Lexapro Interactions: Alcohol, Medications, and Others

Lexapro (escitalopram) is a prescription drug that’s used to treat depression and anxiety. This drug can interact with other medications, alcohol, and some supplements. For example, Lexapro can interact with venlafaxine (Effexor XR) and apixaban (Eliquis).

Lexapro is used to treat major depressive disorder (depression) in adults and certain children. It’s also used to treat generalized anxiety disorder in adults.

An interaction can occur because one substance causes another substance to have a different effect than expected. Interactions can also occur if you have certain health conditions.

Keep reading to learn about Lexapro’s possible interactions. And for more information about Lexapro, including details about its uses, see this article.

Find answers to some frequently asked questions about Lexapro and possible interactions.

When is the best time to take Lexapro for anxiety if I take other medications to treat my condition?

Whether you take Lexapro for generalized anxiety disorder or depression, you’ll likely take one dose a day. You can take this dose either in the morning or evening.

Before you start Lexapro treatment, tell your doctor if you take other medications to treat your condition. They can determine the best dosage schedule based on the medications you take.

For more details about Lexapro’s dosage, see this article.

How do Lexapro’s interactions compare with those of Zoloft?

Lexapro and sertraline (Zoloft) are both used to treat major depressive disorder (depression). These drugs have many of the same interactions.

For example, both Lexapro and Zoloft interact with:

• nonsteroidal anti-inflammatory drugs such as aspirin and ibuprofen (Advil, Aleve)
• serotonin-norepinephrine reuptake inhibitors such as duloxetine (Cymbalta) and venlafaxine (Effexor XR)
• buspirone
• blood thinners such as warfarin (Jantoven) and clopidogrel (Plavix)
• St. John’s wort

It’s also important to note that Lexapro and Zoloft interact with each other. These drugs are both selective serotonin reuptake inhibitors (SSRIs). Taking more than one SSRI at a time can raise your risk of serotonin syndrome (a condition that can be life threatening in some cases). Because of this risk, doctors usually avoid prescribing Lexapro and Zoloft together.

If you have questions about how Lexapro and Zoloft compare, talk with your doctor or pharmacist. And to learn more about Zoloft’s interactions, see this article.

Certain health conditions or other factors could raise your risk of harm if you take Lexapro. In such cases, your doctor may not prescribe Lexapro for you. These are known as contraindications. The list below includes contraindications of Lexapro.

If you take pimozide. Taking Lexapro with pimozide (an antipsychotic drug) can cause an irregular heart rhythm. Due to this risk, doctors usually do not prescribe Lexapro with pimozide. If you must take pimozide, your doctor will likely recommend a treatment option other than Lexapro.

If you take monoamine oxidase inhibitors (MAOIs). Taking MAOIs with Lexapro can raise your risk of serotonin syndrome. With serotonin syndrome, your level of serotonin gets too high. This can result in serious complications that can be life threatening in some cases.

Due to this risk, you should not take an MAOI within 7 days of stopping Lexapro treatment. You should also avoid taking Lexapro within 14 days of stopping an MAOI.

Examples of MAOIs include:

• linezolid (Zyvox)
• methylene blue (ProvayBlue)
• phenelzine (Nardil)
• selegiline (Emsam)

If you’ve had an allergic reaction. If you have had an allergic reaction to Lexapro or any of its ingredients, your doctor likely won’t prescribe Lexapro. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better options for you.

Before you start taking Lexapro, talk with your doctor if any of the factors above apply to you. Your doctor can determine whether Lexapro is safe for you to take.

There is no known interaction between Lexapro and alcohol. But your doctor may recommend that you avoid alcohol while taking Lexapro. This is because alcohol and Lexapro can cause similar side effects. So combining Lexapro and alcohol can raise your risk of these side effects or make the side effects that you experience worse.

Examples of these side effects include:

• sleepiness
• nausea
• fatigue (low energy)

Also, drinking alcohol may worsen symptoms of certain mental health conditions, including depression.

If you drink alcohol, talk with your doctor about how much (if any) is safe to consume during your Lexapro treatment.

Before you start taking Lexapro, tell your doctor and pharmacist about any prescription, over-the-counter, or other drugs you take. Sharing this information with them may help prevent possible interactions. (To learn whether Lexapro interacts with supplements, herbs, and vitamins, see the “Are there other interactions with Lexapro?” section below.)

If you have questions about drug interactions that may affect you, talk with your doctor or pharmacist.

The table below lists drugs that may interact with Lexapro. Keep in mind that this table does not include all drugs that may interact with Lexapro. For more information about some of these interactions, see the “Drug interactions explained” section below.

