From the Guidelines
Lexapro and Xanax should only be prescribed together under careful medical supervision due to potential increased risk of sedation, dizziness, and cognitive impairment. When considering the combination of these medications, it's crucial to weigh the benefits against the risks, particularly in terms of morbidity, mortality, and quality of life. Lexapro, an SSRI, is typically used for long-term management of depression and anxiety disorders, while Xanax, a benzodiazepine, is used for short-term relief of acute anxiety symptoms 1. The combination might be considered when Xanax is used temporarily to manage severe anxiety symptoms until Lexapro reaches its full therapeutic effect, which can take 2-4 weeks.
Key considerations when prescribing this combination include:
- Starting with low doses of both medications and gradually increasing as needed and tolerated.
- Monitoring for signs of increased sedation, dizziness, and cognitive impairment.
- Avoiding alcohol consumption to prevent exacerbating these side effects.
- Regular follow-up with the healthcare provider to assess the effectiveness of the treatment and potential side effects.
Given the potential for drug interactions, particularly the effect of SSRIs on the metabolism of other drugs by inhibiting cytochrome P450 isoenzymes 1, careful selection and dosing of medications are critical. For instance, fluvoxamine (Luvox), another SSRI, requires caution when used with alprazolam (Xanax) or triazolam due to potential interactions 1. However, escitalopram (Lexapro) and sertraline (Zoloft) are noted for having less effect on the metabolism of other medications compared to other SSRIs 1, which might make them preferable in combination therapies.
The goal of combining Lexapro and Xanax is usually to manage acute anxiety symptoms temporarily until the SSRI becomes effective, at which point the benzodiazepine can be tapered off to minimize the risk of dependence and tolerance associated with long-term benzodiazepine use. Patients should be closely monitored and educated on the potential risks and benefits of this combination therapy, as well as the importance of adhering to the prescribed treatment plan and reporting any concerning side effects promptly.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Lexapro and Xanax
- Lexapro, also known as escitalopram, is a selective serotonin reuptake inhibitor (SSRI) used to treat anxiety disorders and major depressive disorder 2, 3.
- Xanax, also known as alprazolam, is a benzodiazepine used to treat anxiety disorders, but its use is not mentioned in the provided studies.
- A study comparing mindfulness-based stress reduction (MBSR) to escitalopram for the treatment of anxiety disorders found that MBSR was noninferior to escitalopram 4.
- Escitalopram has been shown to be effective in the treatment of major depression and anxiety disorders, with a rapid onset of action and a predictable tolerability profile 2, 3.
- The combination of a selective serotonin reuptake inhibitor (SSRI) and cognitive behavioral therapy (CBT) has been shown to be effective in the treatment of depression and anxiety in youth 5.
Treatment Options
- Escitalopram is an effective first-line option in the management of patients with major depressive disorder and anxiety disorders 2, 3.
- Mindfulness-based stress reduction (MBSR) may be a viable alternative to escitalopram for the treatment of anxiety disorders 4.
- Cognitive behavioral therapy (CBT) combined with an SSRI may be an effective treatment option for depression and anxiety in youth 5.
Safety and Efficacy
- Escitalopram has a predictable tolerability profile with generally mild to moderate and transient adverse events 3.
- The combination of an SSRI and CBT has been shown to be safe and effective in the treatment of depression and anxiety in youth 5.
- MBSR has been shown to be noninferior to escitalopram in the treatment of anxiety disorders, with fewer adverse events 4.