Contraindicated
Escitalopram with MAO inhibitors is contraindicated
With: MAO inhibitors (phenelzine, tranylcypromine, linezolid, methylene blue) Monoamine oxidase inhibitor
Why it happens
MAO inhibitors prevent breakdown of serotonin while escitalopram blocks its reuptake.
What can happen
Severe serotonin syndrome, agitation, hyperthermia, seizures, and death.
What to do
The combination is contraindicated. Allow an appropriate washout between agents.
Basis: Escitalopram oxalate tablets prescribing information, Contraindications. source
Major
Escitalopram with other serotonergic drugs: serotonin syndrome
With: Other serotonergic drugs (tramadol, SSRIs, SNRIs, triptans, St John's Wort, linezolid) Serotonergic agent
Why it happens
Escitalopram inhibits serotonin reuptake; adding other serotonergic agents raises serotonergic tone.
What can happen
Serotonin syndrome: agitation, tremor, hyperreflexia, sweating, diarrhea, fever, confusion, and potentially life-threatening reactions.
What to do
Monitor closely, especially when doses change. Serotonin syndrome usually appears within hours of a dose change.
Basis: Escitalopram oxalate tablets prescribing information, Warnings: Serotonin Syndrome. source
Why it happens
Alcohol compounds the sedation and impaired judgment escitalopram can cause.
What can happen
Labeling notes that alcohol may worsen performance-related side effects. Escitalopram is not a controlled substance and withdrawal is not expected, but impairment still matters.
What to do
Limit or avoid alcohol, especially when driving or operating machinery.
Basis: Escitalopram oxalate tablets prescribing information, Warnings and Precautions. source