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If the patient is classified as a poor metabolizer of the enzyme CYP2C19, they are at a greater risk for drug reactions and may want to reduce the dose or consider alternative treatment (8) Adverse Effects and Black Box Warnings Escitalopram has the following side effects: (8): Insomnia Sexual dysfunction Reduce libido Anorgasmia Male ejaculatory delay Nausea Increased sweating Fatigue Somnolence QT prolongation Serotonin syndrome Rare but serious A Black Box Warning is present for Escitalopram for the increased risk of suicidal ideation