A patient is admitted to the psychiatric unit for suicidal ideation. The physician prescribes escitalopram and asks the nurse to review the side effects with the patient. The nurse should include which common side effects in the patient's education?


• Escitalopram (Lexapro) is a selective serotonin reuptake inhibitor (SSRI).

• Common SSRI side effects include sexual dysfunction, nausea, diarrhea or constipation, dizziness, dry mouth, and insomnia.

• Life-threatening, but rare, adverse effects of escitalopram may include neuroleptic malignant syndrome and serotonin syndrome. These answers are incorrect because the nurse was asked to provide teaching about common side effects, which include those the patient might reasonably expect.

• Neuroleptic malignant syndrome is a rare adverse event that most often occurs in the first 2 weeks of treatment with neuroleptic or antipsychotic drugs (but it may develop any time during the therapy). Symptoms include high fever, sweating, unstable blood pressure, stupor, muscular rigidity, and autonomic dysfunction. The syndrome can also occur with abrupt withdrawal of dopaminergic drugs. Intensive care is required. The drug must be discontinued, and the fever is treated aggressively. A muscle relaxant may be prescribed.

• Serotonin syndrome may occur when two drugs or supplements that affect serotonin levels are taken at the same time. For example, if a patient takes migraine medicines in the call of triptans together with selective serotonin reuptake inhibitors (SSRIs) or selective serotonin/norepinephrine reuptake inhibitors (SSNRIs), serotonin levels will be too high. Symptoms occur within minutes to hours, and may include agitation, sweating, fever, hyperreflexia, confusion or hypomania, tremor, ataxia, diarrhea, nausea and vomiting, tachycardia, rapid changes in blood pressure, or hallucinations. Treatment requires hospitalization and benzodiazepines such as diazepam (Valium) or lorazepam (Ativan) to decrease agitation and hyperreflexia, and administration of cyproheptadine (Periactin), a drug that blocks serotonin production. 

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