Feliz S 10/Feliz S 20 Drug Interactions

CNS Drugs: Due to CNS effects of Escitalopram, caution should be used when it is taken in combination with other centrally acting drugs.
Alcohol: Although racemic citalopram did not potentiate the cognitive and motor effects of alcohol, the use of alcohol by patients taking Escitalopram is not recommended.
Lithium: May enhance the serotonergic effects of Escitalopram, caution should be exercised when Escitalopram and lithium are co-administered.
Sumatriptan: There have been rare reports of weakness, hyperreflexia and in-coordination following the use of a selective serotonin reuptake inhibitor (SSRI) and sumatriptan. If concomitant treatment of sumatriptan and an SSRI is clinically warranted, appropriate observation of the patient is advised.
Ketoconazole: Combined administration of racemic citalopram (40 mg), and Ketoconazole (200 mg) decreased the Cmax, and AUC of Ketoconazole by 21% and 10%, respectively, and did not significantly affect the pharmacokinetics of citalopram.
CYP3A4 and - 2C19 inhibitors: The metabolism of escitalopram is mainly mediated by CYP2C19 and CYP3A4 may also contribute to the metabolism although to a smaller extent. Co-administration of escitalopram with omeprazole 30 mg once daily (a CYP2C19 inhibitor) resulted in moderate (approximately 50%) increase in the plasma concentrations of escitalopram. Co-administration of escitalopram with cimetidine 400 mg twice daily (moderately potent general enzyme-inhibitor) resulted in a moderate (approximately 70%) increase in the plasma concentrations of escitalopram.
Thus, caution should be exercised when used concomitantly with CYP2C19 inhibitors (e.g. omeprazole, esomeprazole, fluvoxamine, lansoprazole, ticlopidine) or cimetidine. A reduction in the dose of escitalopram may be necessary based on monitoring of side-effects during concomitant treatment.
Drugs Metabolized by Cytochrome P4502D6: Escitalopram is an inhibitor of the enzyme CYP2D6. Caution is recommended when escitalopram is co-administered with medicinal products that are mainly metabolized by this enzyme, and that have a narrow therapeutic index, e.g. flecainide, propafenone and metoprolol (when used in cardiac failure), or some CNS acting medicinal products that are mainly metabolised by CYP2D6, e.g. antidepressants such as desipramine, clomipramine and nortriptyline or antipsychotics like risperidone, thioridazine and haloperidol. Dosage adjustment may be warranted. Co-administration with desipramine cases in a twofold increase in the plasma levels of desipramine.
Drugs that Interfere with Hemostasis (NSAIDS, Aspirin, Warfarin, etc): NSAIDS and Aspirin may potentiate the risk of bleeding. Altered anticoagulant effects, including increased bleeding, have been reported when SSRIs and SNRIs are coadministered with warfarin.
Metoprolol: Administration of 20 mg/day Escitalopram for 21 days resulted in a 50% increase in Cmax and 82% increase in AUC of the beta-adrenergic blocker Metoprolol (given in a single dose of 100 mg). Increased Metoprolol plasma levels have been associated with decreased cardio-selectivity. Co-administration of Escitalopram and Metoprolol had no clinically significant effects on blood pressure or heart rate.