Generic Name

Escitalopram

Precaution

History of mania or seizure disorders; work requiring mental alertness; renal and hepatic impairment; pregnancy, lactation; withdraw gradually. Lactation Excreted in breast milk; consider risk/benefit ratio

Indication

Major depressive disorder, Depression, Panic disorder, Obsessive compulsive disorder, Anxiety disorder

Contra Indication

Concomitant use with or within 2 wk of MAOI withdrawal.

Dose

N/A

Side Effect

>10% Headache (24%),Nausea (18%),Ejaculation disorder (9-14%),Somnolence (4-13%),Insomnia (7-12%) 1-10% Xerostomia (4-9%),Constipation (3-6%),Fatigue (2-8%),Libido decrease (3-7%),Anorgasmia (2-6%),Flatulence (2%),Toothache (2%),Weight gain (1%),Menstrual disorder (2%),Neck/shoulder pain (3%),Rhinitis (5%),Flu-like syndrome (5%),Ejaculation disorder (9-14%) <1% Arthralgia,Abdominal pain,Abnormal bleeding,Abnormal dreams,Allergy,Blurred vision,Bronchitis,Chest pain,Constipation,Decreased appetite,Decreased concentration,Disrupts platelets/hemostasis,Dizziness,Dyspepsia,Fever,Heartburn,Hot flashes,Impotence,Irritability,Jaw stiffness,Lethargy,Lightheadedness,Menstrual disorder,Hypertension,Palpitations,Migraine,Myalgia,Paresthesia,Rash,Sweating,Tinnitus,Tremor,Urinary frequency,Urinary tract infection,Vertigo,Vomiting,Yawning

Pregnancy Category

Mode of Action

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.

Interaction

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.

Pregnancy Category Note

Pregnancy There are no adequate and well-controlled studies in pregnant women; therefore, use during pregnancy only if the potential benefit justifies the potential risk to the fetus In some cases, the clinical picture is consistent with serotonin syndrome Effect on labor and delivery in humans is unknown Neonates exposed to escitalopram and other SSRIs/SNRIs Neonates exposed to SSRIs/SNRIs late in the third trimester have developed complications requiring prolonged hospitalization, respiratory support, and tube feeding Such complications can arise immediately upon delivery Reported clinical findings include respiratory distress, cyanosis, apnea, seizures, temperature instability, feeding difficulty, vomiting, hypoglycemia, hypotonia, hypertonia, hyperreflexia, tremor, jitteriness, irritability, and constant crying These features are consistent with toxic effects of SSRIs and SNRIs or, possibly, drug discontinuation syndrome Lactation Escitalopram is excreted in human breast milk Limited data from women taking 10-20 mg escitalopram showed that exclusively breast-fed infants receive a ~3.9% of the maternal weight-adjusted dose of escitalopram and 1.7% of the maternal weight-adjusted dose of desmethylcitalopram Caution should be exercised and breastfeeding infants should be observed for adverse reactions when administered to a nursing woman

Adult Dose

Oral Anxiety; Depression; Obsessive compulsive disorder Adult: 10 mg once daily, increased after at least a wk if needed. Max: 20 mg once daily. Panic disorder with or without agoraphobia Adult: Initially, 5 mg once daily, increased after a wk to 10 mg once daily. Max: 20 mg daily. Elderly: Half the adult dose. Hepatic impairment: Mild to moderate: Initially, 5 mg daily, increased to 10 mg daily after 2 wk if needed. Severe: More careful dose titration needed.

Child Dose

Major Depressive Disorder <12 years: Safety and efficacy not established >12 years: 10 mg PO qDay; may increase dose after at least 3 weeks; not to exceed 20 mg/day

Renal Dose

N/A

Administration

May be taken with or without food.