Indications

Escitalopram is indicated in Depressive illness, Generalized anxiety disorder, Obsessive-compulsive disorder, Social anxiety disorder

Therapeutic Class

SSRIs & related anti-depressant drugs

Pharmacology

Escitalopram is a selective inhibitor of serotonin (5-HT) re-uptake. The inhibition of 5-HT re-uptake is the only likely mechanism of action explaining the pharmacological and clinical effects of escitalopram. Escitalopram has no or low affinity for a number of receptors including 5-HT1A, 5-HT2, DA D1 and D2 receptors, α1-, α2-, β-adrenoceptors, histamine H1, muscarine cholinergic, benzodiazepine and opioid receptors.

Dosage & Administration

Adults: The initial dose of Escitalopram Oxalate is 10 mg once daily. (A fixed dose trial of Escitalopram Oxalate demonstrated the effectiveness of both 10 mg and 20 mg of Escitalopram Oxalate, but failed to demonstrate a greater benefit of 20 mg over 10 mg.)

If the dose is increased to 20 mg, this should occur after a minimum of one week.

Panic disorder: Adult over 18 years, initially 5 mg once daily increased to 10 mg daily after 7 days; max. 20 mg daily; elderly initially half adult dose, lower maintenance dose may be sufficient;

Social anxiety disorder: Adult over 18 years, initially 10 mg once daily adjusted after 2-4 weeks; usual dose 5-20 mg daily.

Elderly: A single oral dose of 10 mg/day is the recommended dose for most elderly patients. Administered in excess recommended dose has not been yet established.

Interaction

Escitalopram should not be started until 2 weeks after stopping an MAOI. Conversely, an MAOI should not be started until at least a week after escitalopram or related antidepressant has been stopped.

Contraindications

Concomitant use in patients taking monoamine oxidase inhibitors (MAOIs) is contraindicated. Concomitant use in patients taking pimozide is contraindicated. Esita is contraindicated in patients with a hypersensitivity to escitalopram or citalopram or any of the inactive ingredients.

Side Effects

Escitalopram is well tolerated by most people. The most commonly reported side-effects of Escitalopram are nausea, insomnia, problems with ejaculation, drowsiness, increased sweating and fatigue. Most of the side-effects experienced by patients taking Escitalopram are mild and go away with continued treatment and usually do not cause patients to stop taking Escitalopram.

Pregnancy & Lactation

Pregnancy: The safety of escitalopram during pregnancy and lactation has not been established. Therefore, escitalopram should not be used during pregnancy unless, in the opinion of the physician, the expected benefits to the patient outweigh the possible hazards to the fetus.

Nursing Mothers: Escitalopram is excreted in human milk. Escitalopram should not be given to nursing mothers unless, in the opinion of the physician, the expected benefits to the patient outweigh the possible hazards to the child

Precautions & Warnings

During marketing of escitalopram and other SSRIs and SNRIs (Serotonin and Norepinephrine Reuptake Inhibitors), there have been spontaneous reports of adverse events occurring upon discontinuation of these drugs, particularly when abrupt, including the following: dysphoric mood, irritability, agitation, dizziness, sensory disturbances (e.g., paresthesias such as electric shock sensations), anxiety, confusion, headache, lethargy, emotional lability, insomnia, and hypomania. While these events are generally self-limiting, there have been reports of serious discontinuation symptoms. Patients should be monitored for these symptoms when discontinuing treatment with escitalopram. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose but at a more gradual rate.

Use in Special Populations

Pediatric Use: Safety and effectiveness in children below the age of 18 years have not been established.

Geriatric patients: Escitalopram pharmocokinetics in subjects age 65 and over were compared to younger subjects in a single and multi-dose study. No overall differences in safety or effectiveness between this group and the younger subjects was observed, but greater sensitivity of some elderly individuals ca

Storage Conditions

Store in a cool and dry place below 30º C. Protect from light.