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standards of non-Merck sources.
ALERT: U.S. Boxed Warning
The FDA-approved labeling includes a boxed warning. See Warnings/Precautions section and/or refer to product labeling for additional detail.
Medication Safety Issues
Sound-alike/look-alike issues:
Lexapro® may be confused with Loxitane®
Pronunciation
(es sye TAL oh pram)
U.S. Brand Names
Index Terms
Generic Available
No
Canadian Brand Names
Pharmacologic Category
Pharmacologic Category Synonyms
Use: Labeled Indications
Treatment of major depressive disorder; generalized anxiety disorders (GAD)
Use: Unlabeled/Investigational
Treatment of mild dementia-associated agitation in nonpsychotic patients
Restrictions
An FDA-approved medication guide concerning the use of antidepressants in children, adolescents, and young adults must be distributed when dispensing an outpatient prescription (new or refill) where this medication is to be used without direct supervision of a healthcare provider. Medication guides are available at http://www.fda.gov/cder/Offices/ODS/medication_guides.htm. Dispense to parents or guardians of children and adolescents receiving this medication.
Pregnancy Risk Factor
C
Pregnancy Considerations
Due to adverse effects observed in animal studies, escitalopram is classified as pregnancy category C. Escitalopram is distributed into the amniotic fluid. Limited data is available concerning the use of escitalopram during pregnancy. Nonteratogenic effects in the newborn following SSRI exposure late in the third trimester include respiratory distress, cyanosis, apnea, seizures, temperature instability, feeding difficulty, vomiting, hypoglycemia, hypo- or hypertonia, hyper-reflexia, jitteriness, irritability, constant crying, and tremor. An increased risk of low birth weight and lower APGAR scores have also been reported. Exposure to SSRIs after the twentieth week of gestation has been associated with persistent pulmonary hypertension of the newborn (PPHN). Adverse effects may be due to toxic effects of the SSRI or drug withdrawal without a taper. The long-term effects of in utero SSRI exposure on infant development and behavior are not known. Escitalopram is the S-enantiomer of the racemic derivative citalopram; also refer to the Citalopram monograph.Women treated for major depression and who are euthymic prior to pregnancy are more likely to experience a relapse when medication is discontinued as compared to pregnant women who continue taking antidepressant medications. The ACOG recommends that therapy with SSRIs or SNRIs during pregnancy be individualized; treatment of depression during pregnancy should incorporate the clinical expertise of the mental health clinician, obstetrician, primary healthcare provider, and pediatrician (ACOG, 2007). If treatment during pregnancy is required, consider tapering therapy during the third trimester in order to prevent withdrawal symptoms in the infant. If this is done and the woman is considered to be at risk from her major depressive disorder, the medication can be restarted following delivery, although the dose should be readjusted to that required before pregnancy.
Lactation
Enters breast milk/consider risk:benefit
Breast-Feeding Considerations
Escitalopram and its metabolite are excreted into breast milk. Limited data is available concerning the effects escitalopram may have in the nursing infant and the long-term effects on development and behavior have not been studied. According to the manufacturer, the decision to continue or discontinue breast-feeding during therapy should take into account the risk of exposure to the infant and the benefits of treatment to the mother. Escitalopram is the S-enantiomer of the racemic derivative citalopram; also refer to the Citalopram monograph.
Contraindications
Hypersensitivity to escitalopram, citalopram, or any component of the formulation; concomitant use or within 2 weeks of MAO inhibitors
Warnings/Precautions
Boxed warnings:
• Suicidal thinking/behavior: See “Major psychiatric warnings” below.
Major psychiatric warnings:
• [U.S. Boxed Warning]: Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults (18-24 years of age) with major depressive disorder (MDD) and other psychiatric disorders; consider risk prior to prescribing. Short-term studies did not show an increased risk in patients >24 years of age and showed a decreased risk in patients ?65 years. Closely monitor patients for clinical worsening, suicidality, or unusual changes in behavior, particularly during the initial 1-2 months of therapy or during periods of dosage adjustments (increases or decreases); the patient's family or caregiver should be instructed to closely observe the patient and communicate condition with healthcare provider. A medication guide concerning the use of antidepressants should be dispensed with each prescription. Escitalopram is not FDA approved for use in children.
• The possibility of a suicide attempt is inherent in major depression and may persist until remission occurs. Patients treated with antidepressants should be observed for clinical worsening and suicidality, especially during the initial few months of a course of drug therapy, or at times of dose changes, either increases or decreases. Worsening depression and severe abrupt suicidality that are not part of the presenting symptoms may require discontinuation or modification of drug therapy. Use caution in high-risk patients during initiation of therapy.
• Prescriptions should be written for the smallest quantity consistent with good patient care. The patient's family or caregiver should be alerted to monitor patients for the emergence of suicidality and associated behaviors such as anxiety, agitation, panic attacks, insomnia, irritability, hostility, impulsivity, akathisia, hypomania, and mania; patients should be instructed to notify their healthcare provider if any of these symptoms or worsening depression or psychosis occur.
