Escitalopram

Escitalopram is used to treat depression and anxiety. It works by helping to restore the balance of a certain natural substance (serotonin) in the brain. Escitalopram belongs to a class of drugs known as selective serotonin reuptake inhibitors (SSRI). Escitalopram may improve your energy level and feelings of well-being and decrease nervousness.

• Escitalopram may also be used to treat other mental/mood disorders (such as obsessive-compulsive disorder, panic disorder) and hot flashes that occur with menopause.
• Escitalopram is available under the following different brand names: Lexapro.

Dosages of Escitalopram:

Adult and Pediatric Dosage Forms and Strengths

Tablet

• 5 mg
• 10 mg
• 20 mg

Oral solution

• 5 mg/mL

Dosage Considerations – Should be Given as Follows:

Major Depressive Disorder

• Adults: 10 mg orally once/day; may increase to 20 mg/day after 1 week
• Children under 12 years: Safety and efficacy not established
• Children 12 years and older: 10 mg orally once/day; may increase the dose after at least 3 weeks; not to exceed 20 mg/day
• Geriatric: 10 mg/day is recommended for most elderly; no additional benefits are seen at 20 mg/day dose

Generalized Anxiety Disorder

• 10 mg orally once/day; may increase to 20 mg/day after 1 week; maintain at a lowest effective dose and assess the need of therapy periodically if extended therapy required

Obsessive-Compulsive Disorder (Off-label)

• 10 mg orally once/day; may increase to 20 mg/day after 1 week; maintain at a lowest effective dose and assess the need of therapy periodically if extended therapy required

Insomnia (Off-label)

• Secondary to Depression: 5-20 mg orally over an 8-week period
• Secondary to panic disorder in women: 5-10 mg orally over an 8-week period

Vasomotor Symptoms Associated with Menopause (Off-label)

• 10 mg orally once/day; may increase to 20 mg orally once/day after 4 weeks if symptoms are not adequately controlled

Dosing Considerations

• For extended therapy, maintain at a lowest effective dose and assess periodically the need for continued therapy
• Geriatric: The elderly are more prone to SSRI/SNRI-induced hyponatremia

Side effects of escitalopram include:

• Headache
• Nausea
• Ejaculation disorder
• Somnolence
• Insomnia
• Dry mouth
• Constipation
• Fatigue
• Libido decrease
• Inability to achieve orgasm
• Gas (flatulence)
• Toothache
• Weight gain
• Menstrual disorder
• Neck/shoulder pain
• Runny nose
• Flu-like syndrome

Less common side effects of escitalopram include:

• Abdominal pain
• Abnormal bleeding
• Abnormal dreams
• Allergy
• Blurred vision
• Bronchitis
• Chest pain
• Constipation
• Decreased appetite
• Decreased concentration
• Disrupts platelets/hemostasis
• Dizziness
• Fever
• Heartburn
• High blood pressure (hypertension)
• Hot flashes
• Impotence
• Indigestion
• Irritability
• Jaw stiffness
• Joint pain
• Lethargy
• Lightheadedness
• Menstrual disorder
• Palpitations
• Migraine
• Muscle pain
• Numbness and tingling
• Rash
• Ringing in the ears
• Spinning sensation (vertigo)
• Sweating
• Tremor
• Urinary frequency
• Urinary tract infection
• Vomiting
• Yawning

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

Severe Interactions of escitalopram include:

• goserelin
• isocarboxazid
• leuprolide
• phenelzine
• procarbazine
• selegiline
• tranylcypromine
• ziprasidone

Escitalopram has serious interactions with at least 72 different drugs.

Escitalopram has moderate interactions with at least 131 different drugs.

Escitalopram has mild interactions with at least 39 different drugs.

This information does not contain all possible interactions or adverse effects. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns, or for more information about this medicine.

Warnings

• In short-term studies, antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults (younger than 24 years) taking antidepressants for major depressive disorders and other psychiatric illnesses
• This increase was not seen in patients younger than 24 years; a slight decrease in suicidal thinking was seen in adults older than 65 years.
• The drug is not FDA approved for the treatment of bipolar depression
• In children and young adults, the risks must be weighed against the benefits of taking antidepressants
• Patients should be monitored closely for changes in behavior, clinical worsening, and suicidal tendencies; this should be done during initial 1-2 months of therapy and dosage adjustments
• The patient's family should communicate any abrupt changes in behavior to the healthcare provider
• Worsening behavior and suicidal tendencies that are not part of the presenting symptoms may require discontinuation of therapy
• This drug is not approved for use in pediatric patients younger than 12 years.
• This medication contains escitalopram
• Do not take Lexapro if you are allergic to escitalopram or any ingredients contained in this drug

