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Escitalopram

Generic Name(s): escitalopram (EE sye TAL o pram)
Brand Name(s): Lexapro
User reviews (1890)

Medically reviewed on October 16, 2017 by Carmen Fookes, BPharm

Warning(s):

Increased Risk of Suicidal Thoughts and Behavior in Children and Adolescents with Depression or Other Mood Disorders.

Escitalopram, like other antidepressants, has been associated with an increased risk of suicidal thoughts and behavior in children, adolescents, and adults under the age of 24. Beyond the age of 24 no increase in risk was noted, and over the age of 65 there was a reduction in risk. Monitor behavior.

Serotonin Syndrome

Serotonin syndrome is the name given to a potentially life-threatening collection of symptoms that occur if serotonin levels in the nerve synapses

Withdrawal Symptoms Following Abrupt Discontinuation

Some people have experienced withdrawal symptoms when they have stopped taking escitalopram suddenly. Symptoms have included a low mood, agitation, confusion, dizziness, electric shock sensations or a feeling of burning or prickling on their skin, insomnia, and lethargy. Do not stop taking escitalopram suddenly, unless your doctor tells you to. When it comes time to discontinue escitalopram, your doctor will tell you how to do it slowly.

Risk of Very Low Sodium Levels (Hyponatremia)

Escitalopram may cause low sodium levels (hyponatremia) because of continued and inappropriate secretion of a hormone from the pituitary gland that is responsible for concentrating urine. This is known as the syndrome of inappropriate antidiuretic hormone secretion (SIADH), and it reverses when escitalopram is discontinued. The risk is higher in seniors and in people who are dehydrated or taking diuretics. Symptoms include a headache, confusion, unsteadiness resulting in falls, and weakness; and in severe cases, it may cause death. Seek urgent medical help if you develop symptoms.

Increased Risk of Bleeding

Escitalopram, like other SSRIs, has been associated with an increased risk of bleeding events, particularly gastrointestinal (related to the stomach and intestine) bleeding. The risk is increased in people who also aspirin, nonsteroidal anti-inflammatory drugs, warfarin, or other anticoagulants. Talk to your doctor if you notice it takes longer for you to stop bleeding from a cut or if you notice blood in your stools (feces).

Uses

What is Escitalopram?

Escitalopram is a medicine that may be used for the treatment of major depressive disorder (depression) and generalized anxiety disorder (anxiety).

How does it work?

The exact way escitalopram works for the treatment of depression or anxiety is not known but is thought to be related an increase in serotonin, a chemical transmitter, in nerve synapses (the spaces between nerves) in the brain. Serotonin is involved in the regulation of mood, appetite, and sleep.

What symptoms of depression does escitalopram treat?

In people with depression, treatment with escitalopram aims to:

  • Reduce feelings of sadness
  • Decrease inner tension
  • Improve the ability to initiate and perform everyday activities
  • Improve concentration
  • Restore the experience of enjoying pleasurable activities and the ability to react with the appropriate emotion
  • Reduce pessimistic or suicidal thoughts
  • Improve your quality of life

What symptoms of anxiety does escitalopram treat?

In people with anxiety or a related mood disorder, treatment with escitalopram aims to:

  • Alleviate worries or fearful anticipation
  • Decrease inner tension and help with insomnia
  • Improve concentration and memory
  • Reduce the physical symptoms associated with anxiety such as nausea, trembling, a pounding heartbeat, hot and cold flushes, sweating, or tingling sensations
  • Improve your quality of life

How long does escitalopram take to start working?

Although small changes in the symptoms of depression or anxiety may be noticed within a week, it may take from 4 to 6 weeks after reaching your target dose for significant improvements to be seen.

Friends, family members, or your partner may notice changes that you are not even aware of. It may be useful to keep a diary of your symptoms to monitor your progress.

Before Taking

What Should I Know Before Taking Escitalopram?

Escitalopram may not be suitable for some people and should not be given to children aged less than twelve with depression, or less than 18 years with anxiety.

Escitalopram should NEVER be taken if you have:

Tell your doctor if you or anyone in your family has experienced any of the following, because these conditions may increase the likelihood that you may suffer certain side effects from escitalopram:

Dosage

How Should I take Escitalopram?

