Exuber 10 Drug Interactions

Serotonergic Drugs: Based on the mechanism of action of SNRIs and SSRIs including Escitalopram oxalate tablets, and the potential for serotonin syndrome, caution is advised when escitalopram oxalate tablet is coadministered with other drugs that may affect the serotonergic neurotransmitter systems, such as triptans, linezolid (an antibiotic which is a reversible non-selective MAOI), lithium, tramadol, or St. John's Wort. The concomitant use of Escitalopram oxalate tablets with other SSRIs, SNRIs or tryptophan is not recommended.
Triptans: If concomitant treatment of Escitalopram oxalate tablets with a triptan is clinically warranted, careful observation of the patient is advised, particularly during treatment initiation and dose increases.
CNS Drugs: Given the primary CNS effects of Escitalopram, caution should be used when it is taken in combination with other centrally acting drugs.
Alcohol: Although Escitalopram oxalate tablets did not potentiate the cognitive and motor effects of alcohol in a clinical trial, as with other psychotropic medications, the use of alcohol by patients taking Escitalopram oxalate tablets is not recommended.
Drugs That Interfere with Hemostasis (NSAIDs, Aspirin, Warfarin, etc.): Serotonin release by platelets plays an important role in hemostasis. Epidemiological studies of the case-control and cohort design that have demonstrated an association between use of psychotropic drugs that interfere with serotonin reuptake and the occurrence of upper gastrointestinal bleeding have also shown that concurrent use of an NSAID or aspirin potentiated the risk of bleeding. Thus, patients should be cautioned about the use of such drugs concurrently with Escitalopram oxalate tablets.
Digoxin: In subjects who had received 21 days of 40 mg/day racemic citalopram, combined administration of citalopram and digoxin (single dose of 1 mg) did not significantly affect the pharmacokinetics of either citalopram or digoxin.
Lithium: Coadministration of racemic citalopram (40 mg/day for 10 days) and lithium (30 mmol /day for 5 days) had no significant effect on the pharmacokinetics of citalopram or lithium. Nevertheless, plasma lithium levels should be monitored with appropriate adjustment to the lithium dose in accordance with standard clinical practice. Because lithium may enhance the serotonergic effects of Escitalopram, caution should be exercised when escitalopram oxalate tablets and lithium are coadministered.
Pimozide and Celexa: In a controlled study, a single dose of pimozide 2 mg co-administered with racemic citalopram 40 mg given once daily for 11 days was associated with a mean increase in QTc values of approximately 10 msec compared to pimozide given alone. Racemic citalopram did not alter the mean AUC or C_max of pimozide. The mechanism of this pharmacodynamic interaction is not known.
Sumatriptan: There have been rare post-marketing reports describing patients with weakness, hyperreflexia, and incoordination following the use of an SSRI and Sumatriptan. If concomitant treatment with Sumatriptan and an SSRI (e.g., fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram, Escitalopram) is clinically warranted, appropriate observation of the patient is advised.
Theophylline: Combined administration of racemic citalopram (40 mg/day for 21 days) and the CYP1A2 substrate theophylline (single dose of 300 mg) did not affect the pharmacokinetics of theophylline. The effect of theophylline on the pharmacokinetics of citalopram was not evaluated.
Warfarin: Administration of 40 mg/day racemic citalopram for 21 days did not affect the pharmacokinetics of warfarin, a CYP3A4 substrate. Prothrombin time was increased by 5%, the clinical significance of which is unknown.
Carbamazepine: Combined administration of racemic citalopram (40 mg/day for 14 days) and carbamazepine (titrated to 400 mg/day for 35 days) did not significantly affect the pharmacokinetics of carbamazepine, a CYP3A4 substrate. Although trough citalopram plasma levels were unaffected, given the enzyme-inducing properties of carbamazepine, the possibility that carbamazepine might increase the clearance of escitalopram should be considered if the two drugs are coadministered.
Triazolam: Combined administration of racemic citalopram (titrated to 40 mg/day for 28 days) and the CYP3A4 substrate Triazolam (single dose of 0.25 mg) did not significantly affect the pharmacokinetics of either citalopram or Triazolam.
Ketoconazole: Combined administration of racemic citalopram (40 mg) and Ketoconazole (200 mg), a potent CYP3A4 inhibitor, decreased the C_max and AUC of Ketoconazole by 21% and 10%, respectively, and did not significantly affect the pharmacokinetics of citalopram.
Ritonavir: Combined administration of a single dose of Ritonavir (600 mg), both a CYP3A4 substrate and a potent inhibitor of CYP3A4, and Escitalopram (20 mg) did not affect the pharmacokinetics of either Ritonavir or escitalopram.
Drugs Metabolized by Cytochrome P4502D6: Coadministration with Escitalopram, of a drug that inhibits CYP2D6, is unlikely to have clinically significant effects on escitalopram metabolism. However, there are limited in vivo data suggesting a modest CYP2D6 inhibitory effect for Escitalopram.
Metoprolol: Coadministration of Escitalopram oxalate tablets and Metoprolol had no clinically significant effects on blood pressure or heart rate.
Electroconvulsive Therapy (ECT): There are no clinical studies of the combined use of ECT and Escitalopram.