Can You Take Adderall And Lexapro Together?
In our latest question and answer, the pharmacist discusses if it is safe to combine Adderall and Lexapro.
I have been taking Lexapro for a number of years, and I was just diagnosed with ADHD. My doctor gave me a prescription for Adderall XR, but I want to know if that is safe to combine with Lexapro.
Oct 16, 2022- Adderall and Lexapro can sometimes be prescribed together but require careful monitoring because both drugs affect serotonin and there is a risk of serotonin syndrome, a serious condition with symptoms like confusion, rapid heart rate, sweating, and muscle rigidity.
- If you are taking both medications, your doctor should start you on a lower dose of Adderall and monitor you regularly for any signs of serotonin syndrome.
- The overall risk of serotonin syndrome from this combination is thought to be low because Adderall's serotonergic effects are not as strong as some other drugs.
Answer
While Adderall (Dextroamphetamine and Amphetamine) and Lexapro (escitalopram) are sometimes prescribed together to treat different conditions, they should be combined cautiously due to the increased risk of a rare, but serious, side effect known as serotonin syndrome.
Interaction Detail
Both Lexapro and Adderall have serotonergic effects. The concomitant use of 2 or more drugs that increase serotonin can increase the risk for serotonin syndrome, a condition of serotonergic overstimulation characterized by the following effects:
- Mental status changes
- Anxiety
- Restlessness
- Disorientation
- Increased heart rate
- Sweating
- Hyperthermia
- Increased blood pressure
- Tremors
- Muscle rigidity
The overall risk of serotonin syndrome when Lexapro and Adderall are combined isn't known but is generally thought to be low the serotonergic effects of Adderall aren't as strong as many other drugs. Lexapro increases serotonin concentrations in the brain while amphetamines stimulate catecholamine release, primarily dopamine and norepinephrine, although increased serotonin release may also occur at certain doses.
As mentioned, Lexapro and Adderall are sometimes prescribed together, although there are plenty of considerations that need to be kept in mind in addition to the potential of serotonin syndrome.
For example, stimulants can sometimes exacerbate depressive symptoms, and most guidelines do not recommend using both an SSRI and a stimulant at the same time as first-line therapy for this reason.
Nevertheless, if there is an inadequate response to treatment for one condition, combined therapy of a stimulant and antidepressant can certainly be considered. The guidelines for Major Depression with ADHD in Children and Adolescents states the following:
If , When the depressive symptoms are improved with antidepressants but ADHD symptoms remain serious, adding psychostimulants is recommended by some guidelines.
How To Manage The Interaction
If you are prescribed Lexapro and Adderall, it is important that you are monitored for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, altered reflexes, hyperthermia, sweating, tremor, muscle rigidity, confusion, increased heart rate, etc...) when these drugs are combined.
As you have been on Lexapro, it would be recommended that you are started on Adderall at lower doses, be monitored frequently, and adjust doses as needed.
Final Words
I hope this answer helped! Be sure to reach out anytime!
References & sources
- Rare case of severe serotonin syndrome leading to bilateral compartment syndrome — PubMed
- Relationship between the Serotonergic Activity and Reinforcing Effects of a Series of Amphetamine Analogs — The Journal of Pharmacology and Experimental Therapeutics
- Concurrent use of amphetamine stimulants and antidepressants by undergraduate students — PubMed
- Adderall Prescribing Information — AccessFDA
- Major Depression with ADHD — PubMed
Glossary — Terms in This Answer
- Serotonin syndrome
- A rare but serious condition caused by too much serotonin activity in the brain, leading to symptoms like confusion, rapid heart rate, sweating, and muscle rigidity.
- Serotonergic
- Related to or affecting serotonin, a chemical messenger in the brain that influences mood and other functions.
- Concomitant
- Occurring or existing at the same time; used here to mean taking multiple drugs together.
- Hyperthermia
- A dangerous increase in body temperature above normal.
- Catecholamine
- A type of chemical messenger in the brain, including dopamine and norepinephrine, involved in mood and alertness.
- SSRI
- A type of antidepressant medication that works by increasing serotonin levels in the brain.
- Psychostimulants
- Medications that increase brain activity and alertness, commonly used to treat ADHD.
- Exacerbate
- To make a condition or symptom worse.
Dr. Brian Staiger, PharmD
Doctor of Pharmacy, board certified clinical pharmacist (BCPS), American Herbalist Guild, Medication Therapy Management certified
Brian Staiger, PharmD, BCPS, is a licensed pharmacist with more than 13 years of experience across retail pharmacy, clinical pharmacy, medication safety, pharmacy program development, and healthcare administration. He is the founder of HelloPharmacist.com, where he helps patients...
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