Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes Cipralex (Escitalopram). If you are concerned about side effects, discuss the risks and benefits of Cipralex (Escitalopram) with your doctor.

The following side effects have been reported by at least 1% of people taking Cipralex (Escitalopram). Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• changes in heart rate
• congested or runny nose
• Constipation
• Diarrhea
• difficulty sleeping
• dizziness
• drowsiness
• Dry Mouth
• fatigue
• Fever
• heartburn
• increased sweating
• Insomnia
• loss of appetite
• muscle or joint pain
• nausea
• sexual dysfunction including:
• decreased libido (sex drive)
• Erectile Dysfunction (difficulty getting or keeping an erection)
• inability to have an orgasm
• stomach pain
• stomach upset
• yawning

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• anxiety
• bruising or unusual bleeding from the skin or other areas
• difficulty controlling blood sugar levels
• feeling of skin prickling
• hallucinations
• inability to urinate
• involuntary movements of the body or face
• low blood sodium (confusion, seizures, drowsiness, dryness of mouth, increased thirst, lack of energy)
• mania (overactive behavior and thoughts)
• new or worsening emotional symptoms
• severe agitation or restlessness
• symptoms of Glaucoma, e.g.:
• increased pressure in the eye
• eye pain
• blurred vision
• symptoms of liver damage, e.g.:
• abdominal pain
• dark urine
• clay-coloured stools
• itching
• loss of appetite
• nausea and vomiting
• yellow skin or eyes

Stop taking the medication and seek immediate medical attention if any of the following occur:

• seizure or convulsions
• serotonin syndrome or neuroleptic malignant syndrome – signs include:
• agitation
• confusion
• diarrhea
• fever
• overactive reflexes
• poor coordination
• restlessness
• shivering
• sweating
• talking or acting with excitement you cannot control
• trembling or shaking
• twitching
• symptoms of an abnormal rhythm such as heart palpitations, dizziness, or fainting
• symptoms of a serious allergic reaction such as swelling of the face or throat, Hives, or difficulty breathing
• thoughts of suicide or hurting yourself
• vomiting blood or presence of blood in the stool

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking Cipralex (Escitalopram).

Regular tablets

10 mg
Each film-coated, white, oval, scored tablet, marked with "EL" on one side, contains 10 mg of Cipralex (Escitalopram) (as Cipralex (Escitalopram) oxalate). Nonmedicinal ingredients: colloidal silicon dioxide, croscarmellose sodium, hydroxypropyl methylcellulose, magnesium stearate, microcrystalline cellulose, polyethylene glycol 400, talc, and titanium dioxide (white E-171).

20 mg
Each film-coated, white, oval, scored tablet, marked with "EN" on one side, contains 20 mg of Cipralex (Escitalopram) (as Cipralex (Escitalopram) oxalate). Nonmedicinal ingredients: colloidal silicon dioxide, croscarmellose sodium, hydroxypropyl methylcellulose, magnesium stearate, microcrystalline cellulose, polyethylene glycol 400, talc, and titanium dioxide (white E-171).

Do not take Cipralex (Escitalopram) if you:

• are allergic to Cipralex (Escitalopram), Citalopram, or any ingredients of the medication
• have a condition known as congenital long QT syndrome or have a heart rhythm disturbance called QT prolongation
• are taking the medication Pimozide
• have taken a MAO inhibitor medication (e.g., Phenelzine, Tranylcypromine, Moclobemide) in the past 2 weeks – MAO inhibitors should not be taken until at least 2 weeks after stopping treatment with Cipralex (Escitalopram)

There may be an interaction between Cipralex (Escitalopram) and any of the following:

