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Is there interaction between Lexapro and Zyprexa?

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Posted on Fri, 15 May 2015
Question: I am on Klonopin 1 mg, Lexapro 20 mg, Keppra 1250 mg and Zyprexa 5 mg. I am mild metabolizer for cyp2c19 allele 2 and as far as i understand this cyp is involved in Klonopin and Lexapro, and i am also mild metabolizer for cyp 2d6 4. Since Zyprexa seems to work very well for me, i would like to know if some serotoninergic interaction between Lexapro and Zyprexa is possible and if Zyprexa works also well at a serotoninergic level. My psychiatrist wants to give me a little lower dosage of Lexapro to avoid problems discovered with my cyp.
Thanks beforehand
doctor
Answered by Dr. Shubham Mehta (4 hours later)
Brief Answer:
no interaction between lexapro and zyprexa.

Detailed Answer:
Hello
Welcome to HCM.

Dear,

There are no serotonergic interactions between zyprexa and lexapro because both acts by different mechanisms.

Zyprexa acts on 5HT2A and 5HT2C receptors whereas lexapro acts by blocking serotonin pump.

Lexapro has almost negligible CYP-450 mediated drug interactions. So there should not be any problem.

Hope this helps.

Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shubham Mehta (11 minutes later)
Dr Mehta,
Thanks a lot for your answer. If Zyprexa acts on 5HT2A and 5HT2C, there is no risk of OCD like symptoms?¿Zyprexa then cannot counter effects of Solian in 5HT7 and 5HT2b receptors?
Thanks beforehand
doctor
Answered by Dr. Shubham Mehta (45 minutes later)
Brief Answer:
both have different receptor profiles.

Detailed Answer:
Dear,

Please allow me to tell you some facts about recepetor profiles these two antipsychotics:

Zyprexa acts on number of receptors including D2 (dopamine) and 5HT2A and 5HT2C receptors.

Amisulpride selective acts on D2/D3 receptors. It has negligible affinity for 5HT receptors At low doses (say 50-100mg), it act as partial dopamine agonist. At high doses (say 400-800 mg), it act as dopamine antagonist.

The anti-obsessional action of atypical antpsychotics is due to dopamine receptor blocking activity.

With these facts and as far as my clinical experience is concerned, amisulpride at high doses is better anti-OCD drug. (Zyprexa is known to induce OC symptoms when used in treatment of schizophrenia. On the other hand, it has been fairly studied as an augmenting agent in SSRI-non-responsive OCD).

The mechanisms of action of the antipsychotics are so complicated (and many actions being still researched), that there are much inter-individual variations in response to these drugs.

Its great that your symptoms are responding very well to zyprexa. You must continue with the drug.

I do not think there should be the issue of zyprexa counteracting the effects of solian because both have different receptor profiles.

Hope I could clear your confusion to some extent.

Sorry for a lengthy answer.

Take care.
Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Shubham Mehta

Psychiatrist

Practicing since :2008

Answered : 2134 Questions

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Is there interaction between Lexapro and Zyprexa?

Brief Answer: no interaction between lexapro and zyprexa. Detailed Answer: Hello Welcome to HCM. Dear, There are no serotonergic interactions between zyprexa and lexapro because both acts by different mechanisms. Zyprexa acts on 5HT2A and 5HT2C receptors whereas lexapro acts by blocking serotonin pump. Lexapro has almost negligible CYP-450 mediated drug interactions. So there should not be any problem. Hope this helps. Thanks.