Escitalopram

Class
Antidepressants
Subclass
Selective serotonin reuptake inhibitors
Substance name
Escitalopram oxalate
Brand names
Lexapro®
Common formulations
Film-coated tablet
Dosage and administration
Adults patients
Generalized anxiety disorder
•
Maintenance: 10 mg PO daily
•
Maximum: 20 mg per day
Consider increasing to 20 mg daily at ≥ 1 week depending on response and tolerability.
Major depressive disorder
•
Maintenance: 10 mg PO daily
•
Maximum: 20 mg per day
Consider increasing to 20 mg daily at ≥ 1 week depending on response and tolerability.
Mixed anxiety-depressive disorder • Off-label
•
10-20 mg PO daily
OCD • Off-label
•
Start at: 10 mg PO daily for 1 week
•
Maintenance: 20 mg PO daily
•
Maximum: 40-60 mg per day
Panic disorder • Off-label
•
Start at: 5-10 mg PO daily for 3-7 days
•
Maintenance: 10-20 mg PO daily
•
Maximum: 20 mg per day
Consider increasing to 20 mg daily depending on response and tolerability.
Premenstrual dysphoric disorder • Off-label
•
Start at: 5 mg PO daily on day 1 (ovulation day)
•
Maintenance: 20 mg PO daily
Increase to 10 mg on day 2, and 20 mg thereafter until menstruation.
Social anxiety disorder • Off-label
•
10-20 mg PO daily
Vasomotor symptoms of menopause in females • Off-label
•
10-20 mg PO daily
Reduce to 5 mg in sensitive or older patients.
Indications for use
Labeled indications
Adults
•
Treatment of generalized anxiety disorder
•
Treatment of major depressive disorder
Off-label indications
Adults
•
Treatment of mixed anxiety-depressive disorder
•
Treatment of OCD
•
Treatment of panic disorder
•
Treatment of premenstrual dysphoric disorder
•
Treatment of social anxiety disorder
•
Treatment of vasomotor symptoms of menopause in females
•
Prevention of depression (in patients > 65 years) with cerebrovascular accident
•
Prevention of depression (in patients ≤ 65 years) with cerebrovascular accident
Safety risks
Boxed warnings
Suicidal ideation
•
Use extreme caution in patients with major depressive disorder or other psychiatric disorders, particularly in children, adolescents, and young adults.
Contraindications
Hypersensitivity to escitalopram or its components
Concomitant use of MAOIs
•
Do not use escitalopram with or within 14 days of switching to or from MAOIs.
Concomitant use of pimozide
Warnings and precautions
Accidental injury
•
Use extreme caution in patients performing activities requiring mental alertness, such as driving or operating machinery.
Acute angle-closure glaucoma
•
Use caution in patients with untreated anatomically narrow angles.
Antidepressant discontinuation syndrome
•
Do not discontinue abruptly in any patient.
Bleeding
•
Use caution in patients taking aspirin, NSAIDs, antiplatelet drugs, warfarin, or anticoagulants.
Hyponatremia, SIADH
•
Use caution in all patients, especially in the elderly and in patients with volume depletion or taking diuretics.
Manic or mixed episodes
•
Use caution in patients with bipolar disorder.
Seizure
•
Use caution in patients with seizure disorder.
Serotonin syndrome
•
Use caution in patients taking other serotonergic drugs.
Sexual dysfunction
•
Maintain a high level of suspicion, as SSRIs have been associated with decreased libido, erectile dysfunction, and ejaculatory delay or failure in males, and decreased libido and delayed or absent orgasm in females.
Specific populations
Renal impairment
CrCl ≥ 20 mL/min
•
Use acceptable. No dose adjustment required.
CrCl 0-90 mL/min
•
Use with extreme caution. Reduce dose by 99%.
CrCl < 20 mL/min
•
No guidance available.
Renal replacement therapy
Continuous renal replacement
•
No guidance available.
Intermittent hemodialysis
•
Start at a dose of 5 mg once daily. Titrate with caution.
Peritoneal dialysis
•
Start at a dose of 5 mg once daily. Titrate with caution.
Hepatic impairment
Any severity
•
Use with caution. Maximal dose of 10 mg. Do not exceed frequency of daily.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: C
•
Use only if benefits outweigh potential risks. Evidence of fetal harm in humans. Monitor neonates for direct toxic effects of the drug, discontinuation syndrome and serotonin syndrome.
Breastfeeding
Use only if benefits outweigh potential risks.
•
Limited information indicates that maternal doses of escitalopram up to 20 mg daily produce low levels in milk and would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months. If escitalopram is required by the mother, it is not a reason to discontinue breastfeeding.
Low excretion in breastmilk (5-25%).
Low levels in breastfed infants (5-25%).
May potentially cause adverse effects in breastfed infants.
Some adverse effects on lactation reported.
Adverse reactions
Very common > 10%
•
Antidepressant discontinuation syndrome, anejaculation, headache, insomnia, nausea, somnolence
Common 1-10%
•
Abdominal pain, anorgasmia, back pain, constipation, ↓ libido, dental pain, diarrhea, dizziness, dry mouth, dyspepsia, nightmares, erectile dysfunction, fatigue, flatulence, insomnia, loss of appetite, menstrual irregularity, nasal congestion, neck pain, paresthesia, shoulder pain, sweating, vomiting, yawning, rhinitis
Uncommon < 1%
•
Chest pain, hypertension, palpitations, skin rash, weight gain, skin flushing, heartburn, ↑ appetite, urinary frequency, irritability, difficulty concentrating, myalgia, arthralgia, blurred vision, tinnitus, cough, fever and leukocytosis, mania
Unknown frequency
•
↓ serum sodium, gastrointestinal bleeding, nosebleed, ↑QT interval, torsade de pointes, seizure, suicidal ideation, serotonin syndrome
Interactions
Drug(s)
Check Interactions
Reset

What did you think about this content?

Create free account

Sign up for free to access the full drug resource