Escitalopram and supplements: 4 sourced interactions
SSRI antidepressant, also sold as Lexapro. Of these, 3 studied in people and 1 named by an FDA label or NIH page. Plus 3 predicted from how each works (not established). Plus 1 food and drink line. Each links its source and the date it was checked.
From the Interaction Map Sources checked Oct 25, 2026
A combination missing here is not on our list; that does not mean it is safe together.
Escitalopram with supplements
Most serious first. Open a row for the mechanism, the source's words and the date checked.
Educational only. Check with your pharmacist or prescriber before changing anything you take.
Major
1St John's wortStudiedSt John's wort with an SSRI can cause serotonin syndrome
major · Studied in people (PubMed) · evidence C · Serotonin activity
Both are thought to raise serotonin activity, so together they can push it too high (inferred).
To raise with your pharmacist or prescriberDo not combine without your prescriber's advice. Agitation, tremor, sweating, fever or muscle twitching after starting St John's wort needs urgent care.
- PMID 10447148 · Lantz MS, J Geriatr Psychiatry Neurol 1999 · Case series (5 patients)
- Checked Oct 10, 2026
Moderate
4SAMeLabel or NIHAn NIH page names this pair (serotonin activity).
moderate · Named by an FDA label or NIH page · Serotonin activity
In the source’s own words; rated moderate from that wording, not from a study of the pair.
“It’s also possible that SAMe might interact with drugs and dietary supplements that increase levels of serotonin (a chemical produced by nerve cells), such as antidepressants, L-tryptophan, and St. John’s wort.”
- NIH National Center for Complementary and Integrative Health · S-Adenosyl-L-Methionine (SAMe): In Depth, Safety and Side Effects of SAMe
- Checked Oct 25, 2026
Asian ginsengPredictedBoth can affect clotting or platelets, so bleeding risk may add up.
moderate · Predicted from how each works, not established · Platelets and bleeding
Predicted from what each is known to do, not studied as a pair and not established.
Both can affect clotting or platelets, so bleeding risk may add up.
- FDA drug label (DailyMed) · Escitalopram: affects clotting or platelets (LEXAPRO (escitalopram) tablets and oral solution [Allergan, Inc.], section 5.7)
- NIH National Center for Complementary and Integrative Health · Asian ginseng: affects clotting or platelets (Asian Ginseng: Usefulness and Safety, What Do We Know About Safety?)
- Checked Oct 25, 2026
GarlicPredictedBoth can affect clotting or platelets, so bleeding risk may add up.
moderate · Predicted from how each works, not established · Platelets and bleeding
Predicted from what each is known to do, not studied as a pair and not established.
Both can affect clotting or platelets, so bleeding risk may add up.
- FDA drug label (DailyMed) · Escitalopram: affects clotting or platelets (LEXAPRO (escitalopram) tablets and oral solution [Allergan, Inc.], section 5.7)
- NIH National Center for Complementary and Integrative Health · Garlic: affects clotting or platelets (Garlic: Usefulness and Safety, What Do We Know About Safety?)
- Checked Oct 23, 2026
Vitamin EPredictedBoth can affect clotting or platelets, so bleeding risk may add up.
moderate · Predicted from how each works, not established · Platelets and bleeding
Predicted from what each is known to do, not studied as a pair and not established.
Both can affect clotting or platelets, so bleeding risk may add up.
- FDA drug label (DailyMed) · Escitalopram: affects clotting or platelets (LEXAPRO (escitalopram) tablets and oral solution [Allergan, Inc.], section 5.7)
- NIH Office of Dietary Supplements · Vitamin E: affects clotting or platelets (Office of Dietary Supplements · Vitamin E, Interactions with Medications · Anticoagulant and antiplatelet medications)
- Checked Oct 25, 2026
Minor
2Fish oil (omega-3)StudiedFish oil and SSRIs: small theoretical bleeding concern
minor · Studied in people (PubMed) · evidence C · Platelets and bleeding
SSRIs are thought to blunt platelet function (inferred); fish oil is often assumed to thin blood, though the surgical trial did not find more bleeding.
To raise with your pharmacist or prescriberUsually not a reason to stop either. Mention both to your prescriber before surgery or if you also take NSAIDs, aspirin or blood thinners (inferred).
- PMID 10531103 · de Abajo FJ, BMJ 1999 · Population-based case-control study
- PMID 30571332 · Akintoye E, Circ Cardiovasc Qual Outcomes 2018 · Randomised placebo-controlled trial (1,516 patients)
- Checked Oct 10, 2026
Ginkgo bilobaStudiedGinkgo and SSRIs: small theoretical bleeding concern
minor · Studied in people (PubMed) · evidence C · Platelets and bleeding
SSRIs are thought to blunt platelet function (inferred); ginkgo is often assumed to affect clotting, though the trials did not show it.
To raise with your pharmacist or prescriberMention both to your prescriber, especially before surgery or if you also take NSAIDs, aspirin or blood thinners (inferred).
- PMID 10531103 · de Abajo FJ, BMJ 1999 · Population-based case-control study
- PMID 21923430 · Kellermann AJ, Pharmacotherapy 2011 · Meta-analysis of 18 RCTs
- Checked Oct 10, 2026
Escitalopram with food and drink
Food and drink
1GrapefruitPredictedGrapefruit may raise Escitalopram levels: it slows CYP3A, an enzyme that breaks Escitalopram down.
moderate · Predicted from how each works, not established · Breakdown by liver enzymes
Predicted from what each is known to do, not studied as a pair and not established.
Grapefruit may raise Escitalopram levels: it slows CYP3A, an enzyme that breaks Escitalopram down.
- FDA table of drugs that interact with CYP enzymes · Grapefruit: CYP3A moderate inhibitor (Table 1, row "grapefruit juice", column "CYP Mod INH" (footnote 9: The effect of grapefruit juice varies widely among brands and is concentration-, dose-, and preparation-dependent. Studies have shown that it can be classified as a “strong CYP3A inhibitor” when a certain preparation was used (e.g., high dose, double strength) or more commonly as a “moderate CYP3A inhibitor” when another preparation was used (e.g., low dose, single strength).))
- FDA drug label (DailyMed) · Escitalopram: CYP3A substrate (LEXAPRO (escitalopram) tablets and oral solution [Allergan, Inc.], section 12.3 Pharmacokinetics · Metabolism)
- Checked Oct 23, 2026
How these lines are sourced
Three kinds of line
- Studied in people (PubMed): PubMed records that were opened and read, graded A (several controlled studies, or a finding in the dosing guidance), B (at least one controlled human study) or C (case reports, observational data or mechanism only).
- Named by an FDA label or NIH page: quoted word for word from that page. Its severity comes from the source’s wording, not from a study of the pair.
- Predicted from how each works, not established: built from sourced facts about each substance, such as the FDA’s table of enzyme roles. Never rated major.
Interaction MapCheck Escitalopram with everything else you take, together
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- St. John's wortSt.
- Interaction MapCheck several medicines and supplements at once, each interaction sourced to PubMed, FDA labels or NIH; a pair we have no source for reads as not on our list, never as safe.