Escitalopram

What is Escitalopram?

• Escitalopram (Lexapro) is a selective serotonin reuptake inhibitor (SSRI) used to treat major depressive disorder or generalized anxiety disorder.

Escitalopram

Escitalopram-skeletal

What are the uses of this medicine?

Escitalopram (Lexapro) is a prescription medicine used to treat depression. Lexapro is also used to treat:

• Major Depressive Disorder (MDD)
• Generalized Anxiety Disorder (GAD)

How does this medicine work?

• The mechanism of antidepressant action of escitalopram, the S-enantiomer of racemic citalopram, is presumed to be linked to potentiation of serotonergic activity in the central nervous system (CNS) resulting from its inhibition of CNS neuronal reuptake of serotonin (5-HT).
• Citalopram (sye tal' o pram) and escitalopram (es" sye tal' oh pram) are antidepressants that belong to the class of selective serotonin reuptake inhibitors (SSRIs).
• By blocking the reuptake of serotonin in CNS synaptic clefts, SSRIs increase serotonin levels and serotonin activity which results in antidepressant effects.

Who Should Not Use this medicine ?

This medicine cannot be used in patients who:

• are allergic to escitalopram or citalopram or any of the ingredients in Lexapro.
• Take a monoamine oxidase inhibitor (MAOI)
• Take Pimozide

• Do not take an MAOI within 2 weeks of stopping Lexapro unless directed to do so by your physician
• Do not start Lexapro if you stopped taking an MAOI in the last 2 weeks unless directed to do so by your physician.

What drug interactions can this medicine cause?

• Do not use MAOIs intended to treat psychiatric disorders with Lexapro or within 14 days of stopping treatment with Lexapro. Do not use Lexapro within 14 days of stopping an MAOI intended to treat psychiatric disorders. In addition, do not start Lexapro in a patient who is being treated with linezolid or intravenous methylene blue.
• Concomitant use in patients taking pimozide is contraindicated.
• Caution should be used when it is taken in combination with other centrally acting drugs.
• The use of alcohol by patients taking Lexapro is not recommended.
• Patients receiving warfarin therapy should be carefully monitored when Lexapro is initiated or discontinued.
• Lithium may enhance the serotonergic effects of escitalopram, caution should be exercised when Lexapro and lithium are coadministered.
• If concomitant treatment with sumatriptan and an SSRI (e.g., fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram, escitalopram) is clinically warranted, appropriate observation of the patient is advised.
• Concomitant use with SSRIs, SNRIs or Tryptophan is not recommended.
• Use caution when concomitant use with drugs that affect Hemostasis (NSAIDs, Aspirin, Warfarin).
• If you take Lexapro, you should not take any other medicines that contain escitalopram or citalopram including: Celexa.

Is this medicine FDA approved?

• Escitalopram was approved for medical use in the United States in 2002.

How should this medicine be used?

Recommended dosage: Major Depressive Disorder:

Adolescents dosage

• Initial: 10 mg once daily
• Recommended: 10 mg once daily
• Maximum: 20 mg once daily

Adults dosage:

• Initial: 10 mg once daily
• Recommended: 10 mg once daily
• Maximum: 20 mg once daily

Generalized Anxiety Disorder:

• Adults dosage:
• Initial: 10 mg once daily
• Recommended: 10 mg once daily

• No additional benefits seen at 20 mg/day dose.
• 10 mg/day is the recommended dose for most elderly patients and patients with hepatic impairment.
• No dosage adjustment for patients with mild or moderate renal impairment. Use caution in patients with severe renal impairment.
• A gradual dose reduction is recommended for discontinuing Lexapro.

Administration:

• Lexapro may be taken with or without food.
• If you miss a dose of Lexapro, take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and take your next dose at the regular time. Do not take two doses of Lexapro at the same time.
• If you take too much Lexapro, call your healthcare provider or poison control center right away, or get emergency treatment.

What are the dosage forms and brand names of this medicine?

This medicine is available in fallowing doasage form:

• As Tablets: 5 mg, 10 mg (scored) and 20 mg (scored)
• Oral solution: 1 mg per mL (not currently being marketed)

This medicine is available in fallowing brand namesː

• Lexapro

What side effects can this medication cause?

The most common side effects of this medicine include:

• Nausea
• Sleepiness
• Weakness
• Dizziness
• Feeling anxious
• Trouble sleeping
• Sexual problems
• Sweating
• Shaking
• Not feeling hungry
• Dry mouth
• Constipation
• Infection
• Yawning

Other side effects in children and adolescents include:

• increased thirst
• abnormal increase in muscle movement or agitation
• nose bleed
• difficult urination
• heavy menstrual periods
• possible slowed growth rate and weight change. Your child’s height and weight should be monitored during treatment with Lexapro.

Lexapro may cause serious side effects, including:

• Suicidal thoughts or actions
• Serotonin Syndrome
• Severe allergic reactions
• Abnormal bleeding
• Seizures or convulsions
• Manic episodes
• Changes in appetite or weight
• Low salt (sodium) levels in the blood
• Visual problems
• Sexual Dysfunction

What special precautions should I follow?

