No reports involved the administration of methylene blue by other routes (such as oral tablets or local tissue injection). In addition, do not initiate Lexapro in a patient who is being treated with MAOIs such as linezolid or intravenous methylene blue. The concomitant use of Lexapro with MAOIs is contraindicated. Serotonin syndrome symptoms may include mental status changes (e.g., agitation, hallucinations, delirium, and coma), autonomic instability (e.g., tachycardia, labile blood pressure, dizziness, diaphoresis, flushing, hyperthermia), neuromuscular symptoms (e.g., tremor, rigidity, myoclonus, hyperreflexia, incoordination) seizures, and/or gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea). John’s Wort) and with drugs that impair metabolism of serotonin, i.e., MAOIs. The risk is increased with concomitant use of other serotonergic drugs (including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, amphetamines, and St. SSRIs, including Lexapro, can precipitate serotonin syndrome, a potentially life-threatening condition. Consider changing the therapeutic regimen, including possibly discontinuing Lexapro, in patients whose depression is persistently worse, or who are experiencing emergent suicidal thoughts or behaviors. Counsel family members or caregivers of patients to monitor for changes in behavior and to alert the healthcare provider. Monitor all antidepressant-treated patients for any indication for clinical worsening and emergence of suicidal thoughts and behaviors, especially during the initial few months of drug therapy, and at times of dosage changes. However, there is substantial evidence from placebo-controlled maintenance trials in adults with MDD that antidepressants delay the recurrence of depression and that depression itself is a risk factor for suicidal thoughts and behaviors. It is unknown whether the risk of suicidal thoughts and behaviors in children, adolescents, and young adults extends to longer-term use, i.e., beyond four months. Table 1: Risk Differences of the Number of Patients of Suicidal Thoughts and Behaviors in the Pooled Placebo-Controlled Trials of Antidepressants in Pediatric and Adult Patients Age Rangeĭrug-Placebo Difference in Number of Patients of Suicidal Thoughts and Behaviors per 1000 Patients Treated
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