Product Name: Escitalopram
Common Brand Names: Lexapro
Pharmaceutical Category: Antidepressants / Anti Anxiety
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There is an additional general information about this medication active ingredient escitalopram:
Escitalopram is an antidepressant. This medication selectively inhibits the reuptake of serotonin, increases the concentration of the neurotransmitter in the synaptic cleft, prolongs and enhances the action of serotonin on postsynaptic receptors. Escitalopram practically does not bind to serotonin (5-HT), dopamine (D1 and D2) receptors, alpha-adrenergic-, m-cholinergic receptors, with benzodiazepine and opioid receptors.
Antidepressant effect of this drug is usually develops within 2-4 weeks after starting treatment. The maximum therapeutic effect of the treatment of panic disorder is reached at about 3 months after starting treatment.
The absorption of Escitalopram is independent of ingestion. Bioavailability is 80%. Time to Cmax in the plasma is 4 h. The kinetics of escitalopram is linear. Css achieved after 1 week. The apparent Vd is from 12 up to 26 L / kg. The plasma protein binding is 80%. Metabolized in the liver to the active metabolites. The metabolism of escitalopram with the formation of demethylated metabolite occurs mainly with the participation of isoenzymes CYP2C19, CYPZA4 and CYP2D6.
Why is Escitalopram prescribed?
Depression, panic disorder (including with agoraphobia).
Major depressive disorder, generalized anxiety disorder.
Dosage and administration
Escitalopram is taken orally regardless of the meal. Depending on the testimony of a single dose is 10-20 mg / day. The maximum daily dose is 20 mg. The duration of treatment is a few months. Upon the termination of treatment the dose should be gradually reduced over 1-2 weeks in order to avoid withdrawal symptoms.
For elderly patients (65 years) the recommended dose is 5 mg / day, the maximum daily dose is 10 mg.
If abnormal liver function recommended starting dose within the first 2 weeks of treatment is 5 mg / day. Depending on the individual response dose can be increased to 10 mg / day.
For patients with low activity of isoenzyme CYP2C19 the recommended starting dose for the first 2 weeks of treatment is 5 mg / day. Depending on the individual response the dose can be increased to 10 mg / day.
Escitalopram side effects, adverse reactions
CNS and peripheral nervous system: dizziness, fatigue, insomnia or drowsiness, convulsions, tremor, movement disorders, serotonin syndrome (agitation, tremor, myoclonus, hyperthermia), hallucinations, delusions, confusion, agitation, anxiety, depersonalization, panic attacks, irritability, visual disturbances.
Digestive system: nausea, vomiting, dry mucous membranes of the mouth, taste disturbances, loss of appetite, diarrhea, constipation, changes in laboratory parameters of liver function.
Cardiovascular: orthostatic hypotension.
Endocrine: decreased secretion of ADH, galactorrhea.
Reproductive system: decreased libido, impotence, ejaculation disorder, anorgasmia (in females).
Urinary system: urinary retention.
Dermatological reactions: skin rash, itching, ecchymosis, purpura, sweating.
Allergic reaction: angioedema, anaphylactic reactions.
Metabolic: hyponatremia, hyperthermia.
Musculoskeletal system: arthralgia, myalgia.
Other: sinusitis, withdrawal syndrome (dizziness, headaches and nausea).
Simultaneous administration of MAO inhibitors, childhood and adolescence to 15 years, pregnancy, lactation, hypersensitivity to escitalopram.
Using during pregnancy and breastfeeding
Do not use Escitalopram during pregnancy and lactation (breastfeeding).
Category of the fetus by FDA - C.
With caution Escitalopram should be used in patients with renal insufficiency (creatinine clearance below 30 ml / min), hypomania, mania, pharmacologically uncontrolled epilepsy, depression with suicide attempts, diabetes, in elderly patients, with cirrhosis of the liver, the tendency to bleeding, simultaneously with the admission of drugs that lower the threshold of convulsive readiness, causing hyponatremia, with alcohol, with drugs metabolized with the participation of isoenzymes CYP2C19.
Escitalopram should be prescribed only after 2 weeks after discontinuation of irreversible MAO inhibitors, and 24 h after cessation of treatment reversible inhibitor of MAO.
Non-selective MAO inhibitors may be prescribed no earlier than 7 days after discontinuation of this medication.
Escitalopram should be abolished in the case of epileptic seizures or quickening in pharmacologically uncontrolled epilepsy.
With the development of manic this drug should be abolished.
Escitalopram can increase the concentration of glucose in diabetes, which may require dose adjustment of hypoglycemic medications.
With the development of serotonin syndrome this medicine should be immediately withdrawn and a symptomatic therapy prescribed.
During the treatment, patients should avoid driving vehicles and other activities that require high concentration and speed of psychomotor reactions.
Escitalopram drug interactions
When this drug applied simultaneously with:
- inhibitors increases the risk of serotonin syndrome and serious adverse reactions.
- serotonergic agents (including with tramadol, triptans) may lead to serotonin syndrome.
- drugs to lower the threshold of convulsive readiness, the risk of seizures increases.
Escitalopram increases the effects of tryptophan and lithium drugs, increases the toxicity of preparations based on hypericum, the effects of drugs affecting blood clotting (requires monitoring of indicators of blood coagulation).
Drugs metabolized with the participation of CYP2C19 isoenzyme (including omeprazole), and are potent inhibitors of CYPZA4 and CYP2D6 (including flecainide, propafenone, metoprolol, desipramine, clomipramine, nortriptyline, risperidone, thioridazine, haloperidol), increase concentration of this medication in plasma.
Escitalopram increases the plasma concentrations of desipramine and metoprolol in 2 times.
Escitalopram in case of emergency / overdose
Treatment: achieve and maintain an airway for adequate ventilation and oxygenation, gastric lavage and the use of activated charcoal. It is recommended careful observation and monitoring of vital functions, including cardiac function, symptomatic and supportive therapy. Because of the large volume of distribution of escitalopram is unlikely to efficiency measures such as forced diuresis, dialysis, hemoperfusion and exchange transfusion. There is no specific antidote.