• Lexapro can cause sleepiness or may affect your ability to make decisions, think clearly, or react quickly. You should not drive, operate heavy machinery, or do other dangerous activities until you know how Lexapro affects you. Do not drink alcohol while using Lexapro.
• Serotonin syndrome has been reported with SSRIs and SNRIs, including Lexapro, both when taken alone, but especially when co-administered with other serotonergic agents (including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, amphetamines, and St. John’s Wort). If such symptoms occur, discontinue Lexapro and initiate supportive treatment. If concomitant use of Lexapro with other serotonergic drugs is clinically warranted, patients should be made aware of a potential increased risk for serotonin syndrome, particularly during treatment initiation and dose increases.
• During marketing of Lexapro and other SSRIs and SNRIs (serotonin and norepinephrine reuptake inhibitors), there have been spontaneous reports of adverse events occurring upon discontinuation of these drugs. A gradual reduction in dose rather than abrupt cessation is recommended whenever possible.
• Prescribe with care in patients with a history of seizure.
• In patients with bipolar disorder, treating a depressive episode with Lexapro or another antidepressant may precipitate a mixed/manic episode. Prior to initiating treatment with Lexapro, screen patients for any personal or family history of bipolar disorder, mania, or hypomania.
• Hyponatremia may occur as a result of treatment with SSRIs and SNRIs, including Lexapro. Discontinuation of Lexapro should be considered in patients with symptomatic hyponatremia and appropriate medical intervention should be instituted.
• Because any psychoactive drug may impair judgment, thinking, or motor skills. Use caution in concomitant use with NSAIDs, aspirin, warfarin or other drugs that affect coagulation.
• Use caution when operating machinery. Because any psychoactive drug may impair judgment, thinking, or motor skills.
• Angle closure glaucoma has occurred in patients with untreated anatomically narrow angles treated with antidepressants.
• Use caution in patients with diseases or conditions that produce altered metabolism or hemodynamic responses.
• Lexapro may cause symptoms of sexual dysfunction. Discuss potential management strategies to support patients in making informed decisions about treatment.

What to do in case of emergency/overdose?

Symptoms of overdosage may include:

• Seizures
• Cardiovascular toxicity, which may be delayed, including QRS and QTc interval prolongation, wide complex tachyarrhythmias, and torsade de pointes
• Hypertension
• Serotonin syndrome

Management of overdosage:

• Prolonged cardiac monitoring is recommended in Lexapro overdosage ingestions due to the arrhythmia risk.
• Gastrointestinal decontamination with activated charcoal should be considered in patients who present early after a Lexapro overdose.
• Consider contacting a poison center (1-800-221-2222) or a medical toxicologist for overdosage management recommendations.

Can this medicine be used in pregnancy?

• Taking LEXAPRO late in pregnancy may lead to an increased risk of certain problems in your newborn.
• If you become pregnant while taking LEXAPRO, talk to your healthcare provider about registering with the National Pregnancy Registry for Antidepressants. You can register by calling 1-844-405-6185.

Can this medicine be used in children?

• The safety and effectiveness of Lexapro have been established in adolescents (12 to 17 years of age) for the treatment of major depressive disorder.
• The safety and effectiveness of Lexapro have not been established in pediatric (younger than 12 years of age) patients with major depressive disorder.
• Safety and effectiveness of Lexapro has not been established in pediatric patients less than 18 years of age with Generalized Anxiety Disorder.

What are the active and inactive ingredients in this medicine?

Active ingredient: escitalopram oxalate

Inactive ingredients:

• Tablets: talc, croscarmellose sodium, microcrystalline cellulose/colloidal silicon dioxide, and magnesium stearate. The film coating contains hypromellose, titanium dioxide, and polyethylene glycol.
• Oral Solution: sorbitol, purified water, citric acid, sodium citrate, malic acid, glycerin, propylene glycol, methylparaben, propylparaben, and natural peppermint flavor (oral solution is not currently being marketed).

Who manufactures and distributes this medicine?

Distributed by:

• Allergan USA, Inc.
• Madison, NJ

What should I know about storage and disposal of this medication?

• Store Lexapro at 68°F to 77°F (20°C to 25°C); excursions permitted to 59°F to 86°F (15°C to 30°C).
• Keep Lexapro bottle closed tightly.

The following are antidepressant subclasses and drugs

MAO Inhibitors Isocarboxazid, Phenelzine, Tranylcypromine

SNRIs Duloxetine, Levomilnacipran, Venlafaxine

SSRIs Citalopram, Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline, Vilazodone, Vortioxetine

Tricyclics Amitriptyline, Amoxapine, Clomipramine, Desipramine, Doxepin, Imipramine, Nortriptyline, Protriptyline, Trimipramine

Miscellaneous Bupropion, Flibanserin, Mirtazapine, Nefazodone, Trazodone

• Dailymed label info on Escitalopram
• FDA Escitalopram

Escitalopram Resources
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The following are antidepressant subclasses and drugs

MAO Inhibitors Isocarboxazid, Phenelzine, Tranylcypromine

SNRIs Duloxetine, Levomilnacipran, Venlafaxine

SSRIs Citalopram, Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline, Vilazodone, Vortioxetine

Tricyclics Amitriptyline, Amoxapine, Clomipramine, Desipramine, Doxepin, Imipramine, Nortriptyline, Protriptyline, Trimipramine

Miscellaneous Bupropion, Flibanserin, Mirtazapine, Nefazodone, Trazodone