Drug group or drug name	Drug examples	What can happen
pimozide	—	can increase the risk of side effects from Lexapro and pimozide
nonsteroidal anti-inflammatory drugs (NSAIDs)	• aspirin • ibuprofen (Advil, Aleve)	can increase the risk of side effects from NSAIDs and Lexapro
monoamine oxidase inhibitors (MAOIs)	• phenelzine (Nardil) • linezolid (Zyvox)	can raise the risk of side effects from Lexapro and the MAOI
serotonin-norepinephrine reuptake inhibitors (SNRIs)	• duloxetine (Cymbalta) • venlafaxine (Effexor XR)	can increase the risk of side effects from Lexapro and the SNRI
other serotonin reuptake inhibitors (SSRIs)	• citalopram (Celexa) • paroxetine (Paxil) • sertraline (Zoloft)	can raise the risk of side effects from Lexapro and the SSRI
other drugs that increase serotonin levels	• triptans, such as sumatriptan (Imitrex) • trazodone • fentanyl • amphetamine/ dextroamphetamine (Adderall)	can increase the risk of side effects from Lexapro and the other drug that increases serotonin
tramadol (ConZip)	—	can increase the risk of side effects from Lexapro and tramadol
buspirone	—	can raise the risk of side effects from Lexapro and buspirone
lithium (Lithobid)	—	can increase the risk of side effects from Lexapro
tricyclic antidepressants (TCAs)	amitriptyline	can raise the risk of side effects from Lexapro and TCAs
cimetidine (Tagamet)	—	can increase the risk of side effects from Lexapro
blood thinners	• warfarin (Jantoven) • clopidogrel (Plavix) • apixaban (Eliquis)	can raise the risk of side effects from Lexapro and the blood thinner
carbamazepine (Tegretol)	—	can make Lexapro less effective
ketoconazole	—	can make ketoconazole less effective
drugs broken down by the enzyme CYP2D6	• desipramine (Norpramin) • aripiprazole (Abilify) • metoprolol (Lopressor, Toprol XL) • atomoxetine (Strattera)	can raise the risk of side effects from the other drug

Learn more about certain drug interactions that can occur with Lexapro.

Interaction with drugs broken down by the enzyme (protein) CYP2D6

Your body uses an enzyme (protein) called CYP2D6 to break down certain drugs. Lexapro can interact with drugs broken down by this enzyme.

Examples of drugs broken down by CYP2D6 include:

• desipramine (Norpramin)
• aripiprazole (Abilify)
• metoprolol (Lopressor, Toprol XL)
• atomoxetine (Strattera)
• propafenone (Rythmol SR)

What could happen

Taking Lexapro with a medication broken down by CYP2D6 can cause the level of the drug broken down by this enzyme to build up in your body. This could raise your risk of side effects.

What you can do

Before starting Lexapro treatment, talk with your doctor about all the medications you take. In some cases, your doctor may lower your dose of a medication broken down by CYP2D6 to reduce your risk of side effects.

Interaction with blood thinners

Medications that help decrease blood clotting are sometimes called blood thinners. Lexapro may interact with these medications.

Examples of blood thinners include:

• warfarin (Jantoven)
• clopidogrel (Plavix)
• apixaban (Eliquis)
• dabigatran (Pradaxa)
• rivaroxaban (Xarelto)

What could happen

Both Lexapro and blood thinners can increase your risk of bleeding. Taking these drugs together can increase this risk even more.

Bleeding due to taking Lexapro with blood thinners can include:

• nosebleeds
• unusual bruising
• stomach bleeding

In some cases, bleeding may be severe or life threatening.

What you can do

If you take blood thinners, talk with your doctor before starting Lexapro treatment. They’ll monitor you for any signs of bleeding when you start taking Lexapro, after any dose changes, and when you stop Lexapro treatment.

If you have symptoms of bleeding while taking Lexapro, let your doctor know right away. These symptoms can include:

• unusual bruising
• blood in your stool
• bleeding gums

If you have these symptoms, your doctor can determine whether Lexapro is safe for you to take.

Lexapro may have other interactions. They could occur with supplements, foods, vaccines, or even lab tests. See below for details. Note that the information below does not include all other possible interactions with Lexapro.

Does Lexapro interact with supplements?

Before you start taking Lexapro, talk with your doctor and pharmacist about any supplements, herbs, and vitamins you take. Sharing this information with them may help you avoid possible interactions.

If you have questions about interactions that may affect you, talk with your doctor or pharmacist.

Lexapro interactions with herbs

Lexapro can interact with the herbal supplements tryptophan and St. John’s wort. Taking these supplements with Lexapro can increase your risk of serotonin syndrome.

With serotonin syndrome, your level of serotonin (a chemical in your body) gets too high. This can result in serious complications that can be life threatening in some cases.

If you take either tryptophan or St. John’s wort, your doctor will likely have you stop taking it during your Lexapro treatment. If you have questions, talk with your doctor.

Lexapro and vitamins

There are currently no reports of Lexapro interacting with vitamins. But this doesn’t mean that vitamin interactions won’t be recognized in the future.

For this reason, it’s still important to check with your doctor or pharmacist before taking any of these products while taking Lexapro.

Does Lexapro interact with food?

It’s possible that Lexapro may interact with grapefruit or grapefruit juice. These products may prevent your body from breaking down Lexapro properly. But more research is needed to determine whether this increases your risk of side effects from Lexapro.