  • Escitalopram may be taken with or without food.
  • Take once a day in the morning or evening.
  • Escitalopram takes at least a week in adults to reach steady blood levels after a dosage increase.
  • Do not stop suddenly except on your doctor’s advice because withdrawal symptoms may occur.
  • Treatment is usually required for several months or longer; however, your doctor should re-evaluate the need for treatment every now and then

Depression in Adolescents

Initial dose: 10mg once daily. After a minimum of three weeks, the dosage may be increased to 20mg if necessary.

Depression in Adults

Initial dose: 10mg once daily. After a minimum of one week, the dosage may be increased to 20mg if necessary.

Anxiety in Adults

Initial dose: 10mg once daily. After a minimum of one week, the dosage may be increased to 20mg if necessary.

Depression or Anxiety in Elderly or People with Liver Disease

Initial dose: 10mg once daily.

General Dosing Information

  • Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts than recommended.
  • Do not share this medication with another person (especially a child), even if they have the same symptoms you have.
  • It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant. Also, talk to your doctor if you are breastfeeding.
  • Store at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use.

What Happens if I Miss a Dose?

If you miss a dose, take the missed dose as soon as you remember if it is still the same day of the missed dose. If it is the next day, do not take extra medicine to make up for the missed dose, just take your scheduled dose.

What Happens if I Overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

See also: Dosage in More Detail

Pharmacist Tips

  • Take exactly as prescribed. Escitalopram is usually taken once a day.
  • Escitalopram should make up one component of a total treatment plan for depression or anxiety that includes other non-drug components such as counseling, education, and social support.
  • Even though escitalopram is unlikely to cause drowsiness, it may do so in some people. Do not drive or operate machinery if escitalopram makes you drowsy. Alcohol may potentiate these effects.
  • Report to your doctor any mood changes such as agitation or greatly increased energy, signs of worsening of depression or suicidal thoughts, particularly during the first few months of therapy.
  • Seek urgent medical advice if you develop any symptoms suggestive of serotonin syndrome such as agitation, hallucinations, coma, fast heart rate, dizziness, flushing, muscle tremor or rigidity, with or without stomach symptoms (such as nausea, vomiting, or diarrhea).
  • Talk with your doctor if you notice it takes longer than normal for any cuts to stop bleeding. Also, discuss any persistent headaches or episodes of weakness or confusion with your doctor.
  • Report any changes in vision, redness or swelling around the eye or eye pain.
  • Do not stop suddenly, unless your doctor has told you to, because withdrawal symptoms may occur.
  • Talk to your doctor or pharmacist before taking any other medications with escitalopram, including aspirin, NSAIDs or St. John's Wort because these may interact.

Side Effects

Key Points

  • The abuse potential for escitalopram is considered low; however, trials have not assessed it for this effect.
  • Escitalopram may cause withdrawal symptoms if it is discontinued abruptly.
  • Some people are more likely to suffer from side effects due to escitalopram because they are poor metabolizers. This means it takes them longer to break down escitalopram through the CYP2C19 hepatic enzyme pathway.

Allergies and Allergic Reactions

Allergic reactions to escitalopram are uncommon. Rarely, anaphylaxis, edema, urticaria, and rash have been reported. You should not use this medicine if you are allergic to escitalopram or citalopram (a related drug).

Serious Side Effects

Stop taking escitalopram and call your doctor at once if you have:

  • Signs of an allergic reaction, such as a widespread rash, difficulty breathing, swelling of your face, lips, tongue, or throat, or a rapid heartbeat.
  • Changes in your mood or behavior, such as depression, hallucinations, paranoia, or suicidal thoughts. Monitor mood in children and report any changes to your doctor.
  • A seizure (also called a convulsion).
  • A painful, prolonged erection of your penis.

