Jovia Drug Interactions

Contraindicated combinations: Irreversible non-selective MAOIs: Cases of serious reactions have been reported in patients receiving an SSRI in combination with non-selective, irreversible MAOI, and in patients who have recently discontinued SSRI treatment and have been started on so much MAOI treatment. In some cases, the patient developed serotonin syndrome.
Escitalopram is contraindicated in combination with non-selective, irreversible MAOIs. Escitalopram may be started 14 days after discontinuing treatment with an irreversible MAOI. At least seven days should elapse after discontinuing escitalopram treatment, before starting a non-selective, irreversible MAOI.
Reversible, selective MAO-A inhibitor (moclobemide): Due to the risk of serotonin syndrome, the combination of escitalopram with a MAO-A inhibitor such as moclobemide is contraindicated. If the combination proves necessary, it should be started at the minimum recommended dosage and clinical monitoring should be reinforced.
Reversible, non-selective MAO-B inhibitor (linezolid): The antibiotic linezolid is a reversible non-selective MAO-inhibitor and should not be given to patients treated with escitalopram because of an increased risk of serotonin syndrome. If the combination proves necessary, it should be given with minimum dosages and under close clinical monitoring.
Irreversible, selective MAO-B inhibitor (selegiline): In combination with selegiline (irreversible MAO-B inhibitor), caution is required due to the risk of developing serotonin syndrome. Selegiline doses up to 10 mg per day have been safely co-administered with racemic citalopram.
QT interval prolongation: Pharmacokinetic and pharmacodynamic studies of escitalopram combined with other drugs that prolong the QT interval have not been done. An additive effect of escitalopram and these drugs cannot be excluded. Therefore, concomitant use of escitalopram with drugs that prolong the QT interval, such as Class IA and III antiarrhythmics, antipsychotics (e.g., phenothiazine derivatives, pimozide, haloperidol), tricyclic antidepressants, certain antimicrobial agents (e.g., sparfloxacin, moxifloxacin, erythromycin IV, pentamidine, anti-malarial treatment particularly halofantrine), certain antihistamines (e.g., astemizole, mizolastine), is contraindicated.
Combinations requiring precautions for use: Alcohol: No pharmacodynamic or pharmacokinetic interactions are expected between escitalopram and alcohol. However, as with other psychotropic drugs, the combination with alcohol is not recommended.
Lithium and tryptophan: Enhanced effects when SSRIs have been given together with lithium and tryptophan; therefore, concomitant use of SSRIs with these drugs should be undertaken with caution.
St. John's wort: Concomitant use of SSRIs and herbal remedies containing St. John's wort (Hypericum perforatum) may result in an increased incidence of adverse reactions.
Serotonergic drugs (e.g., tramadol, sumatriptan and other triptans): Concomitant use of serotonergic drugs (e.g., tramadol, sumatriptan and other triptans) may lead to serotonin syndrome.
If concomitant treatment of escitalopram with a triptan is clinically warranted, careful observation of the patient is advised, particularly during treatment initiation and dose increases.
Drugs that interfere with hemostasis (NSAIDS, aspirin, warfarin): Serotonin release by platelets plays an important role in hemostasis. Epidemiological studies of the case-control and cohort studies that have demonstrated an association between use of psychotropic drugs that interfere with serotonin reuptake and the occurrence of upper GI bleeding have also shown that concurrent use of an NSAID or aspirin may potentiate the risk of bleeding.
Altered anticoagulant effect may occur when escitalopram is combined with oral anticoagulants (e.g., warfarin). Patients receiving oral anticoagulant therapy should receive careful coagulation monitoring when escitalopram is started or stopped.
Drugs lowering the seizure threshold (e.g., antidepressants, neuroleptic, mefloquine, bupropion, and tramadol): SSRI can lower the seizure threshold. Caution is advised when concomitantly using other drugs capable of lowering the seizure threshold such as antidepressants (e.g., tricyclics and SSRIs), neuroleptics (e.g., phenothiazines, thioxanthenes and butyrophenones), mefloquine, bupropion, and tramadol.
Drugs affecting the CNS: Given the primary CNS effects of escitalopram, caution should be used when it is taken in combination with other centrally acting drugs.
Drugs inducing hypokalemia/hypomagnesemia: Cautions is warranted for concomitant use of hypokalemia/hypomagnesemia inducing drugs as these conditions increase the risk of malignant arrhythmias.
CYP2C19 inhibitors (e.g., omeprazole, esomeprazole, fluvoxamine, lansoprazole, ticlopidine) or cimetidine: Caution should be exercised when used concomitantly with these drugs. A reduction in the dose of escitalopram may be necessary based on monitoring of side effects during concomitant treatment.
In vitro studies have shown that escitalopram may also cause weak inhibition of CYP2C19. Caution is recommended with concomitant use of drugs that are metabolized by CYP2C19.
Concomitant use with omeprazole resulted in moderate (approximately 50%) increased in the plasma concentrations of escitalopram.
Concomitant use with cimetidine resulted in a moderate (approximately 70%) increase in the plasma concentration of escitalopram. Caution is advised when administering escitalopram in combination with cimetidine. Dose adjustment may be warranted.
Drugs metabolized by CYP2D6: Escitalopram is an inhibitor of the enzyme CYP2D6. Caution is recommended when escitalopram is concomitantly used with drugs that are mainly metabolized by this enzyme, and that have a narrow therapeutic index, such as flecainide, propafenone, metoprolol (when used in cardiac failure), or some CNS acting drugs that are mainly metabolized by CYP2D6, such as antidepressants (e.g., desipramine, clomipramine, and nortriptyline) or antipsychotics (e.g., risperidone, thioridazine, and haloperidol). Dosage adjustment may be warranted.
Desipramine or metoprolol: Concomitant use with desipramine or metoprolol resulted in both cases in a twofold increase in the plasma levels of these two CYP2D6 substrates.