Can you take Lexapro (escitalopram) and hydroxyzine together?
Sometimes, yes. Clinicians do use hydroxyzine (an antihistamine used for anxiety or itching) alongside Lexapro (escitalopram, an SSRI) when they think the benefits outweigh the risks. But the combination can increase side effects and may raise the risk of abnormal heart rhythms in some people, so it should be used only under prescriber guidance.
What side effects might be stronger with the combination?
Common issues patients report when these are taken together include:
- More drowsiness, sedation, and slowed reaction time (hydroxyzine is sedating, and Lexapro can also cause sleepiness in some people)
- Dizziness or lightheadedness
- Dry mouth, constipation, or urinary retention (more often from hydroxyzine)
- Increased nausea or headache
Because hydroxyzine can cause significant drowsiness, many people are advised not to drive or drink alcohol while taking it with Lexapro.
Is there a heart-rhythm risk when mixing them?
Yes, there can be. Escitalopram can lengthen the QT interval in some patients, which can rarely lead to dangerous rhythm problems. Hydroxyzine can also affect heart rhythm in susceptible people. The risk is higher if you:
- Have a history of QT prolongation or abnormal rhythms
- Have low potassium or low magnesium
- Have significant heart disease
- Take other QT-prolonging medicines
If your prescriber thinks the combo is appropriate, they may consider risk factors and, in some cases, check an ECG.
What should you do before taking them together?
Talk with the clinician/pharmacist who prescribed or will prescribe one or both. Ask specifically whether you:
- Have any heart rhythm history or family history of sudden cardiac death
- Take other meds that can prolong QT or cause sedation
- Have electrolyte issues (vomiting/diarrhea, dehydration, diuretics, etc.)
If you were already prescribed both, don’t change doses on your own.
When is it urgent to get help?
Get urgent medical care if you have symptoms like:
- Fainting or near-fainting
- Very fast, irregular heartbeat, or severe palpitations
- Severe dizziness that doesn’t pass
- Trouble breathing, severe swelling, or hives (possible allergic reaction)
Important medication-interaction notes
- Avoid alcohol and other sedatives unless your prescriber says it’s okay.
- Be careful with other medications that cause sleepiness (e.g., sleep meds, some pain meds like opioids, some muscle relaxers).
- If you’re on any other psychiatric meds, anti-nausea meds, antibiotics, or migraine medicines, tell your pharmacist to check for QT and sedation interactions.
If you tell me your details, I can be more specific
What doses are you taking (Lexapro mg and hydroxyzine mg), how often, and for what reason (anxiety vs itching)? Also, do you have any heart history or take any other medicines?