Escitalopram

Escitalopram is widely prescribed to treat depression and other mental health conditions like anxiety, panic disorder, and obsessive-compulsive disorder. It is a type of antidepressant known as a selective serotonin reuptake inhibitor (SSRI).

Escitalopram helps many people to recover from depression by improving their mood and relieving anxiety and tension. It can be taken with or without food. The dose and how often you need it will be decided by your doctor. Do not change the dose or stop taking it without talking to your doctor, even if you feel well.

Escitalopram is a selective serotonin reuptake inhibitor (SSRI) antidepressant. It works by increasing the levels of serotonin, a chemical messenger in the brain. This improves mood and physical symptoms of depression and also relieves symptoms of anxiety, panic attacks and obsessive-compulsive disorders.

• Major Depressive Episodes: Used for the treatment of depression.
• Panic Disorder: Used for panic disorder with or without agoraphobia.
• Social Anxiety Disorder: Used for social phobia.
• Generalised Anxiety Disorder: Used for generalized anxiety disorder.
• Obsessive-Compulsive Disorder: Used for OCD.

SSRIs & related anti-depressant drugs

Selective Serotonin Reuptake Inhibitor (SSRI)

Escitalopram is an orally administered selective serotonin reuptake inhibitor (SSRI). Escitalopram is the pure S-enantiomer of the racemic bicyclic phthalate derivative citalopram. Escitalopram is at least 100 fold more potent than the R-enantiomer with respect to inhibition of 5-HT reuptake. Escitalopram has no or very low affinity for serotonergic or other receptors.

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.

Adult Dose:

• Anxiety, Depression, OCD: 10 mg once daily; increase after at least 1 week if needed; Max: 20 mg/day.
• Panic Disorder: Initial: 5 mg once daily; increase to 10 mg/day after 1 week; Max: 20 mg/day.
• Social Anxiety Disorder: 10 mg once daily; may decrease to 5 mg or increase to 20 mg/day.
• Elderly (>65 years): Initial: 5 mg/day; may increase to 10 mg/day if needed.
• Hepatic impairment (mild-moderate): Initial: 5 mg/day for 2 weeks; may increase to 10 mg/day if needed.

Child Dose (≥12 years): 10 mg PO qDay; may increase after 3 weeks; Max: 20 mg/day.

Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Escitalopram may be taken with or without food, but it is better to take it at a fixed time.

If you miss a dose of Escitalopram, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular schedule. Do not double the dose.

Common Side Effects:

• Anorgasmia (decreased orgasm in women)
• Decreased libido
• Delayed ejaculation
• Fatigue
• Increased sweating
• Insomnia (difficulty in sleeping)
• Nausea
• Sleepiness
• Headache
• Dizziness
• Dry mouth

Others: Anxiety, akathisia, decreased appetite/weight loss, seizures, serotonin syndrome, QT prolongation.

Precautions:

• Escitalopram may affect your ability to drive.
• Take it in the morning (can keep you awake if taken late at night).
• Talk to your doctor if you notice sudden mood changes or develop suicidal thoughts.
• Lower chance of causing sexual dysfunction than other similar medications.
• Addiction or dependence potential is very less.
• Do not stop taking suddenly without talking to your doctor (withdrawal symptoms).
• Inform doctor if you have epilepsy, diabetes, liver/kidney disease, heart problems.
• Inform doctor if taking MAO inhibitors.

Contraindications:

• Hypersensitivity to escitalopram or citalopram
• Concomitant use with or within 2 weeks of MAOI withdrawal
• Concomitant use with pimozide

Drug Interactions:

• Aspirin, NSAIDs, coagulation-affecting drugs: Increased risk of bleeding.
• CYP2C19 inducers (carbamazepine, rifampin, phenytoin): Serum levels may be reduced.
• CYP2C19 inhibitors (fluconazole, fluvoxamine, omeprazole): Serum levels may be increased.
• Desipramine or metoprolol: Serum levels may be increased.
• Linezolid or sibutramine: Increased risk of serotonin syndrome.
• Alcohol: Enhances sedative effects.
• Potentially Fatal: Concomitant administration with MAOIs may lead to serious or fatal reactions.

Food Interactions: It is unsafe to consume alcohol with Escitalopram. Alcohol may enhance sedative effects.

Use in Pregnancy: Escitalopram may be unsafe to use during pregnancy. Animal studies have shown harmful effects on the developing baby. Your doctor will weigh the benefits and any potential risks before prescribing.

Use in Lactation: Escitalopram is probably unsafe to use during breastfeeding. Limited human data suggests that the drug may pass into the breastmilk and harm the baby.

Pediatric Use: Not recommended for use in children under 18 years. For 12-18 years with major depressive disorder, dosage provided above.

Geriatric Use: Initial dose: 5 mg/day; may increase to 10 mg/day if needed.

Renal Impairment: Mild-moderate: no adjustment; severe (CrCl <30 mL/min): caution advised.

Hepatic Impairment: Use with caution. Mild-moderate: 5 mg/day for 2 weeks, then may increase to 10 mg/day.

Overdose:

Symptoms: CNS (dizziness, tremor, agitation, serotonin syndrome, convulsion, coma), GI (nausea/vomiting), Cardiovascular (hypotension, tachycardia, QT prolongation, arrhythmia), Electrolyte (hypokalemia, hyponatremia).

Management: No specific antidote. Establish airway, ensure oxygenation. Gastric lavage and activated charcoal. Cardiac monitoring recommended.

Storage: Store below 30°C, protect from light and moisture. Keep out of reach of children.

Escitalopram