Escitalopram × Prednisolone

Two separate risks add up in the same pair. First the mucosa: the corticosteroid slows epithelial turnover and escitalopram depletes platelet serotonin, so gastrointestinal bleeding risk rises. Second the rhythm: escitalopram prolongs the QT interval in a dose-dependent way, and a systemic corticosteroid drives potassium loss. The droperidol and amiodarone labels name glucocorticoids alongside potassium-wasting diuretics as drugs that induce electrolyte imbalance and raise torsade de pointes risk. The escitalopram label contraindicates use with QT-prolonging drugs and asks for hypokalaemia and hypomagnesaemia to be corrected before starting.

On the gastrointestinal side: epigastric pain, black stools, coffee-ground vomit, anaemia with no obvious cause. On the cardiac side: palpitations, dizziness, syncope; on ECG, a prolonged QTc. Muscle weakness and cramps flag the low potassium that precedes the arrhythmia.

Potassium and magnesium before the pair starts and during follow-up, with an ECG and QTc if the corticosteroid runs for weeks or other factors are present: older age, heart disease, another QT-prolonging drug. The escitalopram dose over 65 is capped at 10 mg a day per the label. With a corticosteroid beyond two weeks, a history of ulcer or older age, gastroprotection with a proton pump inhibitor is added. Check whether the corticosteroid is still indicated: the shortest route is stopping what is no longer needed.