More Common Side Effects

This table shows side effects that were reported during trials of escitalopram for depression or anxiety at a dose of 20mg/day. A prevalence of 10% means that, on average, 10 out of every 100 people who take escitalopram are likely to develop this side effect. The highest reported prevalence is stated.
Cardiovascular Effects Prevalence
Increase in blood pressure >1%
Palpitations >1%
Gastrointestinal Problems Prevalence
Abdominal pain 2%
Constipation 6%
Decreased appetite 3%
Diarrhea 14%
Dry mouth 9%
Flatulence 2%
Increased weight 1%
Indigestion (dyspepsia) 6%
Nausea 18%
Vomiting 3%
Nervous System or Mood Effects Prevalence
Abnormal dreams 3%
Dizziness 7%
Fatigue (tiredness) 6%
Headache 24%
Insomnia (inability to sleep) 14%
Pins and needles in fingers or toes 2%
Sleepiness (sedation) 13%
Sexual or urinary problems Prevalence
Decreased libido 3% (females) 6% (males)
Ejaculation problems 12%
Erectile dysfunction 2%
Inability to orgasm (females only) 3%
Menstrual disorders 2%
Skin Reactions Prevalence
Increased sweating (hyperhidrosis) 8%
Rash >1%
Other Prevalence
Influenza-like symptoms 5%
Neck/shoulder pain 3%
Rhinitis 5%
Sinusitis 3%
Toothache 2%
Yawning 2%

Important: This is not a full list of side effects. For a full list, including those reported post-marketing (outside of a clinical trial), click the link below. Always call your doctor for medical advice about side effects. Side effects may also be reported to the FDA at 1-800-FDA-1088.

See also: Side Effects in More Detail

Drug Interactions

Alcohol

Alcohol (ethanol) can enhance the side effects of escitalopram and should be avoided.

What other drugs should I avoid while taking escitalopram?

Some medicines may interact with escitalopram and enhance its side effects or increase or decrease blood levels. If a drug is listed as having a major interaction with escitalopram, then the combination should be avoided. Always talk to your doctor or pharmacist before taking any other medication with escitalopram, including medicines bought over-the-counter, to check that they are compatible.

Major Interactions
MAOI inhibitors (eg, linezolid, phenelzine, selegiline) Serious, sometimes fatal reactions.
Separate administration by at least 14 days.
Pimozide Significant increase in QTc levels.
Moderate Interactions
Carbamazepine Possible increase in the clearance of escitalopram.
Medicines that decrease the ability of the blood to clot (eg, aspirin, NSAIDs, warfarin) Increased risk of bleeding.
Medicines that increase serotonin levels (eg, lithium, triptans, antipsychotics, tramadol) Additive effect of increased serotonin levels.
Medicines that cause sedation, dizziness or other CNS effects (eg, benzodiazepines, sedating antihistamines) Sedation, dizziness, increased risk of falls.
Medicines that enhance the QT-interval (eg, amiodarone, antipsychotics, flecainide) Possibly an additive QT-interval enhancing effect with escitalopram.
Minor Interactions
Cimetidine Increased blood levels of cimetidine.
Dosage adjustment not usually recommended.
Drugs that inhibit or induce CYP2C19, CYP2D6, or CYP 3A4 hepatic enzymes. Blood level effects usually minor.
Dosage adjustment not usually recommended.
Metoprolol Increases blood levels of metoprolol but no effect noted on blood pressure or heart rate.
Cardioselectivity may be lost.
Dosage adjustment not usually recommended.

This guide does NOT list all possible interactions.

See also: Interactions in more Detail

Key Summary

Sources
  • Escitalopram [Package Insert]. Revised 05/2017. Taro Pharmaceuticals U.S.A., Inc. https://www.drugs.com/pro/escitalopram-tablets.html
  • Montgomery-Asberg Depression Scale (MADRS). OutcomeTracker.org. https://www.outcometracker.org/library/MADRS.pdf Hamilton Anxiety Rating Scale (HAM-A) https://pdbp.ninds.nih.gov/sites/default/files/assets/crfs/Hamilton%20Anxiety%20Rating%20Scale%20(HAM-A).pdf
  • Davidson JR, Bose A, Korotzer A, Zheng H. Escitalopram in the treatment of generalized anxiety disorder: double-blind, placebo controlled, flexible-dose study. Depress Anxiety. 2004;19(4):234-40.
  • Culpepper L. Escitalopram: A New SSRI for the Treatment of Depression in Primary Care. Primary Care Companion to The Journal of Clinical Psychiatry. 2002;4(6):209-214.
Disclaimer
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use escitalopram only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.
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