with other medications that may cause dizziness or confusion.selpercatinibMonitor Closely (1)selpercatinib increases toxicity of escitalopram by QTc interval. Use Caution/Monitor.serdexmethylphenidate/dexmethylphenidateMonitor Closely (1)serdexmethylphenidate/dexmethylphenidate increases effects of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Minor (1)serdexmethylphenidate/dexmethylphenidate increases effects of escitalopram by decreasing metabolism. Minor/Significance Unknown.sertralineSerious - Use Alternative (2)escitalopram and sertraline both increase serotonin levels. Avoid or Use Alternate Drug. escitalopram increases toxicity of sertraline by QTc interval. Avoid or Use Alternate Drug.sevofluraneSerious - Use Alternative (1)sevoflurane and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.siponimodSerious - Use Alternative (1)siponimod and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.sodium sulfate/?magnesium sulfate/potassium chlorideMonitor Closely (1)sodium sulfate/?magnesium sulfate/potassium chloride increases effects of escitalopram by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using bowel preps together with drugs that lower the seizure threshold.sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycolMonitor Closely (1)escitalopram, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.sodium sulfate/potassium sulfate/magnesium sulfateMonitor Closely (1)sodium sulfate/potassium sulfate/magnesium sulfate increases effects of escitalopram by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using bowel preps together with drugs that lower the seizure threshold.solifenacinMonitor Closely (1)escitalopram increases toxicity of solifenacin by QTc interval. Use Caution/Monitor.sorafenibMonitor Closely (1)sorafenib and escitalopram both increase QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)escitalopram increases toxicity of sorafenib by QTc interval. Avoid or Use Alternate Drug.sotalolSerious - Use Alternative (1)escitalopram and sotalol both increase QTc interval. Avoid or Use Alternate Drug.Minor (1)escitalopram increases levels of sotalol by decreasing metabolism. Minor/Significance Unknown.sparsentanMonitor Closely (1)sparsentan will decrease the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Sparsentan (a CYP2C19 inducer) decreases exposure of CYP2C19 substrates and reduces efficacy related to these substrates. St John's WortSerious - Use Alternative (1)escitalopram and St John's Wort both increase serotonin levels. Avoid or Use Alternate Drug.stiripentolMonitor Closely (1)stiripentol will decrease the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider reducing the dose of CYP2C19 substrates, if adverse reactions are experienced when administered concomitantly with stiripentol.sufentanilSerious - Use Alternative (1)sufentanil, escitalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.sufentanil SLMonitor Closely (1)sufentanil SL, escitalopram. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.sulfasalazineMonitor Closely (1)escitalopram, sulfasalazine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.sulindacMonitor Closely (1)escitalopram, sulindac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.sumatriptanMonitor Closely (1)sumatriptan and escitalopram both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)escitalopram, sumatriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.sumatriptan intranasalMonitor Closely (1)sumatriptan intranasal and escitalopram both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)escitalopram, sumatriptan intranasal. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.sunitinibMonitor Closely (1)escitalopram increases toxicity of sunitinib by QTc interval. Use Caution/Monitor.tacrolimusMonitor Closely (1)escitalopram increases toxicity of tacrolimus by QTc interval. Use Caution/Monitor.tapentadolMonitor Closely (1)escitalopram and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely.tazemetostatMonitor Closely (1)tazemetostat will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.tecovirimatMonitor Closely (2)tecovirimat will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Tecovirimat is a weak inhibitor of CYP2C8 and CYP2C19. Monitor for adverse effects if coadministered with sensitive substrates of these enzymes. tecovirimat will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.tedizolidSerious - Use Alternative (1)tedizolid, escitalopram. Either increases effects of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. both increase serotonin levels; increased risk of serotonin syndrome.telavancinMonitor Closely (1)escitalopram increases toxicity of telavancin by QTc interval. Use Caution/Monitor.tetrabenazineSerious - Use Alternative (1)escitalopram increases toxicity of tetrabenazine by QTc interval. Avoid or Use Alternate Drug.thioridazineContraindicated (1)escitalopram increases toxicity of thioridazine by QTc interval. Contraindicated.timololMinor (1)escitalopram increases levels of timolol by decreasing metabolism. Minor/Significance Unknown.tipranavirMonitor Closely (1)tipranavir will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.tizanidineMonitor Closely (1)tizanidine increases toxicity of escitalopram by pharmacodynamic synergism. Use Caution/Monitor. CNS depressants may enhance the psychomotor impairment of escitalopram.tolfenamic acidMonitor Closely (1)escitalopram, tolfenamic acid. