (versus 1% with placebo) 1
Nausea is the most common adverse effect, occurring in more than 10% of escitalopram-treated patients and is the primary reason for treatment discontinuation among all SSRIs. 2, 3
Timing and Clinical Course
- Most gastrointestinal side effects emerge within the first few weeks of treatment, typically within 1-2 weeks. 2, 4
- These symptoms often improve with continued treatment as tolerance develops. 2
- The severity is generally mild to moderate. 3
Dose-Dependent Effects
Higher doses of escitalopram (20 mg/day) are associated with significantly higher rates of gastrointestinal side effects compared to 10 mg/day. 1 Specifically:
- Diarrhea increases from 6% at 10 mg to 14% at 20 mg daily 1
- Nausea rates are consistently elevated across all doses 1
Comparative Tolerability
Among second-generation antidepressants, escitalopram and sertraline are associated with the highest rates of gastrointestinal side effects, being linked to nausea, vomiting, diarrhea, and abdominal pain. 5 However, escitalopram may still be better tolerated overall than sertraline in some patients. 2
Management Strategies
To minimize gastrointestinal side effects:
- Start with a lower dose (5-10 mg) and titrate gradually. 2, 4
- Take the medication with food, which can help reduce nausea. 2
- Reassure patients that symptoms typically improve within the first few weeks. 2, 4
- Monitor closely during the initial 1-2 weeks of treatment. 2
Important Clinical Caveat
If gastrointestinal symptoms appear as part of a constellation including mental status changes, autonomic instability (tachycardia, labile blood pressure, hyperthermia), and neuromuscular symptoms (tremor, rigidity, myoclonus), serotonin syndrome must be ruled out immediately. 2 This is particularly important in patients on multiple serotonergic medications or after recent dose increases. 2