Lexapro Side Effects

Generic Name: escitalopram

Note: This page contains information about the side effects of escitalopram. Some of the dosage forms included on this document may not apply to the brand name Lexapro.

Not all side effects for Lexapro may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.

For the Consumer

Applies to escitalopram: oral solution, oral tablet

In addition to its needed effects, some unwanted effects may be caused by escitalopram (the active ingredient contained in Lexapro). In the event that any of these side effects do occur, they may require medical attention.

You should check with your doctor immediately if any of these side effects occur when taking escitalopram:

Rare
  • Coma
  • confusion
  • convulsions
  • decreased urine output
  • dizziness
  • fast or irregular heartbeat
  • headache
  • increased thirst
  • muscle pain or cramps
  • nausea or vomiting
  • shortness of breath
  • swelling of the face, ankles, or hands
  • unusual tiredness or weakness

Some of the side effects that can occur with escitalopram may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

More common
  • Constipation
  • decreased interest in sexual intercourse
  • diarrhea
  • dry mouth
  • ejaculation delay
  • gas in the stomach
  • heartburn
  • inability to have or keep an erection
  • loss in sexual ability, desire, drive, or performance
  • sleepiness or unusual drowsiness
  • trouble sleeping
Less common
  • Bloated or full feeling
  • burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  • chills
  • cough
  • decreased appetite
  • excess air or gas in the stomach or intestines
  • fever
  • general feeling of discomfort or illness
  • increased sweating
  • joint pain
  • muscle aches and pains
  • not able to have an orgasm
  • pain in the neck or shoulders
  • pain or tenderness around the eyes and cheekbones
  • passing gas
  • runny nose
  • shivering
  • sneezing
  • sore throat
  • stuffy nose
  • tightness of the chest
  • tooth problems
  • trouble breathing
  • unusual dreams
  • unusual drowsiness, dullness, tiredness, weakness or feeling of sluggishness
  • yawning

For Healthcare Professionals

Applies to escitalopram: oral solution, oral tablet

Nervous system

Convulsions (including grand mal convulsions) and extrapyramidal disorder have been reported with racemic citalopram.

Very common (10% or more): Headache, somnolence
Common (1% to 10%): Dizziness, paraesthesia
Uncommon (0.1% to 1%): Carpal tunnel syndrome, dysesthesia, disequilibrium, hypoesthesia, lightheadedness, migraine, nerve root lesion, neuralgia, neuropathy, paralysis, sedation, syncope, tics, vertigo
Frequency not reported: Cerebrovascular accident, convulsions, extrapyramidal disorder, grand mal convulsions, myoclonus

Gastrointestinal

Very common (10% or more): Nausea
Common (1% to 10%): Abdominal pain, constipation, diarrhea, dry mouth, dyspepsia, flatulence, indigestion, toothache, vomiting
Uncommon (0.1% to 1%): Abdominal cramp, abdominal discomfort, belching, bloating, bruxism, change in bowel habit, colitis, dysgeusia, enteritis, epigastric discomfort, gastritis, gastrointestinal bleeding, gastrointestinal hemorrhage (including rectal hemorrhage) gastroesophageal reflux, hemorrhoids, heartburn, increased stool frequency, irritable bowel syndrome, melena, periodontal destruction, tooth disorder, ulcerative colitis, ulcerative stomatitis
Frequency not reported: Gastroenteritis
Postmarketing reports: Dysphagia, Pancreatitis, stomatitis

General

Side effects have been reported to be generally mild and transient. They are most common during the first 2 weeks of treatment and decrease in intensity and frequency with continued treatment. They generally do not lead to treatment cessation.

The overall incidence of rates of side effects in trials with patients treated with escitalopram (the active ingredient contained in Lexapro) 10 mg per day (66%) was similar to placebo-treated patients (61%); the incidence rate in the group treated with escitalopram 20 mg per day was greater (86%). Common side effects that occurred in the 20 mg per day group with an incidence approximately twice that of the 10 mg group and approximately twice that of the placebo group included insomnia, diarrhea, dry mouth, somnolence, dizziness, increased sweating, constipation, fatigue, and indigestion.

Psychiatric

Very common (10% or more): Insomnia
Common (1% to 10%): Abnormal dreams, agitation, anxiety, nervousness, restlessness, somnolence
Uncommon (0.1% to 1%): Abnormal thinking, aggravated depression, aggressive reaction, aggravated restlessness, alcohol problem, amnesia, apathy, concentration impairment, confusion, confusional state, depersonalization, depression, emotional lability, excitability, feeling unreal, forgetfulness, hallucination, hypomania, irritability, jitteriness, lethargy, obsessive-compulsive disorder, panic reaction, paroniria, sleep disorder, suicide attempt
Frequency not reported: Mania, psychomotor restlessness/akathisia, suicidal ideation
Postmarketing reports: Acute psychosis, anger, delirium, delusion, disorientation, dysarthria, non-accidental overdose, mood swings, nightmare, psychotic disorder

Antidepressants may have a role in inducing worsening of depression and the emergence of suicidality in certain patients during the early phases of treatment. An increased risk of suicidal thinking and behavior in children, adolescents, and young adults (aged 18 to 24 years) with major depressive disorder (MDD) and other psychiatric disorders has been reported with short-term use of antidepressant drugs.

