What Are The Side Effects Of Lexapro (Escitalopram)?

Lexapro (escitalopram) is associated with a variety of side effects.

Question

Hello. My doctor gave me 20mg of Lexapro to help with my anxiety. I haven't taken it yet cause I've been feeling better. I'm afraid of side effects though. How bad are the side effects of 20mg Lexapro?

Asked by Mr. Mike On Nov 08, 2018

Answered by
Medical Content Reviewed By PharmacistAnswers Staff

On Nov 10, 2018

Side Effects Title

Side Effects Of Lexapro

Common side effects include:

  • Changes in appetite
  • Change in sex drive or performance
  • Headache
  • Increased sweating
  • Indigestion
  • Nausea
  • Dizziness
  • Dry mouth
  • Tiredness
  • Lethargy
  • Tremors


The above side effects are relatively common and usually do not require medical attention. You should however be sure to report to your doctor or health care professional if they continue or are bothersome.


Side effects that you should report to your doctor or health care professional as soon as possible include:

  • Allergic reactions (e.g. skin rash, itching or hives, swelling of the face, lips, or tongue
  • Anxiousness
  • Black, tarry stools
  • Changes in vision
  • Confusion
  • Elevated mood
  • Decreased need for sleep
  • Racing thoughts
  • Impulsive behavior
  • Eye pain
  • Fast, irregular heartbeat
  • Feeling faint or lightheaded,
  • Feeling agitated, angry, or irritable
  • Hallucination
  • Loss of contact with reality
  • Loss of balance or coordination
  • Loss of memory
  • Painful or prolonged erections
  • Restlessness, pacing, inability to keep still
  • Seizures
  • Stiff muscles
  • Suicidal thoughts or other mood changes
  • Trouble sleeping
  • Unusual bleeding or bruising
  • Unusually weak or tired
  • Vomiting


Lexapro is classified as a SSRI (selective serotonin reuptake inhibitor). The side effects listed above are associated with all SSRI medications but can vary in incidence rate depending on the specific drug.


The guidelines for the treatment of major depressive disorder (Practice Guidelines For The Treatment of Patients With Major Depressive Disorder) states the following regarding side effects for SSRI drugs:

"SSRIs have comparable tolerability overall, but the specific medications differ somewhat in their side effect profiles, which may guide selection of an agent for an individual patient. Pharmacokinetic issues, including halflife and effect on the CYP-450 enzyme system, are additional considerations in the choice of an SSRI."


Side Effect Categories

SSRI Title

The major depressive disorder guidelines list the possible side effects of SSRIs (such as Lexapro) into 7 major categories:

  • Gastrointestinal
  • Activation/insomnia
  • Sexual
  • Neurological Effects
  • Falls
  • Effects On Weight
  • Serotonin Syndrome


Gastrointestinal

Adverse gastrointestinal (GI) effects are among the most frequently reported adverse reactions during treatment with SSRIs, including Lexapro (escitalopram). Most of these side effects are 'dose-related', meaning that higher doses increase the incidence of side effects.


Gastrointestinal adverse events are generally mild, and tend to occur when therapy is first initiated or doses are increased. Their severity tends to decrease over the first few weeks of treatment. 


Activation/Insomnia

Lexapro can precipitate or exacerbate a feeling of restlessness, anxiety, insomnia and irritability. It also has the potential to cause impulse control symptoms. These side effects tend to decrease over time. Additionally, starting Lexapro at a low dose and slowly increasing can help to decrease the incidence of these side effects.


These side effects are also associated with discontinuation of Lexapro.


Sexual

Both males and females have been reported to experience sexual side effects, which includes libido decrease, impotence (male) and orgasm dysfunction.


It can be difficult to discern the true incidence of sexual side effects as sexual dysfunction is often part of depression and other psychiatric disorders.


Strategies for mitigating sexual side effects of Lexapro include:

  • Maintain therapy (they tend disappear with time)
  • Lowering the dose
  • Discontinuing or substituting for another antidepressant (e.g. Wellbutrin)


Neurological Effects

Lexapro can potentially exacerbate headaches, especially when therapy is first started. However, SSRIs can help reduce the incidence of headaches with long-term use.


