Over-the-Counter Medications to Avoid With Lexapro (Escitalopram)
Lexapro (escitalopram) increases bleeding risk when combined with OTC drugs that affect hemostasis, including aspirin and NSAIDs. [1] Lexapro also increases serotonin syndrome risk when combined with OTC products that have serotonergic activity, including dextromethorphan-containing cough products. [1] [2]
OTC Agents That Increase Bleeding Risk
The following OTC products may increase bleeding or bruising risk when used with Lexapro.
- Aspirin [1] [3]
- NSAIDs (including ibuprofen and naproxen) [1] [3]
OTC Agents That Increase Serotonin Syndrome Risk
The following OTC products may increase the risk of serotonin syndrome when used with Lexapro.
- Dextromethorphan (commonly found in OTC cough and cold products) [2] [1]
- St. John’s wort [3]
- Tryptophan (OTC supplement) [3]
Key Evidence Supporting These Restrictions
Lexapro labeling includes warnings that serotonin reuptake–inhibiting antidepressants can increase bleeding risk and that concomitant use with drugs that affect hemostasis (including aspirin and NSAIDs) may potentiate bleeding. [1] Serotonin syndrome can occur with antidepressants and products containing dextromethorphan, a serotonergic OTC cough ingredient. [2]
Practical Selection for OTC Medication Categories
Safe selection is based on avoiding OTC drug categories specifically highlighted for interaction risk.
- Avoid OTC cough/cold products containing dextromethorphan. [2] [1]
- Avoid OTC pain relievers that are aspirin or NSAIDs. [1] [3]
- Avoid OTC supplements containing St. John’s wort or tryptophan. [3]
Common Pitfalls to Avoid
Many OTC products contain more than one active ingredient. [3] Dextromethorphan is frequently present in OTC cough-and-cold formulations. [2] Aspirin and NSAIDs are frequently present in OTC pain and “headache” combination products. [1] [4]
When Additional Caution Is Needed
Bleeding risk is increased with concomitant use of Lexapro and OTC drugs that affect hemostasis. [1] Serotonin syndrome risk is increased when Lexapro is combined with other serotonergic agents, including dextromethorphan-containing OTC cough products. [1] [2]