Contraindications

• Hypersensitivity
• Co-administration with serotonergic drugs
  • Concomitant use or within 14 days of MAOIs increases the risk of serotonin syndrome
  • Symptoms include tremor, myoclonus, diaphoresis, nausea, vomiting, flushing, dizziness, hyperthermia with features resembling neuroleptic malignant syndrome, seizures, rigidity, autonomic instability with possible rapid fluctuations of vital signs, and mental status changes that include extreme agitation progressing to delirium and coma
  • Starting escitalopram in a patient who is being treated with linezolid or IV methylene blue is contraindicated because of an increased risk of serotonin syndrome
  • If linezolid or IV methylene blue must be administered, discontinue SSRI immediately and monitor for CNS toxicity; may resume 24 hours after last linezolid or methylene blue dose, or after 2 weeks of monitoring (5 weeks for fluoxetine), whichever comes first

Effects of Drug Abuse

• None

Short-Term Effects

• Risk of cognitive and motor function impairment; use caution when operating heavy machinery
• See "What Are Side Effects Associated with Using Escitalopram?"

Long-Term Effects

• Bone fractures are associated with antidepressant therapy; consider the possibility of a fracture in patients with unexplained bone pain, swelling, or bruising
• See "What Are Side Effects Associated with Using Escitalopram?"

Cautions

• Conflicting evidence regarding the use of SSRIs during pregnancy and increased risk of persistent pulmonary hypertension of the newborn, or PPHN (see Pregnancy)
• In neonates exposed to SNRIs/SSRIs late in the third trimester: risk of complications such as feeding difficulties, irritability, and respiratory problems
• Caution with a seizure disorder, bipolar mania, severe renal impairment; not FDA approved for the treatment of bipolar depression
• NRIs/SSRIs have been associated with the development of SIADH; hyponatremia has been reported rarely
• May worsen psychosis in some patients and precipitate a shift to mania or hypomania in patients with bipolar disorder
• Risk of hyponatremia
• Risk of mydriasis; may trigger angle closure attack in patients with angle-closure glaucoma with anatomically narrow angles without a patent iridectomy
• Bone fractures are associated with antidepressant therapy; consider the possibility of a fracture in patients with unexplained bone pain, swelling, or bruising
• Prescriptions should be written for the smallest quantity consistent with good patient care and the family or caregiver alerted to monitor the patient for the emergence of suicidality and associated behaviors (anxiety, agitation, panic attacks, insomnia, hostility, akathisia, impulsivity, irritability)
• SSRIs/SNRIs increase the risk of abnormal bleeding (further increased if concomitant aspirin, NSAIDs or anticoagulants, or hemorrhagic diathesis)
• Prolongation of QT interval and ventricular arrhythmias was reported, especially in female patients with preexisting QT prolongation or other risk factors
• Risk of cognitive and motor function impairment; use caution when operating heavy machinery
• Use with caution in patients with a history of seizure disorders or conditions predisposing to seizures including brain damage and alcoholism
• May impair platelet aggregation that can result in an increased risk of bleeding events including GI bleeding especially if taken concomitantly with aspirin, warfarin, or NSAIDs
• Risk of serotonin syndrome or neuroleptic malignant syndrome (NMS)-like reactions have been reported with SSRIs and SNRIs, including desvenlafaxine, 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 symptoms occur, discontinue therapy and initiate supportive treatment; if concomitant use of desvenlafaxine with other serotonergic drugs is clinically warranted, patients should be made aware of increased risk for serotonin syndrome, particularly during treatment initiation and dose increases
• No additional benefits at 20 mg/day
• May cause or exacerbate sexual dysfunction
• Gradually taper dose before discontinuation; abrupt discontinuation may cause dysphoric mood, dizziness, sensory disturbances, agitation, confusion, anxiety, headache, insomnia, tinnitus, seizures, irritability

Pregnancy and Lactation

Use escitalopram with caution during pregnancy if the benefits outweigh the risks. Animal studies show risk and human studies are not available or neither animal nor human studies are done.

Use of escitalopram late in the third trimester is associated with complications in newborns and may require prolonged hospitalization, respiratory support, and tube feeding.

Persistent pulmonary hypertension of the newborn:

• The potential risk of persistent pulmonary hypertension of the newborn when used during pregnancy
• Initial Public Health Advisory in 2006 was based on a single published study; since then, there have been conflicting findings from new studies, making it unclear whether the use of SSRIs during pregnancy can cause PPHN
• FDA has reviewed the additional new study results and has concluded that, given the conflicting results from different studies, it is premature to reach any conclusion about a possible link between SSRI use in pregnancy and PPHN
• FDA recommendation: FDA advises healthcare professionals not to alter their current clinical practice of treating depression during pregnancy and to report any adverse events to the FDA MedWatch program
• A meta-analysis of 7 observational studies, found exposure to SSRIs in late pregnancy (i.e., greater than 20 weeks gestation) more than doubled the risk of PPHN that could not be explained by other etiologies (e.g., congenital malformations, meconium aspiration)

Escitalopram is excreted in breast milk; consider risk/benefit ratio before using while breastfeeding.