Drug interactions
Escitalopram + Levomilnacipran
Severity: Major
Escitalopram and Levomilnacipran: major interaction.
Last updated Sources: US FDA label
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Combining an SSRI with an SNRI increases serotonergic activity and the risk of serotonin syndrome, with agitation, tremor, hyperthermia, clonus and autonomic instability. Both can also raise bleeding risk and blood pressure.
What this interaction means in plain words
Escitalopram and Levomilnacipran can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Escitalopram belongs to Central Nervous System; Levomilnacipran belongs to Central Nervous System.
Why it happens
Additive serotonergic effects from inhibition of serotonin reuptake by both drugs.
What to do
Avoid using two serotonergic antidepressants together and cross-taper with care when switching. If combined, monitor for signs of serotonin toxicity, especially after dose changes.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Escitalopram
- Cisapride + Escitalopram Contraindicated
- Citalopram + Escitalopram Contraindicated
- Escitalopram + Isocarboxazid Contraindicated
- Escitalopram + Methylene blue Contraindicated
- Escitalopram + Phenelzine Contraindicated
- Escitalopram + Pimozide Contraindicated
Other interactions of Levomilnacipran
- Isocarboxazid + Levomilnacipran Contraindicated
- Levomilnacipran + Linezolid Contraindicated
- Levomilnacipran + Methylthioninium chloride Contraindicated
- Levomilnacipran + Phenelzine Contraindicated
- Levomilnacipran + Procarbazine Contraindicated
- Levomilnacipran + Rasagiline Contraindicated
Frequently asked questions
Can I take Escitalopram with Levomilnacipran?
MediHelp rates the interaction as major. Escitalopram and Levomilnacipran can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Combining an SSRI with an SNRI increases serotonergic activity and the risk of serotonin syndrome, with agitation, tremor, hyperthermia, clonus and autonomic instability. Both can also raise bleeding risk and blood pressure.
How serious is the interaction between Escitalopram and Levomilnacipran?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid using two serotonergic antidepressants together and cross-taper with care when switching. If combined, monitor for signs of serotonin toxicity, especially after dose changes.
What other medicines interact with Escitalopram?
MediHelp also lists interactions of Escitalopram with, for example, Cisapride, Citalopram, Isocarboxazid. The full list is on the Escitalopram page.
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