• acetylsalicylic acid (ASA)
• alcohol
• amiodarone
• amphetamines (e.g., Dextroamphetamine, Lisdexamfetamine)
• anticoagulants (e.g., Apixaban, clopidogrel, dabigatran, Rivaroxaban, Warfarin)
• antihistamines (e.g., cetirizine, doxylamine, Diphenhydramine, Hydroxyzine, Loratadine)
• antipsychotics (e.g., Chlorpromazine, Clozapine, Haloperidol, Olanzapine, Paliperidone, pimozide, Quetiapine, Risperidone)
• Anagrelide
• Apalutamide
• Asenapine
• barbiturates (e.g., butalbital, pentobarbital, Phenobarbital)
• benzodiazepines (e.g., Alprazolam, Diazepam, Lorazepam)
• Bosentan
• Buserelin
• Buspirone
• chloral hydrate
• chloroquine
• cimetidine
• Clonidine
• Deferasirox
• Desmopressin
• Dextromethorphan
• diabetes medications (e.g., Canagliflozin, chlorpropamide, Glyburide, insulin, Metformin, Rosiglitazone)
• dipyridamole
• Disopyramide
• dofetilide
• Domperidone
• efavirenz
• Entacapone
• Enzalutamide
• ergot alkaloids (e.g., ergotamine, Dihydroergotamine)
• etravirine
• Flecainide
• fluconazole
• Heparin
• herbal products that affect blood clotting (e.g., cat's claw, chamomile, fenugreek, evening primrose, feverfew, garlic, ginger, ginseng, glucosamine, turmeric)
• itraconazole
• ketoconazole
• laxatives
• Lanreotide
• Linezolid
• lithium
• lopinavir
• low molecular weight heparins (e.g., Dalteparin, Enoxaparin, Tinzaparin)
• macrolide antibiotics (e.g., clarithromycin, erythromycin)
• Metoclopramide
• Methadone
• Methylphenidate
• metoclopramide
• Mexiletine
• mifepristone
• Mirtazapine
• Mitotane
• monoamine oxidase inhibitors (M.O.S. e.g., moclobemide, Rasagiline, Selegiline, tranylcypromine, methylene blue)
• multivitamin supplements
• Modafinil
• muscle relaxants (e.g., Baclofen, Cyclobenzaprine, methocarbamol, orphenadrine)
• narcotic pain relievers (e.g., Codeine, Fentanyl, Morphine, Oxycodone)
• nefazodone
• non-steroidal anti-inflammatory medications (NSAIDs; e.g., Diclofenac, ibuprofen, naproxen)
• Obinutuzumab
• Octreotide
• omeprazole
• Pasireotide
• pentamidine
• Pentoxifylline
• procainamide
• Propafenone
• protein kinase inhibitors (e.g., Crizotinib, Nilotinib, Lapatinib, Pazopanib, Sunitinib)
• quinidine
• quinine
• quinolone antibiotics (e.g., ciprofloxacin, Ofloxacin)
• rifampin
• St. John's wort
• saquinavir
• scopolamine
• seizure medications (e.g., Clobazam, Levetiracetam, phenobarbital, Phenytoin, primidone, Topiramate, Valproic acid, zonisamide)
• other selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, Fluoxetine, Paroxetine, Sertraline)
• serotonin antagonists (anti-emetic medications; e.g., Dolasetron, Granisetron, Ondansetron)
• serotonin/norepinephrine reuptake inhibitors (SNRIs; e.g., Desvenlafaxine, Duloxetine, Venlafaxine)
• siltuximab
• sotalol
• Stiripentol
• sulfonamide antibiotics ("sulfas"; e.g., sulfisoxazole, sulfamethoxazole)
• Tapentadol
• Tetrabenazine
• thiazide diuretics (water pills; e.g., Hydrochlorothiazide, Indapamide, Metolazone)
• Thyroid replacements (e.g., desiccated thyroid, Levothyroxine)
• tipranavir
• Tocilizumab
• tolcapone
• Tramadol
• Trazodone
• tricyclic antidepressants (e.g., Clomipramine, Desipramine, Imipramine)
• triptans (e.g., Naratriptan, Sumatriptan, Zolmitriptan)
• Tryptophan
• vitamin E
• Voriconazole
• Zolpidem
• Zopiclone

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with Cipralex (Escitalopram). Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the Nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use Cipralex (Escitalopram).

Abnormal heart rhythm: Cipralex (Escitalopram) may cause an abnormal heart rhythm, especially at higher doses. Your doctor may occasionally monitor your heart rate and rhythm with a test called an electrocardiogram. People with a history of a heart rhythm disturbance called QT prolongation should not take Cipralex (Escitalopram). If you have Congestive Heart Failure, have slow heart rhythm, are at risk of low potassium or magnesium levels because of certain illnesses or medications, or are taking certain medications that can affect the heart rhythm (e.g., Amiodarone, Sotalol), you should discuss with your doctor how Cipralex (Escitalopram) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Cipralex (Escitalopram), and whether any special monitoring is needed.

