Oxycodone with Escitalopram Interaction Details

Brand Names Associated with Oxycodone

Brand Names Associated with Escitalopram

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Nov 13, 2023

Interaction Effect

An increased risk of serotonin syndrome and increased CYP2D6 substrate exposure

Interaction Summary

Coadministration of oxyCODONE and another serotonergic agent like escitalopram may result in serotonin syndrome, because both drugs affect the serotonergic neurotransmitter system. If concomitant use of oxyCODONE and escitalopram is clinically required, monitor patients carefully, especially during treatment initiation and dosage adjustment. Discontinue oxyCODONE if serotonin syndrome is suspected. Cases of serotonin syndrome, a potentially life-threatening condition, have been reported during concomitant use of opioids with serotonergic drugs. Coadministration of oxyCODONE and escitalopram resulted in the development of serotonin syndrome in an 88-year-old woman . Also, concomitant use of escitalopram (a CYP2D6 inhibitor) with oxyCODONE (a CYP2D6 substrate) may increase the oxyCODONE concentrations and the risk of oxyCODONE-related adverse reactions. Exercise caution during coadministration of escitalopram and oxyCODONE .

Severity

Major

Onset

Delayed

Evidence

Probable

How To Manage Interaction

Coadministration of oxyCODONE and another serotonergic agent like escitalopram may result in serotonin syndrome, because both drugs affect the serotonergic neurotransmitter system. If concomitant use of oxyCODONE and escitalopram is clinically required, monitor patients carefully, especially during treatment initiation and dosage adjustment. Discontinue oxyCODONE if serotonin syndrome is suspected. Also, concomitant use of escitalopram (a CYP2D6 inhibitor) with oxyCODONE (a CYP2D6 substrate) may increase the oxyCODONE concentrations and the risk of oxyCODONE-related adverse reactions. Exercise caution during coadministration of escitalopram and oxyCODONE .

Mechanism Of Interaction

Additive serotonergic effects; inhibition of CYP2D6 substrate metabolism by escitalopram

Literature Reports

A) Symptoms of serotonin syndrome developed in an 88-year-old woman following concurrent administration of oxycodone and escitalopram. The woman was taking escitalopram 10 mg/day and extended-release oxyCODONE 20 mg twice daily. Approximately 5 weeks prior to the current presentation, the dose of extended-release oxyCODONE had been doubled. She presented to the emergency room with acutely elevated blood pressure (200/90 millimeters of mercury) and frequent myoclonic jerks in the lower extremities. Both escitalopram and oxyCODONE were stopped and the patient was treated with intravenous lorazepam, which led to resolution of the myoclonic jerks and a return to baseline blood pressure in less than a day. Subsequent re-initiation of extended-release oxyCODONE (20 mg twice daily), but not escitalopram, did not result in myoclonus or blood pressure elevation .

B) Cases of serotonin syndrome, a potentially life-threatening condition, have been reported during concomitant use of opioids with serotonergic drugs .

C) Administration of a single dose of desipramine 50 mg, a CYP2D6 substrate, to subjects treated with a 21-day regimen of escitalopram 20 mg/day resulted in desipramine Cmax and AUC elevations of 40% and 100%, respectively .

Oxycodone Overview

• Oxycodone is used to relieve moderate to severe pain. Oxycodone extended-release tablets and extended-release capsules are used to relieve severe pain in people who are expected to need pain medication around the clock for a long time and who cannot be treated with other medications. Oxycodone extended-release tablets and extended-release capsules should not be used to treat pain that can be controlled by medication that is taken as needed. Oxycodone extended-release tablets, extended-release capsules, and concentrated solution should only be used to treat people who are tolerant (used to the effects of the medication) to opioid medications because they have taken this type of medication for at least one week. Oxycodone is in a class of medications called opiate (narcotic) analgesics. It works by changing the way the brain and nervous system respond to pain.

• Oxycodone is also available in combination with acetaminophen (Oxycet, Percocet, Roxicet, Xartemis XR, others); aspirin (Percodan); and ibuprofen. This monograph only includes information about the use of oxycodone alone. If you are taking an oxycodone combination product, be sure to read information about all the ingredients in the product you are taking and ask your doctor or pharmacist for more information.

Escitalopram Overview

• 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:

• Gold Standard Drug Database
• Micromedex
• Lexicomp
• DrugBank

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.