Escitalopram with Pranoprofen Interaction Details
Brand Names Associated with Escitalopram
- Escitalopram
- Lexapro®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 10, 2023
Interaction Effect
An increased risk of bleeding
Interaction Summary
Use caution with the concomitant use of NSAIDs and antidepressants, including SSRIs due to an increased risk of intracranial hemorrhage and gastrointestinal (GI) bleeding . Bleeding events have included epistaxis, ecchymosis, hematoma, petechiae, and life-threatening hemorrhages . When an SSRI and an NSAID are given concurrently, closely monitor the patient for signs of adverse events, including GI bleeds, especially in elderly and those with a history of GI ulcers. Consider other types of pain management (eg, acetaminophen), review the chosen antidepressant (ie, consider agents with less serotonin reuptake inhibition), or prescribe prophylaxis with antiulcer drugs .
Severity
Major
Onset
Unspecified
Evidence
Established
How To Manage Interaction
Use caution if NSAIDs and SSRIs are coadministered. Concomitant use of NSAIDs and SSRIs may cause an increased risk of intracranial hemorrhage and gastrointestinal (GI) bleeding . When an SSRI and an NSAID are given concurrently, closely monitor the patient for signs of adverse events, including GI bleeds, especially in elderly and those with a history of GI ulcers. Consider other types of pain management (eg, acetaminophen), review the chosen antidepressant (ie, consider agents with less serotonin reuptake inhibition), or prescribe prophylaxis with antiulcer drugs .
Mechanism Of Interaction
Depletion of platelet serotonin by SSRI; additive effects on hemostasis
Literature Reports
A) Concomitant use of NSAIDs and antidepressants, including tricyclic antidepressants, SSRIs, serotonin-norepinephrine reuptake inhibitors, and MAOIs, resulted in a 60% increased risk of intracranial hemorrhage within 30 days of concomitant use compared with antidepressant use alone. There was no significant difference between the antidepressant drug classes and the increased risk; however, there was an increased risk associated with male patients compared with female patients .
B) SSRIs increase the risk of upper gastrointestinal (GI) bleeding, and this effect is potentiated by concurrent use of NSAIDs or low-dose aspirin. Hospitalizations for upper GI bleeding were searched among 26,005 users of antidepressant medications and compared with the number of hospitalizations in those patients who did not receive prescriptions for antidepressants. The amount of upper GI bleeding episodes was 3.6 times more than expected. Combined use of an SSRI and NSAIDs or low-dose aspirin increased the risk to 12.2 and 5.2 times, respectively. The findings of this study demonstrate an increased risk of upper GI bleeding during the use of SSRIs. Combined use of SSRIs and NSAIDs or low-dose aspirin increased the risk even further .
C) Two metaanalyses of incidents of upper GI bleed due to SSRIs, NSAIDs, and their combination found that SSRIs increased the risk by 1.73 to 2.36 times , NSAIDs by 2.55 times , and the combination of SSRIs and NSAIDs by 4.02 to 6.33 times .
D) The release of serotonin by platelets is important for maintaining hemostasis. Case-control and cohort studies have shown that the combined use of SSRIs and NSAIDs have been associated with an increased risk of bleeding .
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.