Escitalopram

Indications
 Oral
Depression
Adult: 10 mg once daily, increased if necessary. Max: 20 mg daily.
Elderly: Half the adult dose.
Hepatic impairment: Dosage adjustments may be required.
Oral
Obsessive compulsive disorder
Adult: 10 mg once daily, increased if necessary. Max: 20 mg daily.
Elderly: Half the adult dose.
Hepatic impairment: Dosage adjustments may be required.
Oral
Anxiety
Adult: 10 mg once daily, increased if necessary. Max: 20 mg daily.
Elderly: Half the adult dose.
Hepatic impairment: Dosage adjustments may be required.
Oral
Panic disorder
Adult: Initially, 5 mg daily, increased to 10 mg daily after 7 days. Max: 20 mg daily.
Elderly: Half the adult dose.
Hepatic impairment: Dosage adjustments may be required.

Special Populations: Patients with hepatic impairment: 5 mg daily. May increase to 10 mg daily after 2 wk.
Contraindications
 Concomitant use with or within 2 wk of MAOI withdrawal.
Warnings / Precautions
 History of mania or seizure disorders; work requiring mental alertness; renal and hepatic impairment; pregnancy, lactation; withdraw gradually. Children and adolescents <18 yr
Adverse Reactions
 Nausea, diarrhoea, increased sweating, insomnia, impotence, ejaculation disorder, fatigue, somnolence; postural hypotension, sinusitis, taste disturbances. Increased appetite and wt gain.
Overdose Reactions
 Symptoms include convulsions, coma, dizziness, hypotension, insomnia, nausea, vomiting, sinus tachycardia, somnolence, ECG changes (including QT prolongation and rarely, torsade de pointes). Treatment includes establishing and maintaining an airway to ensure adequate ventilation and oxygenation. Gastric lavage and activated charcoal may be used. Monitor cardiac and vital signs, along with general symptomatic and supportive care. Forced diuresis, dialysis, haemoperfusion, and exchange transfusion may not be useful.
Drug 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.
See Below for More escitalopram Drug Interactions
Food Interactions
 Increased CNS depression with valerian, St John's wort, kava kava and gotu kola.
Mechanism of Actions
 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.
Onset: 1-2 wk.
Absorption: Readily absorbed from the GI tract (oral).
Distribution: Protein-binding: 56%.
Metabolism: Hepatic; converted to metabolites.
Excretion: Urine (as unchanged drug); 27-32 hr (elimination half-life).
Administration
 May be taken with or without food.
Storage Conditions
 Oral: Store at 25°C.
ATC Classification
 N06AB10 - escitalopram ; Belongs to the class of selective serotonin reuptake inhibitors. Used in the management of depression.
Storage
 Oral: Store at 25°C.
Available As
  • Escitalopram 10 mg
  • Escitalopram Oxalate 10 mg
  • Escitalopram 100 mg
  • Escitalopram 20 mg
  • Escitalopram Oxalate 20 mg
  • Escitalopram 5 mg
  • Escitalopram Oxalate 5 mg
  • Escitalopram 50 mg
  • Escitalopram 7.5 mg

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