Adult and pediatric patients receiving antidepressants for MDD, as well as for psychiatric and nonpsychiatric indications, have reported symptoms that may be precursors to emerging suicidality, including anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia, hypomania, and mania. Causality has not been established.

Respiratory

Common (1% to 10%): Pharyngitis, rhinitis, sinusitis, upper respiratory tract infection, yawning
Uncommon (0.1% to 1%): Asthma, bronchitis, coughing, dyspnea, epistaxis, laryngitis, nasal congestion, nasopharyngitis, pneumonia, respiratory tract infection, shortness of breath, sinus congestion, sinus headache, sleep apnea, snoring, tracheitis, throat tightness
Postmarketing reports: Pulmonary embolism, pulmonary hypertension of the newborn

Genitourinary

Very common (10% or more): Ejaculation disorder
Common (1% to 10%): Anorgasmia, decreased libido, ejaculation failure, impotence, menstrual disorder, vaginal bleeding
Uncommon (0.1% to 1%): Amenorrhea, atrophic vaginitis, breast pain, cystitis, delayed ejaculation, dysmenorrhea, dysuria, genital infection, genital moniliasis, intermenstrual bleeding, loss of libido, menopausal symptoms, menorrhagia, menstrual cramps, metrorrhagia, micturition disorder, micturition frequency, nocturia, ovarian cyst, polyuria, postmenopausal bleeding, premenstrual tension, prostatic disorder, sexual function abnormality, unintended pregnancy, urinary incontinence, urinary retention, urinary tract infection, uterine fibroid, vaginal candidiasis, vaginal hemorrhage, vaginitis
Frequency not reported: Galactorrhea, priapism
Postmarketing reports: Spontaneous abortion

Urinary retention and galactorrhea have been reported with other SSRIs. The estimates of the incidence of untoward sexual experience and performance may underestimate their actual incidence, partly because patients and physicians may be reluctant to discuss this issue.

Cardiovascular

Cases of QT interval prolongation and ventricular arrhythmias reported in postmarketing experience were predominantly in females, with hypokalemia, or with pre-existing QT interval prolongation or other cardiac diseases.

Postural hypotension has been reported with other SSRIs.

Common (1% to 10%): Palpitation
Uncommon (0.1% to 1%): Abnormal ECG, aggravated hypertension, angina pectoris, bradycardia, cerebrovascular disorder, chest tightness, chest pain, facial edema, flushing, hot flush, hypertension, hypotension, myocardial infarction, myocardial ischemia, myocarditis, edema, edema of extremities, peripheral edema, peripheral ischemia, tachycardia, varicose vein, vein disorder, vein distended
Frequency not reported: Orthostatic hypotension
Postmarketing reports: Atrial fibrillation, cardiac failure, prolonged QT, deep vein thrombosis, hypertensive crisis, phlebitis, thrombosis, torsades de pointes, ventricular arrhythmia, ventricular tachycardia

Hypersensitivity

Uncommon (0.1% to 1%): Aggravated allergy, allergic reactions
Frequency not reported: Anaphylaxis, angioedema
Postmarketing reports: Hypersensitivity not otherwise specified, photosensitivity reaction

Angioedema has been reported with racemic citalopram.

Hematologic

Uncommon (0.1% to 1%): Anemia, hypochromic anemia, leucopenia
Frequency not reported: Thrombocytopenia
Postmarketing reports: Agranulocytosis, aplastic anemia, Decreased prothrombin, hemolytic anemia, idiopathic thrombocytopenia purpura, increased INR

Metabolic

Common (1% to 10%): Decreased appetite, increased appetite, weight increased
Uncommon (0.1% to 1%): Abnormal glucose tolerance, carbohydrate craving, diabetes mellitus, gout, hypercholesterolemia, hyperglycemia, hyperlipemia, thirst, weight decreased
Frequency not reported: Anorexia, hyponatremia, inappropriate antidiuretic hormone secretion (SIADH)
Postmarketing reports: Hypoglycemia, hypokalemia

Numerous cases of hyponatremia have been reported following treatment with an SSRI. Risk factors for the development of SSRI- associated hyponatremia including advanced age, female gender, concomitant use of diuretics, low body weight, and lower baseline serum sodium levels have been identified. Hyponatremia tends to develop within the first few weeks of treatment (range 3 to 120 days) and typically resolves within 2 weeks (range 48 hours to 6 weeks) after therapy has been discontinued with some patients requiring treatment. The proposed mechanism for the development of hyponatremia involves SIADH via release of antidiuretic hormone.

