Lexapro and Metoprolol (Is it safe?) 

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In this blog, we are going to talk about possible interactions between Lexapro and Metoprolol. Lexapro is an antidepressant which is most commonly prescribed and it can interact with other medications. 

This blog will cover the benefits and risks of using Lexapro and Metoprolol together. 

Lexapro and Metoprolol: Is there any interaction?

Several studies suggest that lexapro can interact with metoprolol by inhibiting its metabolism. This increases the time duration of metoprolol stay in your body and can result in either toxicity or desensitisation of metoprolol sensitive receptors in cardiac muscles. 

Scientists have thoroughly explained this mechanism. Lexapro and other antidepressants are believed to be the inhibitors of cytochrome P2D6 enzymes. These enzymes are responsible for the metabolism of metoprolol. 

All oral drugs have to go through the first pass metabolism which facilitates their excretion. This inhibition of CYP2D6 increases the availability of metoprolol in your body as the drug gets neither metabolised, nor excreted. It could result in two possible outcomes. 

One, the increased amount of metoprolol gets accumulated and causes toxicity. It might dangerously lower your heart rate and cause serious side effects, which we will discuss later in this blog. 

The second outcome of increased amount of metoprolol for a prolonged period of time is desensitisation of metoprolol sensitive receptors. 

This means that the beta blocker remains available for such a long period of time, that the receptors start adapting to its presence and stop responding to it. This results in therapeutic failure and the drug becomes completely useless for you. 

Your doctor may prescribe another medication to control your blood pressure and heart rate. 

Is there anything you can do to avoid the possible interaction between Lexapro and Metoprolol? 

There are two possible solutions which can help solve this problem. These include:

Do not take Lexapro and Metoprolol together 

In order to minimise this pharmacokinetic drug interaction, it is best to avoid taking these two meds together. You can set separate timings for the administration of these drugs which may help you recover from this interaction. 

This way you will have lesser concentration of one drug in your body when you take the next one. It doesn’t ensure 100% safety from this effect, but can definitely reduce the percentage of inhibition of metoprolol metabolism. 

Your doctor may switch one of the two medications 

If this problem persists, your healthcare provider might switch any one of the two meds, either lexapro or metoprolol. 

There are antidepressants which are mild inhibitors of Cytochrome P2D6 and cause little to no effect when taken with meds which are metabolised via these enzymes. Examples include Zoloft (Sertraline), Effexor (venlafaxine), Tolvon (mianserin) and Remeron (mirtazapine) etc. 

Similarly, there are other antihypertensive and heart rate control medications which are metabolised by other cytochrome enzyme systems and can be taken with Lexapro. 

This is decided by your healthcare provider after weighing the pros and cons and determining what option would be most suitable for you, according to your condition. 

It is not advised to start or stop using any medication without your doctor’s approval, especially those which are capable of causing dependence. 

What are the most common side effects associated with Lexapro and Metoprolol? 

Both of these drugs are associated with side effects of their own. 

Lexapro 

Common side effects of Lexapro include:

  • Loss of appetite 
  • Constipation or diarrhoea
  • Sexual issues
  • Difficulty in falling asleep
  • Vertigo 
  • Decreased salivation or dry mouth
  • Sweating
  • Anxiety 
  • Infections caused by decreased immunity
  • Nausea
  • Shaking
  • Weakness
  • Sleepiness and fatigue
  • Weight gain 

Some serious and rare side effects include allergic reactions associated with symptoms like redness of skin, itching, burning sensation, blisters, blue-purple patches, tightness of chest, wheezing, difficulty in breathing, hoarseness etc. 

It may also cause angle-closure glaucoma which causes symptoms like eye pain, vision changes, or swelling or redness in your eyes. 

Some studies suggest that lexapro can cause low sodium levels which can result in psychological symptoms like confusion, agitation, inability to understand surroundings, memory loss etc. 

It can also cause elongation of QT interval, causing increased heartbeat or arrhythmia and teeth grinding. 

Lexapro when used together with medications such as nonsteroidal anti-inflammatories (NSAIDs), warfarin (an anticoagulant medication), or other anticoagulants etc, can put you at an increased risk of dangerous bleeding. 

Metoprolol 

Common side effects of metoprolol include:

  • Xerostomia or dry mouth 
  • Nausea 
  • Vomiting 
  • Constipation 
  • Flatulence 
  • Acid reflux 
  • Depression 
  • Fatigue 
  • Lightheadedness 
  • Abnormal pain
  • Acid reflux 
  • Flu like symptoms 
  • Skin rash

Some serious side effects include:

  • Difficulty in breathing and chest tightness 
  • Swollen hands and feet as a result of an allergic reaction. 
  • Wheezing
  • Blackouts 
  • Unexplained weight gain or loss
  • Arrhythmia 

Make sure you talk to your healthcare provider if you suffer from any of the above mentioned side effects of both lexapro and Metoprolol. It is hard to predict how medications will react when used together. 

People and their physiological compositions also react differently to different medicine combinations. Some accept it readily, while others fight them off. It is best to start from the lowest effective doses when you’re trying a new medicine combination. 

