exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. apalutamide will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.apixabanMonitor Closely (1)escitalopram increases effects of apixaban by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.apomorphineMonitor Closely (1)escitalopram increases toxicity of apomorphine by QTc interval. Use Caution/Monitor.arformoterolMonitor Closely (1)escitalopram increases toxicity of arformoterol by QTc interval. Use Caution/Monitor.aripiprazoleMonitor Closely (1)aripiprazole and escitalopram both increase QTc interval. Use Caution/Monitor.arsenic trioxideSerious - Use Alternative (1)escitalopram increases toxicity of arsenic trioxide by QTc interval. Avoid or Use Alternate Drug.artemetherSerious - Use Alternative (1)artemether and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.artemether/lumefantrineSerious - Use Alternative (1)escitalopram increases toxicity of artemether/lumefantrine by QTc interval. Avoid or Use Alternate Drug.asenapineSerious - Use Alternative (1)escitalopram increases toxicity of asenapine by QTc interval. Avoid or Use Alternate Drug.asenapine transdermalSerious - Use Alternative (1)asenapine transdermal and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.aspirinMonitor Closely (1)escitalopram, aspirin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.aspirin rectalMonitor Closely (1)escitalopram, aspirin rectal. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.aspirin/citric acid/sodium bicarbonateMonitor Closely (1)escitalopram, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.atazanavirMonitor Closely (1)atazanavir increases levels of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased risk of serotonin syndrome.atenololMinor (1)escitalopram increases levels of atenolol by decreasing metabolism. Minor/Significance Unknown.atomoxetineMonitor Closely (2)atomoxetine and escitalopram both increase QTc interval. Use Caution/Monitor. escitalopram increases levels of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.azithromycinMonitor Closely (1)azithromycin increases toxicity of escitalopram by QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)escitalopram increases toxicity of azithromycin by QTc interval. Avoid or Use Alternate Drug.bedaquilineMonitor Closely (1)escitalopram and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closelybelzutifanMonitor Closely (1)belzutifan will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information. benzhydrocodone/acetaminophenMonitor Closely (1)benzhydrocodone/acetaminophen, 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.betaxololMinor (1)escitalopram increases levels of betaxolol by decreasing metabolism. Minor/Significance Unknown.betrixabanMonitor Closely (1)escitalopram, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.bisoprololMinor (1)escitalopram increases levels of bisoprolol by decreasing metabolism. Minor/Significance Unknown.bortezomibMinor (1)bortezomib will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.bumetanideMinor (1)bumetanide, escitalopram. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible additive hyponatremia.buprenorphineSerious - Use Alternative (1)buprenorphine and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine buccalSerious - Use Alternative (1)buprenorphine buccal and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine subdermal implantMonitor Closely (1)escitalopram, buprenorphine subdermal implant. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.Serious - Use Alternative (1)buprenorphine subdermal implant and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine transdermalSerious - Use Alternative (1)buprenorphine transdermal and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine, long-acting injectionMonitor Closely (1)escitalopram, buprenorphine, long-acting injection. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.Serious - Use Alternative (1)buprenorphine, long-acting injection and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.bupropionSerious - Use Alternative (1)escitalopram increases toxicity of bupropion by unspecified interaction mechanism. Avoid or Use Alternate Drug. May lower seizure threshold; keep bupropion dose as low as possible.buspironeSerious - Use Alternative (1)escitalopram and buspirone both increase serotonin levels. Avoid or Use Alternate Drug.butabarbitalMonitor Closely (1)butabarbital will decrease the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.butalbitalMonitor Closely (1)butalbital will decrease the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.cannabidiolMonitor Closely (1)cannabidiol will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider reducing the dose of sensitive CYP2C19 substrates, as clinically appropriate, when coadministered with cannabidiol. carbamazepineMonitor Closely (1)carbamazepine will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.carvedilolMinor (1)escitalopram increases levels of carvedilol by decreasing metabolism. Minor/Significance Unknown.celecoxibMonitor Closely (1)escitalopram, celecoxib. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.celiprololMinor (1)escitalopram increases levels of celiprolol by decreasing metabolism. Minor/Significance Unknown.cenobamateMonitor Closely (3)cenobamate, escitalopram. Either increases effects of the other by sedation. Use Caution/Monitor. cenobamate will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate. cenobamate will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate. ceritinibSerious - Use Alternative (2)ceritinib and escitalopram both increase QTc interval. Avoid or Use Alternate Drug. ceritinib will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.chloramphenicolMonitor Closely (1)chloramphenicol will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.chloroquineMonitor Closely (1)chloroquine increases toxicity of escitalopram by QTc interval. Use Caution/Monitor.chlorpromazineSerious - Use Alternative (1)escitalopram increases toxicity of chlorpromazine by QTc interval. Avoid or Use Alternate Drug.choline magnesium trisalicylateMonitor Closely (1)escitalopram, choline magnesium trisalicylate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.ciprofloxacinMonitor Closely (1)escitalopram increases toxicity of ciprofloxacin by QTc interval. Use Caution/Monitor.cisaprideContraindicated (1)escitalopram increases toxicity of cisapride by QTc interval. Contraindicated.citalopramSerious - Use Alternative (1)citalopram and escitalopram both increase serotonin levels. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions. ECG monitoring is recommended, along with drugs that may prolong the QT interval.clarithromycinSerious - Use Alternative (3)clarithromycin, escitalopram. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. To monitor for the prolongation of QT/QTc and/or development of ventricular tachyarrhythmias the labeling recommends monitoring QT interval or ECG. escitalopram increases toxicity of clarithromycin by QTc interval. Avoid or Use Alternate Drug. clarithromycin will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.clofazimineMonitor Closely (1)escitalopram increases toxicity of clofazimine by QTc interval. Modify Therapy/Monitor Closely.clomipramineMonitor Closely (1)escitalopram increases toxicity of clomipramine by QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)escitalopram and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug.clonidineMonitor Closely (1)clonidine, escitalopram. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration enhances CNS depressant effects.clopidogrelMonitor Closely (1)escitalopram increases effects of clopidogrel by pharmacodynamic synergism. Use Caution/Monitor. SSRIs affect platelet activation; coadministration of SSRIs with clopidogrel may increase the risk of bleeding.clozapineMonitor Closely (2)escitalopram increases levels of clozapine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Plasma levels of clozapine may be increased, resulting in increased pharmacologic and toxic effects. Adjust clozapine dose as needed when initiating or discontinuing certain SSRIs. . escitalopram increases toxicity of clozapine by QTc interval. Use Caution/Monitor.cobicistatMonitor Closely (2)cobicistat will increase the level or effect of escitalopram by Other (see comment). Use Caution/Monitor. Carefully titrate dose of the antidepressant to the desired effect, including using the lowest feasible initial or maintenance dose, and monitor its response during coadministration with SSRIs and cobicistat. cobicistat will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.cocaine topicalMonitor Closely (1)escitalopram and cocaine topical both increase serotonin levels. Modify Therapy/Monitor Closely.crizotinibMonitor Closely (2)crizotinib and escitalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval. crizotinib increases levels of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Dose reduction may be needed for coadministered drugs that are predominantly metabolized by CYP3A.Serious - Use Alternative (1)escitalopram increases toxicity of crizotinib by QTc interval. Avoid or Use Alternate Drug.cyclobenzaprineSerious - Use Alternative (1)escitalopram and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.cyclophosphamideMinor (1)cyclophosphamide will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.cyproheptadineMonitor Closely (1)cyproheptadine decreases effects of escitalopram by pharmacodynamic antagonism. Use Caution/Monitor. Cyproheptadine may diminish the serotonergic effect of SSRIs.dabrafenibMonitor Closely (1)dabrafenib will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.daridorexantMonitor Closely (1)escitalopram and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment. darunavirMinor (1)darunavir will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown. Coadministration with SSRIs, TCAs, or trazodone may require dose titration of antidepressant to desired effect (eg, using the lowest feasible initial or maintenance dose). Monitor for antidepressant response.dasatinibMonitor Closely (1)escitalopram increases toxicity of dasatinib by QTc interval. Use Caution/Monitor.defibrotideMonitor Closely (1)defibrotide increases effects of escitalopram by Other (see comment). Use Caution/Monitor. Comment: Defibrotide may enhance effects of platelet inhibitors.degarelixMonitor Closely (1)escitalopram increases toxicity of degarelix by QTc interval. Use Caution/Monitor.desfluraneSerious - Use Alternative (1)desflurane and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.desipramineMonitor Closely (1)escitalopram increases toxicity of desipramine by QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)escitalopram and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.desvenlafaxineSerious - Use Alternative (1)escitalopram and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.deutetrabenazineMonitor Closely (1)escitalopram increases toxicity of deutetrabenazine by QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).dexfenfluramineMonitor Closely (1)escitalopram and dexfenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.dexmethylphenidateMonitor Closely (1)dexmethylphenidate increases effects of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.dextroamphetamineMonitor Closely (1)escitalopram and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.dextroamphetamine transdermalMonitor Closely (1)escitalopram, dextroamphetamine transdermal. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and concomitant serotonergic drug(s).dextromethorphanSerious - Use Alternative (1)escitalopram and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.diazepam intranasalMonitor Closely (1)diazepam intranasal, escitalopram. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.dichlorphenamideMonitor Closely (1)dichlorphenamide, escitalopram. sedation. Use Caution/Monitor.diclofenacMonitor Closely (1)escitalopram, diclofenac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.difelikefalinMonitor Closely (1)difelikefalin and escitalopram both increase sedation. Use Caution/Monitor.diflunisalMonitor Closely (1)escitalopram, diflunisal. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.dihydroergotamineMonitor Closely (1)escitalopram and dihydroergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.dihydroergotamine intranasalMonitor Closely (1)escitalopram and dihydroergotamine