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.tolmetinMonitor Closely (1)escitalopram, tolmetin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.toremifeneSerious - Use Alternative (1)escitalopram increases toxicity of toremifene by QTc interval. Avoid or Use Alternate Drug.torsemideMinor (1)torsemide, escitalopram. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible additive hyponatremia.tramadolMonitor Closely (1)escitalopram and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.tranylcypromineContraindicated (1)tranylcypromine and escitalopram both increase serotonin levels. Contraindicated.trazodoneSerious - Use Alternative (1)escitalopram and trazodone both increase serotonin levels. Avoid or Use Alternate Drug.triclabendazoleMonitor Closely (1)triclabendazole will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. If plasma concentrations of the CYP2C19 substrates are elevated during triclabendazole, recheck plasma concentration of the CYP2C19 substrates after discontinuation of triclabendazole. trimipramineMonitor Closely (1)escitalopram increases toxicity of trimipramine by QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)escitalopram and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.triptorelinSerious - Use Alternative (1)triptorelin increases toxicity of escitalopram by QTc interval. Avoid or Use Alternate Drug. Increases risk of torsades de pointes.tucatinibSerious - Use Alternative (1)tucatinib will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.umeclidinium bromide/vilanterol inhaledSerious - Use Alternative (1)escitalopram increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.valbenazineMonitor Closely (1)valbenazine and escitalopram both increase QTc interval. Use Caution/Monitor.valerianMonitor Closely (1)valerian and escitalopram both increase sedation. Use Caution/Monitor.vandetanibSerious - Use Alternative (1)escitalopram, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.vardenafilMonitor Closely (1)escitalopram increases toxicity of vardenafil by QTc interval. Use Caution/Monitor.vemurafenibSerious - Use Alternative (2)escitalopram increases toxicity of vemurafenib by QTc interval. Avoid or Use Alternate Drug. vemurafenib and escitalopram both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.venlafaxineSerious - Use Alternative (1)escitalopram and venlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.vilanterol/fluticasone furoate inhaledSerious - Use Alternative (1)escitalopram increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.vilazodoneSerious - Use Alternative (1)escitalopram, vilazodone. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug. Concomitant therapy should be discontinued immediately if signs or symptoms of serotonin syndrome emerge and supportive symptomatic treatment should be initiated. .voclosporinMonitor Closely (1)voclosporin, escitalopram. Either increases effects of the other by QTc interval. Use Caution/Monitor.vorapaxarMonitor Closely (1)escitalopram, vorapaxar. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive antiplatelet effect may occur; SSRIs and SNRIs may cause platelet serotonin depletion .voriconazoleMonitor Closely (3)voriconazole will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. voriconazole will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. escitalopram increases toxicity of voriconazole by QTc interval. Use Caution/Monitor.vorinostatMonitor Closely (1)escitalopram increases toxicity of vorinostat by QTc interval. Use Caution/Monitor.vortioxetineSerious - Use Alternative (1)escitalopram, vortioxetine. Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug.voxelotorSerious - Use Alternative (1)voxelotor will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.warfarinMonitor Closely (1)escitalopram, warfarin. