Escitalopram

Indications

Escitalopram is used for: Major depressive disorder, Depression, Panic disorder, Obsessive compulsive disorder, Anxiety disorder

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

Administration

May be taken with or without food.

Contra Indications

Concomitant use with or within 2 wk of MAOI withdrawal.

Precautions

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

Pregnancy-Lactation

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.

Adverse Effects

Side effects of Escitalopram : >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

Mechanism 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.