But because of the possible risks, it’s recommended that you avoid grapefruit and grapefruit juice while taking Lexapro.

Does Lexapro interact with vaccines?

Currently, there are no reports of Lexapro interacting with vaccines. Talk with your doctor if you have questions about getting vaccines while you’re taking Lexapro.

Does Lexapro interact with lab tests?

There aren’t any lab tests known to interact with Lexapro. If you’re concerned about having lab tests during your Lexapro treatment, talk with your doctor.

Does Lexapro interact with cannabis or CBD?

There are currently no reports of Lexapro interacting with cannabis (commonly called marijuana) or cannabis products such as cannabidiol (CBD). But as with any drug or supplement, talk with your doctor before using cannabis with Lexapro.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Certain medical conditions or other health factors may raise the risk of interactions with Lexapro. Before taking Lexapro, talk with your doctor about your health history. They’ll determine whether Lexapro is right for you.

Health conditions or other factors that might interact with Lexapro include:

Bipolar disorder or mania. If you have bipolar disorder or mania, taking Lexapro can raise your risk of a manic or mixed episode. Before taking Lexapro, talk with your doctor about any mental health conditions you have. They can determine whether Lexapro is safe for you. If you have bipolar disorder, your doctor may recommend a different medication for your depression.

Low sodium level in your blood. Taking Lexapro can lower your blood sodium level. If you already have a low sodium level, Lexapro may lower it further. Let your doctor know if you’ve had problems your blood sodium level in the past. They’ll likely monitor your level regularly during your Lexapro treatment. In some cases, they may recommend a different treatment option for you.

Bleeding problems. Lexapro can increase your risk of bleeding. If you already have a condition that affects bleeding, such as hemophilia, Lexapro may worsen it. Your doctor can determine whether this drug is right for you.

Glaucoma. If you have a condition called closed-angle glaucoma, taking Lexapro could worsen it. Before starting Lexapro treatment, tell your doctor if you have this condition. They’ll determine whether this drug is safe for you to take.

Liver problems. If you have liver problems, talk with your doctor before taking Lexapro. If your liver isn’t working as well as usual, it may cause the level of the drug to build up in your body. This may increase your risk of side effects from Lexapro. Your doctor may need to prescribe a lower dose of Lexapro if you have liver problems.

Kidney problems. Having kidney problems can cause the level of Lexapro to build up in your body. This can increase your risk of side effects from this drug. If you have kidney problems, talk with your doctor before taking Lexapro. They can determine whether this medication is safe for you to take.

Heart problems. Taking Lexapro can cause an irregular heart rhythm. Your risk of this side effect may be higher if you already have heart problems, such as heart failure. Before starting Lexapro treatment, let your doctor know about any heart conditions you have. They’ll determine whether this medication is safe for you.

Seizures. It’s not known whether it’s safe to take Lexapro if you have a history of seizures. If you have a history of seizures, talk with your doctor. They can determine whether this medication is safe for you to take.

Pregnancy. It’s not known whether it’s safe to take Lexapro during pregnancy. If you’re pregnant or planning a pregnancy, talk with your doctor before taking Lexapro. They can discuss your treatment options.

Breastfeeding. It’s unknown whether Lexapro is safe to take while breastfeeding. The drug passes into breast milk and may cause side effects in a child who is breastfed. These side effects can include excessive sleepiness, restlessness, and trouble feeding. If you’re breastfeeding or planning to do so before starting Lexapro treatment, talk with your doctor about your options.

Allergic reaction. If you’ve had an allergic reaction to Lexapro or any of its ingredients, your doctor will likely not prescribe Lexapro. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better choices for you.

Taking certain steps can help you avoid interactions with Lexapro. Before starting treatment, talk with your doctor and pharmacist. Things to discuss with them include:

• whether you drink alcohol or use cannabis
• other medications you take, as well as any vitamins, supplements, and herbs (your doctor or pharmacist can help you fill out a medication list )
• what to do if you start taking a new drug during your Lexapro treatment

It’s also important to understand Lexapro’s label and other paperwork that may come with the drug. Colored stickers that describe interactions may be on the label. And the paperwork (sometimes called the patient package insert or medication guide) may have other details about interactions. (If you did not get paperwork with Lexapro, ask your pharmacist to print a copy for you.)

If you have trouble reading or understanding this information, your doctor or pharmacist can help.

Taking Lexapro exactly as prescribed can also help prevent interactions.

If you still have questions about Lexapro and its possible interactions, talk with your doctor.

Questions you may want to ask include:

• If I take Lexapro and have certain health conditions, will I be monitored more closely during my treatment?
• Does my risk of interactions depend on my dosage of Lexapro?
• Should I let you know if I make lifestyle changes while taking Lexapro, such as to my diet or exercise routine?

To learn more about Lexapro, see these articles:

• All About Lexapro
• Dosage Details for Lexapro

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Disclaimer: Austra Health has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Last medically reviewed on March 27, 2023