Does Lexapro interact with Zofran? (+3 alternatives)

In this article, we will explore whether Lexapro interacts with Zofran or not. Furthermore, the potential interactions and countermeasures may also be discussed.

Does Lexapro interact with Zofran?

Yes, Lexapro can interact with Zofrann especially if the doses are not adjusted properly. However, in rare cases, there may be an increased risk of serotonin syndrome and QT prolongation when taking these medications together.

They are considered safe to be taken together for most people. However, as with any indication, responses can vary and there is always the potential for rare unusual interactions. Lexapro (escitalopram) is an antidepressant (1) that also helps with social anxiety, while Zofran (ondansetron) is an anti-emetic medication used to treat nausea and vomiting(2). Whereas, both of these affect serotonin levels. 

The two medications have distinct purposes but it is essential to consult your healthcare provider before taking these two medications together.

How does Lexapro interact with Zofran?

Lexapro (escitalopram) is a selective serotonin reuptake inhibitor or SSRI. It primarily works by increasing serotonin levels in brain cells (3). The elevated levels of serotonin help in improving moods and reduce the symptoms of depression and social anxiety.

Zofran (ondansetron) is an anti-emetic medication, that blocks the serotonin receptors particularly the 5-HT3 receptor in the brain and gastrointestinal tract (4). It is used to treat nausea and vomiting often in the context of chemotherapy and radiotherapy or surgery.  

When these two drugs are taken together there is generally no significant interaction. However, due to their common effect on serotonin, the body can experience an increased level of serotonin in the brain causing serotonin syndrome (5).  It is a serious and potentially dangerous reaction that can lead the body to a comma, if not treated properly. 

What are the potential interactions of Lexapro and Zofran?

The concurrent use of Lexapro with Zofran can potentially lead to interactions and it is essential to be aware of such potential interactions. The primary concern is the risk of development of serotonin syndrome, a rare but serious condition. Here are some potential interactions to consider.

Serotonin syndrome

Both Lexapro and Zofran affect the serotonin levels in the brain, albeit through different mechanisms. Lexapro is an SSRI that increases serotonin levels, while Zofran blocks serotonin receptors. When taken together, there is a risk of excessive serotonin activity, which can lead to serotonin syndrome (5). 

Symptoms of serotonin syndrome include (6):

• Hallucinations
• Seizures
• High blood pressure
• Increased heart rate
• Fever
• Shivering
• Muscle rigidity

It can be very life-threatening. It is important to note that not everyone faces these signs and symptoms. These may vary from patient to patient.

QT prolongation

Lexapro and Zofran are two different medications. Their interaction can cause QT prolongation in some patients as well. This can cause a condition called torsades de points which is life-threatening. 

Both drugs are associated with QT prolongation independently and affect the electrical activity of the heart (7) (8).  This effect is dose-dependent (9). When used together, the effect can potentially increase due to the additive effect and the severity may be more as compared to when medications are taken independently.  

It is essential to note that the risk is higher at higher doses. Your healthcare provider may adjust the doses of both these medications if QT prolongation is reported.

What factors influence the Lexapro and Zofran interaction?

The interaction between Lexapro and Zofran can be influenced by multiple factors such as:

Dose: Doses can influence the severity of the effect of medications. Higher doses can cause a higher risk of serotonin syndrome.

Individual variability: Every individual’s body processes medication differently due to genetic and metabolic uniqueness. Due to these factors, some people may be more susceptible to the effects.

Duration of use: Long-term use of both these medications can cause an increased risk of cumulative effects.

Other medications: Concurrent use of this combination with some other medication may cause the appearance of signs and symptoms of serotonin syndrome. The medications include other SSRIs, Triptans, Tricyclic antidepressants, MAOIs and other serotonergic medications.

Other medical health conditions: You may be more susceptible to these conditions if you have a congenital long QT syndrome, electrolyte balance or cardiac abnormalities.

What to do if Lexapro and Zofran show interactions?

The combination is prescribed only when the healthcare provider thinks that the potential benefits outweigh the risks. Usually, Lexapro and Zofran are not prescribed as a combination for their additive effects, These drugs are only prescribed when a patient with depression has the problem of nausea or vomiting as well.

Although the interaction of Lexapro and Zofran is rare, if the effects are observed, then consulting your healthcare provider is essential. In case of the appearance of serotonin syndrome, the doctor may suggest:

• Benzodiazepines such as diazepam and lorazepam may be administered to control agitation and seizure.
• Hyperthermia is a common symptom so cooling measures may be adopted to elevate the body temperature.
• IV fluid may be administered to maintain hydration and electrolyte balance.
• In severe cases, muscle relaxants may also be given.
• Cyproheptadine, an anti-serotonin medication or a serotonin antagonist helps counteract the effects of excess serotonin to relieve the patient (9).

What other drugs can replace Zofran if interactions are observed?

If you are taking Lexapro with Zofran and interactions are observed and even the dose adjustment is not sufficient to pervent you from the side effects, then after a detailed discussion with your healthcare provider, Zofran can be replaced by one of these drugs that also have an anti-emetic effect.

• Metoclopramide: It helps food and acid to move out of the stomach quickly.
• Promethazine: It is an antihistamine having an antiemetic effect as well.
• Prochlorperazine: It is an antipsychotic medication that helps with nausea and vomiting.
• Dramamine: It is an over-the-counter antihistamine having anti-emetic effects.

Conclusion

In my perspective, Lexapro and Zofran do not have any therapeutic additive effects. These are two drugs used for different purposes through different mechanisms. However, taking them together in rare cases can lead to interactions such as serotonin syndrome in patients.

References