Higher doses are more likely to cause side effects, whereas side effects associated with lower doses are much easier to handle and they are not life threatening. 

What are the necessary precautions with the use of Lexapro and Metoprolol? 

Both of these meds require precautions and should not be used in certain conditions. It is important to make sure you’re taking your meds properly. In case of lexapro, it should not be coupled with any medication which increases the amount of excitatory neurotransmitters. 

The concomitant use can result in serotonin syndrome. It also tends to induce suicidal behavior in users younger than 24 years of age. 

If you have someone who shows suicidal behavior or you see hopelessness in them, make sure you keep an eye on them and get medical attention as soon as you can. 

Do not stop Lexapro abruptly. If it’s time for you to stop your antidepressant, your doctor will simply make a taper schedule for you, which should be followed vigilantly if you wish to keep withdrawal symptoms at bay. 

Metoprolol, on the other hand, should be used cautiously if you’re using it for non-cardiovascular diseases because it can dangerously lower your heart rate and blood pressure. 

Your healthcare provider might keep you on a low dose and monitor your heart rate from time to time. If you’re a diabetic patient, use metoprolol carefully as you may not be able to detect low blood glucose level because this med keeps your heart rate slow all the time. 

However, metoprolol and other beta blockers are completely contraindicated to be used by patients who suffer from chronic breathing illnesses, including asthma, chronic obstructive pulmonary disease (COPD) and emphysema. 

This is because metoprolol can cause bronchoconstriction (narrowing of airways) which make breathing even more difficult for such patients. Metoprolol should also not be used during pregnancy as it may cause fetal side effects. 

Importance drug tips

  • Do not suggest medications, unless you are a healthcare professional yourself. Do not share medications. You might think your conditions match but oftentimes they don’t. It’s actually pretty dangerous.
  • If you fail to understand how to use the drug properly or have any other question, ask your doctor or pharmacist.
  • In case of overdose, immediately reach out to the hospital. Make sure you properly guide them about how much drug you have taken and when. 
  • If you have missed a dose and you’re way past the usual time at which you take your med, do not take it. It will cause you to overdose when you take your next dose, which is not too far away. It’s better to skip the missed dose and take the next one. If you remember your missed dose earlier, it’s safe for you to take it.

Conclusion 

In this blog, we have discussed the possible interactions between Lexapro and Metoprolol. We have learned that lexapro can increase the concentration of metoprolol by inhibiting its metabolism. 

This effect is seen because lexapro and other antidepressants are believed to be the inhibitors of cytochrome P2D6 enzymes. These enzymes are responsible for the metabolism of metoprolol. 

This inhibition results in either toxicity or desensitisation of metoprolol sensitive receptors in cardiac muscles. We also learned that one of two things can help solve this problem. 

You can either avoid taking these meds at the same time or your healthcare provider might switch one of the two drugs. It is not recommended to take such matters into your own hands. Do not start or stop taking any medication without your doctor’s approval. 

FAQs: lexapro and metoprolol  

Can you take beta blocker with Lexapro?

Yes, you can take beta blockers with lexapro if your healthcare provider has prescribed this combination. However, it is not advised to self medicate. You should never start taking any medication without your doctor’s approval. 

What antidepressant can I take with metoprolol?

Studies suggest that antidepressants which are mild inhibitors of Cytochrome P2D6 and cause little to no effect when taken with metoprolol. Examples include Zoloft (Sertraline), Effexor (venlafaxine), Tolvon (mianserin) and Remeron (mirtazapine) etc.

Does Lexapro lower BP?

Lexapro does not lower your blood pressure, but it can decrease your heart rate. This effect is not common. 

What drugs should not be taken with metoprolol?

Metoprolol should not be taken with any drug which is a potent inhibitor of cytochrome P2D6 enzymes. The concomitant use can dangerously increase the concentration of metoprolol in your body. It is also contraindicated with medications which can increase your heart rate or blood pressure. 

What drugs should not be taken with Lexapro?

  • Do not take lexapro with:
  • Monoaminoxidase inhibitors (MAOIs). The combination use can increase the risk of serotonin syndrome. 
  • Non-steroidal anti-inflammatory drugs (NSAIDS). The combination use can increase the risk of bleeding. 
  • Pimozide. The concomitant use can increase the plasma concentration(availability of a drug in the blood) of pimozide to much higher levels. It can result in life-threatening arrhythmia.
  • Controlled substances, including all narcotic analgesics. The concomitant use can cause severe psychological side effects. 
  • Mood stabilisers 
  • Alcohol 

What are the worst side effects of Lexapro?

  • Allergic reaction associated with symptoms like redness of skin, itching, burning sensation, blisters, blue-purple patches, tightness of chest, wheezing, difficulty in breathing, hoarseness etc. 
  • Angle-closure glaucoma causes symptoms like eye pain, vision changes, or swelling or redness in your eyes.
  • It could cause low sodium levels which can result in psychological symptoms like confusion, agitation, inability to understand surroundings, memory loss etc.
  • It can cause elongation of QT interval, causing increased heartbeat or arrhythmia
  • Teeth grinding
  • Convulsions 

References 

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