Can You Take Lexapro (Escitalopram) With Nyquil?

In our latest question and answer, the pharmacist discusses the interaction between the SSRI Lexapro (escitalopram) and Nyquil.

Question

Can you take Nyquil with Lexapro? I heard there is an interaction but I need something for my cough.

Asked by Joe On Sep 06, 2022

Answered by
Medical Content Reviewed By HelloPharmacist Staff

Published Sep 06, 2022
Last updated Apr 19, 2024

Key points

  • There is an interaction between dextromethorphan, the cough suppressant contained in NyQuil, and Lexapro.
  • Taking both can increase the risk of a rare, but serious condition known as serotonin syndrome.

Answer

There is an interaction between one of the ingredients in Nyquil and Lexapro (escitalopram), considered to be major by most medical sources.

Due to the interaction, it is recommended to avoid combining the two medications if there are other options available to you. Taking both increases the risk of a rare, but serious condition known as serotonin syndrome.

Nyquil - Lexapro Interaction Details

Dextromethorphan, the cough suppressant in Nyquil, is known to have mild serotonergic properties. Studies aren't conclusive in regard to what doses provide serotonergic effects, but multiple case studies have been published with dextromethorphan precipitating what is known as 'serotonin syndrome' in patients who are also taking other drugs affecting serotonin.

Serotonin syndrome is a rare, but serious condition that is characterized by the following symptoms:

  • Confusion
  • Hyperthermia
  • High blood pressure
  • Muscle spasm/paralysis
  • Delerium 
  • Anxiety 
  • Increased heart rate

The incidence of serotonin syndrome is low, but extremely serious if it occurs. Most cases of serotonin syndrome are due to a patient being on more than one drug that increases serotonin. As such, it is important to limit the number of serotonergic medications you are taking and be aware of the signs and symptoms of serotonin syndrome should it occur. If it does occur, all offending agents should be stopped and immediate medical attention is required.

To decrease the risk of serotonin syndrome while on Lexapro, it is recommended to avoid over-the-counter dextromethorphan and find alternative therapies such as cough drops, expectorants (e.g. Mucinex), and humidifiers.

Nyquil Ingredients & Information

Nyquil is a combination cough/cold medication that contains the following ingredients:

  • Acetaminophen (analgesic)
  • Dextromethorphan (cough suppressant)
  • Doxylamine (sedating antihistamine)

The ingredients in Nyquil help to relieve common cold and flu symptoms such as pain, sore throat, fever, cough, post-nasal drip, and congestion.

It should be noted that there are a variety of different Nyquil products including Nyquil Cough and Nyquil Severe. However, the ingredient we are concerned about is the cough suppressant, dextromethorphan.

Lexapro Information

Lexapro (escitalopram) is an antidepressant classified as an SSRI (Selective Serotonin Reuptake Inhibitor). It works by blocking serotonin reuptake in the brain and also increases the amount of serotonin released by neurons. The net result is an increase in serotonin in the brain, a neurotransmitter thought to play a major role in treating depression.

SSRI medications, such as Lexapro, are effective in the treatment of a variety of indications including depression, anxiety, and other mood disorders. As with all medications, you need to be aware of potential interactions with Lexapro, especially with other medications that could potentially affect serotonin.

Final Words

Thanks for your question and please feel free to contact us again!

References

  • Dextromethorphan-induced serotonin syndrome, PubMed
  • Serotonin syndrome in dextromethorphan ingestion responsive to propofol therapy, PubMed

About the Pharmacist

Dr. Brian Staiger, PharmD

Dr. Brian has been practicing pharmacy for over 13 years and has wide-ranging experiences in many different areas of the profession. From retail, clinical, program development, and administrative responsibilities, he's your knowledgeable and go-to source for all your pharmacy and medication-related questions! Dr. Brian Staiger also has herbalist training and educational certificates in the field of medical ethnobotany. Feel free to send him an email at [email protected]! You can also connect with Dr. Brian Staiger on LinkedIn.

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