Bleeding disorders: Other medications from the same class as Cipralex (Escitalopram) may cause bleeding disorders. Report any unusual bruising or bleeding to your doctor, especially if you are taking medications that affect platelets (special blood cells that help the blood to clot). These medications include Asa, Clopidogrel, Dipyridamole, nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., Ibuprofen or Naproxen), and certain antipsychotic medications.

Bone health: Studies have shown that there is an increased risk of bone fractures with the use of medications similar to Cipralex (Escitalopram). If you have Osteoporosis, or are at risk of developing osteoporosis, discuss with your doctor how Cipralex (Escitalopram) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Cipralex (Escitalopram), and whether any special monitoring is needed.

Diabetes: If you have diabetes, your doctor should closely monitor your condition while you are taking Cipralex (Escitalopram), as it may affect blood sugar control (either increase or decrease blood sugar levels).

Glaucoma: Cipralex (Escitalopram) may cause the symptoms of glaucoma (increased pressure in the eye) to become worse. If you have glaucoma, discuss with your doctor how Cipralex (Escitalopram) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Cipralex (Escitalopram), and whether any special monitoring is needed. Report any changes in vision to your doctor as soon as possible while you are taking Cipralex (Escitalopram).

Kidney function: If you have severely reduced kidney function, your doctor should closely monitor your condition while you are taking Cipralex (Escitalopram).

Liver function: Decreased liver function or liver disease may cause Cipralex (Escitalopram) to build up in the body, causing increased side effects. If you have reduced liver function, discuss with your doctor how Cipralex (Escitalopram) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Cipralex (Escitalopram), and whether any special monitoring is needed.

Mania: Cipralex (Escitalopram) may cause activation of mania. This means that people who are prone to mania may be more likely to have their mania start up again. If you have a history of mania or bipolar disorder, your doctor should closely monitor your condition while you are taking Cipralex (Escitalopram).

Neuroleptic malignant syndrome (NMS): Cipralex (Escitalopram), like other similar medications that act on serotonin, can cause a potentially fatal syndrome known as neuroleptic malignant syndrome (NMS). If you notice the symptoms of NMS such as high fever, muscle stiffness, confusion or loss of consciousness, sweating, racing or irregular heartbeat, or fainting, get immediate medical attention.

Seizures: If you have a history of seizures, your doctor should closely monitor your condition while you are taking Cipralex (Escitalopram). If you develop seizures, stop taking the medication and contact your doctor.

Serotonin syndrome: Severe reactions are possible when Cipralex (Escitalopram) is combined with other medications that act on serotonin, such as tricyclic antidepressants and "triptan" migraine medications. Symptoms of a reaction may include muscle rigidity and spasms, difficulty moving, changes in mental state including delirium and agitation. Coma and death are possible.

Stopping the medication: Cipralex (Escitalopram) should not be stopped abruptly due to the risk of discontinuation symptoms (dizziness, abnormal dreams, numbness, electric shock feelings, agitation, anxiety, difficulty concentrating, headache, tremor, nausea, vomiting, and sweating). A gradual reduction in dose over a period of time is recommended. If you are thinking of stopping the medication, talk to your doctor or pharmacist about how to do this safely.

Suicidal or agitated behaviour: Adults and children taking Cipralex (Escitalopram) may feel agitated (restless, anxious, aggressive, emotional, and feeling not like themselves), or they may want to hurt themselves or others. These symptoms may occur within several weeks after a person starts taking Cipralex (Escitalopram) or when doses are adjusted. People taking Cipralex (Escitalopram) should be closely monitored by their doctor for emotional and behavioural changes.

Pregnancy: The safe use of Cipralex (Escitalopram) during pregnancy has not been established. Newborn babies may experience serious adverse effects if the mother is taking citalopram during the 3 months before the baby is born. Doctors and pregnant women should carefully consider the benefits and the risks of all treatment options. If you become pregnant while taking Cipralex (Escitalopram), contact your doctor immediately.

Breast-feeding: It is known that the medication citalopram, which is similar to Cipralex (Escitalopram), passes into breast milk. If you are a breast-feeding mother and are taking Cipralex (Escitalopram), it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children and adolescents: The safety and efficacy of Cipralex (Escitalopram) for children and adolescents under 18 years of age have not been established. It may cause behavioural and emotional changes, such as suicidal thoughts and behaviour.