Other potential neurological effects include:

  • Akathisia (feeling of inner restlessness)
  • Dystonia (involuntary muscle contractions)
  • Parkinsonism


Falls

Lexapro may increase the risk of falls, which must be considered, especially in elderly individuals.


Reasons for increased falls are due to the potential for Lexapro to cause dizziness and weakness, as well as the fact that it can cause hyponatremia (low sodium levels) in a small number of individuals.


Weight Changes

SSRI medications are associated with changes in weight. Effects on weight vary by SSRI. Paxil (paroxetine) is typically associated with the most weight gain.


Lexapro specifically has been associated with both weight loss and weight gain. Decreased weight has been observed in children and adolescents receiving Lexapro and it is recommended to periodically monitor both height and weight.


Serotonin Syndrome

Serotonin syndrome has been reported during use of SSRIs alone (like Lexapro), or when used concurrently with other medications that affect serotonin.


Serotonin syndrome is rare, but if symptoms occur, Lexapro and any other serotonergic agent should be discontinued and immediate medical attention should be sought.


Symptoms of serotonin syndrome include:

  • Nausea
  • Vomiting
  • Diaphoresis (sweating)
  • Facial flush
  • Mental status changes
  • Myoclonia (eyelid spasm)
  • Restlessness
  • Shivering
  • Elevated blood pressure


Lexapro Information

Escitalopram Structure Title

Overview

Lexapro, generic name escitalopram (es sye TAL oh pram), is used to treat depression and certain types of anxiety. It is also used off-label for a variety of indications, including panic disorder and social phobia.

  • Lexapro should be taken by mouth with a glass of water. It can be taken with or without food. If it upsets your stomach, take it with food.
  • It is important to not stop taking Lexapro suddenly except upon the advice of your doctor. Abrupt discontinuation can cause serious side effects, withdrawal reactions and your condition may worsen.
  • Lexapro tablets and associated generics can safely be cut or split if necessary.
  • Be sure to tell your doctor if your symptoms do not get better or if they get worse. Like all SSRI medications, it may take several weeks to see the full effects and it is important to continue your treatment as prescribed by your doctor.


Interactions

Lexapro has several potential drug interactions, including with:

  • Fluconazole
  • Itraconazole
  • Ketoconazole
  • Posaconazole
  • Celexa (citalopram)
  • Linezolid
  • MAOIs (e.g. selegiline)
  • Certain blood thinners (e.g. aspirin, Plavix)
  • Certain antiarrhythmics (e.g. Dofetilide)
  • Codeine


You can look into potential Lexapro interactions by using our free 'Drug Interaction Checker'.


Precautions

  • Individuals taking Lexapro should be observed for clinical worsening and suicidality, especially during the initial few months of a course of drug therapy, or at times of dose changes. Communicate immediately with the prescriber the emergence of side effects such as agitation, irritability, unusual changes in behavior, or, emergence of suicidality.
  • Lexapro should be used with caution in patients with a history of seizure disorder. These patients were excluded from clinical studies during the premarketing testing.


Missed Dose

  • If you miss a dose, take it as soon as you can.
  • If it is almost time for your next dose, take only that dose. Do not take double or extra doses.


Overdose

Take Lexapro as directed by your doctor. Taking too much increases the risk of serious side effects. Symptoms of overdose include:

  • Hypotension (low blood pressure)
  • Insomnia
  • Sweating
  • Shaking
  • Tremor
  • Confusion
  • Increased respiration


If you or someone else has symptoms of an overdose, or has told you about a potential overdose, call a Poison Control Center at 1-800-222-1222 or visit their website. If someone collapses or isn't breathing, call 911 immediately. 


Storage

  • Lexapro should be stored at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Throw away any unused medicine after the expiration date.

About the Pharmacist

Dr. Brian Staiger Pharm.D

Dr. Brian Staiger is a licensed pharmacist in New York State and the founder of PharmacistAnswers.com. He graduated from the University At Buffalo with a Doctor Of Pharmacy degree in 2010. He has been featured in several publications including the Huffington Post as well as a variety of health and pharmacy related blogs. Please feel free to reach out to him directly if you have any questions or want to connect! [email protected]; Office: 716-389-3076

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