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Escitalopram information from DrugsUpdate  

See Available Brands of Escitalopram in India

P - Caution when used during pregnancy
L - Caution when used during lactation
FI - Food *

Escitalopram (trade names Lexapro, Cipralex) is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class. It is approved by the U.S. Food and Drug Administration (FDA) for the treatment of major depressive disorder and generalized anxiety disorder in adults; other indications include social anxiety disorder, panic disorder and obsessive-compulsive disorder. Escitalopram is the S-stereoisomer (enantiomer) of the earlier Lundbeck drug citalopram (Celexa), hence the name escitalopram. Escitalopram is noted for its high selectivity of serotonin reuptake inhibition and, as a result has fewer side effects not related to its serotonergic activity. According to a meta-analysis of 12 new-generation antidepressants, escitalopram and sertraline (Zoloft) are the best in terms of efficacy and acceptability in the acute-phase treatment of adults with major depression; however, sertraline may be a better choice because of the lower cost.

Pharmacodynamics

Pharmacokinetics

Escitalopram selectively inhibits CNS neuronal re-uptake of serotonin (5-HT) and potentiates serotonergic activity. It has minimal effects on norepinephrine and dopamine neuronal re-uptake.


Onset
1-2 weeks

Absorption
Readily absorbed from the GI tract (oral).

Distribution
Protein-binding: 56%.

Metabolism
Hepatic; converted to metabolites

Excretion
Urine (as unchanged drug); 27-32 hr (elimination half-life).

Escitalopram Indications / Escitalopram Uses

Information Not Available

Escitalopram Adverse Reactions / Escitalopram Side Effects

Nausea, diarrhoea, increased sweating, insomnia, impotence, ejaculation disorder, fatigue, somnolence; postural hypotension, sinusitis, taste disturbances. Increased appetite and weight gain.

Precautions

Warnings
Suicidality
Compared with placebo, antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults taking antidepressants for MDD and other psychiatric disorders. Appropriately monitor and closely observe patients of all ages who are started on antidepressant therapy for clinical worsening, suicidality, or unusual changes in behavior. Advise families and caregivers of the need for close observation and communication with the prescriber.

Monitor
Ensure that therapy is periodically reviewed to determine if it needs to be continued without change or if a dose change (eg, increase, decrease, discontinuation) is indicated. Monitor for clinical worsening, suicidality, and unusual changes in behavior, especially during the first few months of therapy or at times of increases or decreases in dose. Evaluate children at least weekly with face-to-face contact with the patient or their family members or caregiver during the first 4 wk of therapy, then every other week for the next 4 wk, then at 12 wk, and as clinically indicated thereafter. The following symptoms may represent precursors to suicidality and should be reported to the health care provider immediately if noted or suspected: aggressiveness, agitation, anxiety, hostility, hypomania, impulsivity, insomnia, irritability, mania, panic attacks, and psychomotor restlessness. Frequently assess patient for response to treatment.

Special Precautions

History of mania or seizure disorders; work requiring mental alertness; renal and hepatic impairment; pregnancy, lactation; withdraw gradually. Children and adolescents <18 yr

Other Drug Interactions

Increased risk of bleeding when used with aspirin, NSAIDs or drugs that affect coagulation. Serum levels may be reduced by CYP2C19 inducers (e.g. carbamazepine, rifampin, phenytoin) or CYP3A4 inducers (e.g. nafcillin, nevirapine). Serum levels may also be increased by CYP2C19 inhibitors (e.g. fluconazole, fluvoxamine, omeprazole) or CYP3A4 inhibitors (e.g. azole antifungals, clarithromycin). May increase serum levels of desipramine or metoprolol. Increased risk of serotonin syndrome when used with linezolid or sibutramine. Escitalopram may enhance the sedative effects of alcohol.

Potentially Fatal: Concomitant administration with MAOIs may lead to serious or fatal reactions; should not be started until at least 2 wk after stopping escitalopram or vice versa. Moclobemide may increase the risk of serotonin syndrome.

Other Interactions

Food Interactions
Increased CNS depression with valerian, St John's wort, kava kava and gotu kola.

Dosage

Oral
Depression
Adult: 10 mg once daily, increased if necessary. Max: 20 mg daily.
Elderly: Half the adult dose.
Hepatic impairment: Dosage adjustments may be required.

Oral
Obsessive compulsive disorder
Adult: 10 mg once daily, increased if necessary. Max: 20 mg daily.
Elderly: Half the adult dose.
Hepatic impairment: Dosage adjustments may be required.

Oral
Anxiety
Adult: 10 mg once daily, increased if necessary. Max: 20 mg daily.
Elderly: Half the adult dose.
Hepatic impairment: Dosage adjustments may be required.

Oral
Panic disorder
Adult: Initially, 5 mg daily, increased to 10 mg daily after 7 days. Max: 20 mg daily.
Elderly: Half the adult dose.
Hepatic impairment: Dosage adjustments may be required.

Food(before/after)

May be taken with or without food

List of Contraindications

Escitalopram and Pregnancy

Caution when used during pregnancy.
Category C: Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.

Escitalopram and Lactation

Caution when used during lactation

Escitalopram and Children

Information Not Available

Escitalopram and Geriatic

Information Not Available

Escitalopram and Other Contraindications

Concomitant use with or within 2 weeks of MAOI withdrawal.

Storage

Oral
Store at 25°C.

Lab interference

Oral
Store at 25°C.

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