A 62-year-old woman developed hyponatremia approximately 3- weeks after initiating treatment with escitalopram. Following discontinuation of the drug and administration of intravenous normal saline solution, the patient's serum sodium and serum and urine osmolality returned to normal levels.

In a similar case, hyponatremia developed in a 75-year-old woman five days after initiating treatment with escitalopram. Following discontinuation of escitalopram serum sodium levels returned to normal values over a period of 5 days. The authors suggest that the risk of hyponatremia is highest during the initial weeks of treatment and is higher in women than in men, in patients 65 years of age or older, and in patients receiving multiple drugs that may also cause hyponatremia.

Musculoskeletal

At least one case of escitalopram-induced paroxysmal dystonia has been reported in the literature. A 44-year-old woman developed paroxysmal cervical-cranial dystonia after receiving several days of treatment with escitalopram (the active ingredient contained in Lexapro) The paroxysmal movement disorders were characterized by cervical and oral contracture with sustained and painful laterocollis and twisting tongue movements. The episodes occurred several times a day lasting for several minutes and would resolve spontaneously. The day after escitalopram was discontinued, the paroxysmal symptoms resolved without recurrence.

Epidemiological studies, primarily in patients aged 50 years or older, have shown an increased risk of bone fractures in patients receiving SSRIs or TCAs.

Common (1% to 10%): Arthralgia, back pain, myalgia, neck/shoulder pain, tremor
Uncommon (0.1% to 1%): Arthritis, arthropathy, arthrosis, ataxia, bursitis, costochondritis, dystonia, fibromyalgia, hyperkinesia, hyperreflexia, hypertonia, ischial neuralgia, jaw stiffness, leg pain, limb pain, leg cramps, lumbar disc lesion, muscle contractions, muscle cramp, muscle spasms, muscle stiffness, muscle tightness, muscle weakness, myopathy, osteoporosis, plantar fasciitis, tendinitis, tenosynovitis, tetany, twitching
Frequency not reported: Dyskinesia, movement disorder
Postmarketing reports: Abnormal gait, choreoathetosis, parkinsonism, rhabdomyolysis, tardive dyskinesia

Dermatologic

Common (1% to 10%): Increased sweating
Uncommon (0.1% to 1%): Acne, aggravated psoriasis, alopecia, cellulitis, dry skin, eczema, erythematous rash, fungal dermatitis, furunculosis, hematomas, lichenoid dermatitis, onychomycosis, pruritus, purpura, pustular rash, rash, scar, skin disorder, urticaria, verruca
Frequency not reported: Ecchymosis
Postmarketing reports: Epidermal necrolysis, erythema multiforme, Stevens Johnson syndrome, toxic epidermal necrolysis

Ocular

Uncommon (0.1% to 1%): Abnormal accommodation, abnormal vision, blepharospasm, blurred vision, dry eyes, eye infection, eye irritation, eye pain, mydriasis, ocular hemorrhage, visual disturbance, xerophthalmia
Postmarketing reports: Angle closure glaucoma, diplopia, nystagmus

Other

Potentially life-threatening serotonin syndrome has been reported with SSRIs and SNRIs as monotherapy, but particularly with concomitant use of other serotonergic drugs and drugs that impair the metabolism of serotonin. Serotonin syndrome has been reported with racemic citalopram.

Common (1% to 10%): Fatigue, pyrexia
Uncommon (0.1% to 1%): Abscess, accidental injury, asthenia, bite, burn, deafness, earache, ear disorder, ear infection not otherwise specified, fall, fever, food poisoning, fractured neck of femur, hernia, inflicted injury (unintended injury), lethargy, malaise, otitis externa, otosalpingitis, rigors, sting, surgical intervention, tinnitus, traumatic hematoma
Rare (less than 0.1%): Serotonin syndrome
Postmarketing reports: Injury not otherwise specified, neuroleptic malignant syndrome, withdrawal syndrome

Hepatic

Uncommon (0.1% to 1%): Bilirubinemia, hepatic enzymes increased
Postmarketing reports: Fulminant hepatitis, hepatic failure, hepatic necrosis, hepatitis, increased bilirubin

Renal

Uncommon (0.1% to 1%): Pyelonephritis, renal calculus
Postmarketing reports: Acute renal failure

Endocrine

Postmarketing reports: Hyperprolactinemia

Immunologic

Common (1% to 10%): Influenza-like symptoms
Uncommon (0.1% to 1%): Bacterial infection, herpes simplex, herpes zoster, infection, moniliasis, parasitic infection, tuberculosis

Oncologic

Uncommon (0.1% to 1%): Cyst, female breast neoplasm, ovarian cyst

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