Escitalopram with Miconazole Interaction Details
Brand Names Associated with Escitalopram
- Escitalopram
- Lexapro®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 10, 2023
Interaction Effect
Increased risk of serotonin syndrome (hypertension, tachycardia, hyperthermia, myoclonus, mental status changes)
Interaction Summary
Escitalopram is a selective serotonin reuptake inhibitor primarily metabolized by CYP3A4, CYP2D19, and CYP2D6 isoenzymes . Miconazole, a known inhibitor of CYP2C9 and CYP3A4 , and an inhibitor of CYP2D6 enzymes when studied in vitro, may cause increased escitalopram plasma concentrations when the drugs are coadministered. Although the pharmacokinetics of coadministered escitalopram and miconazole have not been studied, there is a case report of an 88-year-old female who presented with symptoms of serotonin syndrome 48 hours after initiating low dose escitalopram and buccal miconazole. If escitalopram and miconazole are used concurrently, use with caution, especially in the elderly .
Severity
Major
Onset
Delayed
Evidence
Probable
How To Manage Interaction
The concomitant administration of escitalopram, a selective serotonin reuptake inhibitor, and miconazole, an inhibitor of CYP2C9 and CYP3A4 enzymes , may result in increased escitalopram exposure and increase the risk of serotonin syndrome, therefore use with caution .
Mechanism Of Interaction
Inhibition of escitalopram CYP450-mediated metabolism by miconazole
Literature Reports
A) A case report described serotonin toxicity in an 88-year-old woman following the concomitant use of escitalopram and oral miconazole. The patient, who had hypothyroidism, cataract, and glaucoma, was diagnosed with new-onset major depression and oral candidiasis and prescribed escitalopram 5 mg/day and miconazole gingival mucoadhesive tablet 50 mg/day. Forty-eight hours after initiation of escitalopram and miconazole, the patient presented with drowsiness, confusion, hypertonia, and tremors of all four limbs, leading to hospitalization. Physical exam revealed hypertension (180/100 mmHg), tachycardia at a rate of 110 beats/minute, and increased reflexes with bilateral extrapyramidal hypertonia. Serotonin syndrome was suspected and escitalopram and miconazole were immediately discontinued; associated symptoms subsided within three days. Investigators postulated that the patient had an age-related increase in systemic absorption of miconazole, which may have contributed to the likely case of serotonin syndrome. In an assessment of causality, the association of serotonin syndrome and concomitant use of escitalopram and miconazole was rated as probable on the Naranjo adverse drug reaction probability scale .
Escitalopram Overview
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Escitalopram is used to treat depression in adults and children and teenagers 12 years of ago or older. Escitalopram is also used to treat generalized anxiety disorder (GAD; excessive worry and tension that disrupts daily life and lasts for 6 months or longer) in adults. Escitalopram is in a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs). It works by increasing the amount of serotonin, a natural substance in the brain that helps maintain mental balance.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.