Potential Interactions Between Escitalopram and Medicinal Cannabis

Pharmacokinetic Interactions

Cannabis and cannabinoids inhibit several cytochrome P450 enzymes (specifically CYP3A4, CYP2C19, and others) that are responsible for metabolizing many medications, including escitalopram, according to the American Society of Clinical Oncology 1, 2

Increased escitalopram levels may lead to enhanced serotonergic effects and potentially increase the risk of adverse effects, including behavioral activation, sexual dysfunction, and increased risk of bleeding, as reported by the American Academy of Child and Adolescent Psychiatry 3
Theoretical concern for serotonin syndrome exists when combining serotonergic medications with other substances that may affect serotonin levels, as noted by the American Academy of Child and Adolescent Psychiatry 3

Cannabis products have variable THC and CBD content, making drug interactions unpredictable, according to the American Society of Clinical Oncology 1, 2
CBD presents risks for hepatotoxicity, with dose-related, reversible transaminase elevations reported, though typically at higher doses (>300 mg/day), as reported by the American Society of Clinical Oncology 4
Common side effects of cannabis that may compound with escitalopram effects include dizziness, confusion, dry mouth, and fatigue, as well as more serious effects like tachycardia, orthostatic hypotension, severe confusion, and paranoia, according to the American Society of Clinical Oncology 2

Start cannabis products at the lowest possible dose and increase slowly with sufficient time between doses to gauge effects, as recommended by the American Society of Clinical Oncology 1, 2
Be vigilant for signs of serotonin syndrome, including confusion, agitation, anxiety, tremors, hyperreflexia, muscle rigidity, hypertension, tachycardia, and diaphoresis, as advised by the American Academy of Child and Adolescent Psychiatry 3
Consider monitoring liver function tests when using CBD products, particularly at higher doses, as suggested by the American Society of Clinical Oncology 4
Avoid high-fat meals when taking oral cannabis products, as this significantly increases cannabinoid absorption and may exacerbate drug interactions, according to the American Society of Clinical Oncology 2

Elderly patients and those with hepatic impairment may be at higher risk for adverse effects due to reduced drug clearance, as noted by the American Society of Clinical Oncology 2
The limited clinical data on these interactions suggests caution and close monitoring is warranted when combining these substances, as recommended by the American Society of Clinical Oncology 1

CBD presents risks for hepatotoxicity, with dose-related, reversible transaminase elevations reported, though typically at higher doses (>300 mg/day) 5

Cannabis use may be associated with an increased risk for developing depressive disorders and may exacerbate psychiatric disorders in vulnerable individuals 6
Cannabis users are at higher risk of motor vehicle accidents, with drivers who test positive for cannabis being more than twice as likely as other drivers to be involved in motor vehicle crashes 6

Older adults may be at higher risk of confusion and falls when using cannabis than younger people 7
Patients with a history of psychiatric disorders should exercise particular caution, as cannabis may exacerbate these conditions 6
Patients receiving immunotherapy for cancer should be advised to avoid cannabis use, as preliminary data suggest poorer clinical outcomes 8

If using both substances, maintain open communication with healthcare providers about all medications and substances being used 5
Avoid driving when feeling the effects of cannabis, which may be compounded by escitalopram 6
Store cannabis products safely away from children and pets 7
Be aware of local and federal laws regarding cannabis use 7