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Serotonin release by platelets plays an important role in hemostasis. SSRIs and SNRIs may increase anticoagulation effect of warfarin. .zanubrutinibMonitor Closely (1)escitalopram, zanubrutinib. Either increases effects of the other by anticoagulation. Modify Therapy/Monitor Closely. Zanubrutinib-induced cytopenias increases risk of hemorrhage. Coadministration of zanubritinib with antiplatelets or anticoagulants may further increase this risk.ziprasidoneContraindicated (2)escitalopram and ziprasidone both increase QTc interval. Contraindicated. ziprasidone and escitalopram both increase QTc interval. Contraindicated.zolmitriptanMonitor Closely (1)zolmitriptan and escitalopram both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)escitalopram, zolmitriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain. >10% Headache (24%) Nausea (15-18%) Insomnia (7-14%) Diarrhea (6-14%) Somnolence (4-13%) Ejaculation disorder (9-12%) 1-10% Xerostomia (4-9%) Constipation (3-6%) Fatigue (2-8%) Dizziness (4-7%) Libido decrease (3-7%) Anorgasmia (2-6%) Indigestion (2-6%) Sweating increased (4-5%) Rhinitis (5%) Flu-like syndrome (5%) Abnormal dreaming (3%) Neck/shoulder pain (3%) Decreased appetite (3%) Vomiting (3%) Sinusitis (3%) Lethargy (3%) Impotence (3%) Menstrual disorder (1-2%) Flatulence (2%) Toothache (2%) Yawning (2%) Abdominal pain (2%) Weight gain (1%) Postmarketing Reports Blood and lymphatic system disorders: Anemia, agranulocytosis, aplastic anemia, hemolytic anemia, idiopathic thrombocytopenia purpura, leukopenia, thrombocytopenia Cardiac disorders: Atrial fibrillation, bradycardia, cardiac failure, myocardial infarction, tachycardia, torsades de pointes, ventricular arrhythmia, ventricular tachycardia Ear and labyrinth disorders: Vertigo Endocrine disorders: Diabetes mellitus, hyperprolactinemia, SIADH Eye disorders: Angle closure glaucoma, diplopia, mydriasis, visual disturbance Gastrointestinal disorder: Dysphagia, gastrointestinal hemorrhage, gastroesophageal reflux, pancreatitis, rectal hemorrhage General disorders and administration site conditions: Abnormal gait, asthenia, edema, fall, feeling abnormal, malaise Hepatobiliary disorders: Fulminant hepatitis, hepatic failure, hepatic necrosis, hepatitis Immune system disorders: Allergic reaction, anaphylaxis Investigations: Bilirubin increased, decreased weight, QT prolongation, hepatic enzymes increased, hypercholesterolemia, INR increased, prothrombin decreased Metabolism and nutrition disorders: Hyperglycemia, hypoglycemia, hypokalemia, hyponatremia Musculoskeletal and connective tissue disorders: Muscle cramp, muscle stiffness, muscle weakness, rhabdomyolysis Nervous system disorders: Akathisia, amnesia, ataxia, choreoathetosis, cerebrovascular accident, dysarthria, dyskinesia, dystonia, extrapyramidal disorders, grand mal seizures (or convulsions), myoclonus, nystagmus, Parkinsonism, restless legs, seizures, syncope, tardive dyskinesia, tremor Pregnancy, puerperium and perinatal conditions: Spontaneous abortion Psychiatric disorders: Acute psychosis, aggression, agitation, anger, anxiety, apathy, completed suicide, confusion, depersonalization, depression aggravated, delirium, delusion, disorientation, feeling unreal, hallucinations (visual and auditory), mood swings, nervousness, nightmare, panic reaction, paranoia, restlessness, self-harm or thoughts of self-harm, suicide attempt, suicidal ideation, suicidal tendency Renal and urinary disorders: Acute renal failure, dysuria, urinary retention Reproductive system and breast disorders: Menorrhagia, priapism Respiratory, thoracic and mediastinal disorders: Dyspnea, epistaxis, pulmonary embolism, pulmonary hypertension of the newborn Skin and SC tissue disorders: Alopecia, angioedema, dermatitis, ecchymosis, erythema multiforme, photosensitivity reaction, Stevens Johnson syndrome, toxic epidermal necrolysis, urticaria Vascular Disorders: Deep vein thrombosis, flushing, hypertensive crisis, hypotension, orthostatic hypotension, phlebitis, thrombosis Pediatric patients ≥2% MDD Back pain Urinary tract infection Vomiting Nasal congestion GAD Dizziness (3%) Nasopharyngitis (3%) Abdominal discomfort (3%) Anxiety (3%) Irritability (2%) Anger (2%) Black Box Warnings Suicidality and antidepressants In short-term studies, antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults (<24 years) taking antidepressants for major depressive disorders and other psychiatric illnesses This increase was not seen in patients >24 years; a slight decrease in suicidal thinking was seen in adults >65 years Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide Monitor patients of all ages initiating antidepressant therapy and closely observe for clinical worsening, suicidality, or unusual changes in behavior Advise families and caregivers of the need for close observation and communication with the prescriber Not approved children aged <12 years Contraindications Hypersensitivity to escitalopram or citalopram Pimozide Monoamine oxidase inhibitors (MAOIs) Use of MAOIs intended to treat