• May worsen psychosis in some patients or precipitate a shift to mania or hypomania in patients with bipolar disorder. Monotherapy in patients with bipolar disorder should be avoided. Patients presenting with depressive symptoms should be screened for bipolar disorder. Escitalopram is not FDA approved for the treatment of bipolar depression.
Concerns related to adverse effects:
• Anticholinergic effects: Relatively devoid of these side effects.
• Bleeding risk: May impair platelet aggregation resulting in increased risk of bleeding events, particularly if used concomitantly with aspirin, NSAIDs, warfarin or other anticoagulants. Bleeding related to SSRI use has been reported to range from relatively minor bruising and epistaxis to life-threatening hemorrhage.
• CNS depression: Has a low potential to impair cognitive or motor performance; caution operating hazardous machinery or driving.
• Sexual dysfunction: May cause or exacerbate sexual dysfunction.
• SIADH and hyponatremia: SSRIs and SNRIs have been associated with the development of SIADH; hyponatremia has been reported rarely (including severe cases with serum sodium <110 mmol/L), predominately in the elderly. Volume depletion and/or concurrent use of diuretics likely increases risk.
Disease-related concerns:
• Hepatic impairment: Use with caution in patients with hepatic impairment; clearance is decreased and plasma concentrations are increased; a lower dosage may be needed.
• Renal impairment: Use with caution in patients with renal impairment; clearance is decreased and plasma concentrations are increased; a lower dosage may be needed.
• Seizure disorders: Use with caution in patients with a previous seizure disorder or condition predisposing to seizures such as brain damage or alcoholism.
Concurrent drug therapy issues:
• Agents which lower seizure threshold: Concurrent therapy with other drugs which lower the seizure threshold.
• Anticoagulants/Antiplatelets: Use caution with concomitant use of NSAIDs, ASA, or other drugs that affect coagulation; the risk of bleeding may be potentiated.
• CNS depressants: Use caution with concomitant therapy.
• MAO inhibitors: Potential for severe reaction when used with MAO inhibitors; autonomic instability, coma, death, delirium, diaphoresis, hyperthermia, mental status changes/agitation, muscular rigidity, myoclonus, neuroleptic malignant syndrome features, and seizures may occur.
• Serotonin syndrome: Symptoms of agitation, confusion, hallucinations, hyper-reflexia, myoclonus, shivering, and tachycardia may occur with concomitant proserotonergic drugs (ie, SSRIs/SNRIs or triptans) or agents which reduce escitalopram's metabolism. Concurrent use of serotonin precursors (eg, tryptophan) is not recommended.
Special populations:
• Elderly: Use caution in elderly patients; risk of hyponatremia and other adverse events may be increased.
• Pregnancy: Use caution in pregnant patients; high doses of citalopram have been associated with teratogenicity in animals.
Other warnings/precautions:
• Electroconvulsive therapy: May increase the risks associated with electroconvulsive therapy; consider discontinuing, when possible, prior to ECT treatment.
• Withdrawal syndrome: May cause dysphoric mood, irritability, agitation, dizziness, sensory disturbances, anxiety, confusion, headache, lethargy, emotional lability, insomnia, hypomania, tinnitus, and seizures. Upon discontinuation of escitalopram therapy, gradually taper dose. If intolerable symptoms occur following a decrease in dosage or upon discontinuation of therapy, then resuming the previous dose with a more gradual taper should be considered.
Adverse Reactions
>10%:
Central nervous system: Headache (24%), somnolence (6% to 13%), insomnia (9% to 12%)
Gastrointestinal: Nausea (15%)
Genitourinary: Ejaculation disorder (9% to 14%)
1% to 10%:
Cardiovascular: Chest pain, hypertension, palpitation
Central nervous system: Dizziness (5%), fatigue (5% to 8%), dreaming abnormal, concentration impaired, fever, irritability, lethargy, lightheadedness, migraine, vertigo, yawning
Dermatologic: Rash
Endocrine & metabolic: Libido decreased (3% to 7%), anorgasmia (2% to 6%), hot flashes, menstrual cramps, menstrual disorder
Gastrointestinal: Diarrhea (8%), xerostomia (6% to 9%), appetite decreased (3%), constipation (3% to 5%), indigestion (3%), abdominal pain (2%), abdominal cramps, appetite increased, flatulence, gastroenteritis, gastroesophageal reflux, heartburn, toothache, vomiting, weight gain/loss
Genitourinary: Impotence (3%), urinary tract infection, urinary frequency
Neuromuscular & skeletal: Arthralgia, limb pain, muscle cramp, myalgia, neck/shoulder pain, paresthesia, tremor
Ocular: Blurred vision
Otic: Earache, tinnitus
Respiratory: Rhinitis (5%), sinusitis (3%), bronchitis, cough, nasal or sinus congestion, sinus headache
Miscellaneous: Diaphoresis (4% to 5%), flu-like syndrome (5%), allergy
<1%: Abdominal discomfort, acne, agitation, alopecia, amnesia, anaphylaxis, anemia, anxiety attack, apathy, arthritis, arthropathy, asthma, auditory hallucination, back discomfort, belching, bilirubin increased, bloating, bradycardia, bruise, bruxism, carbohydrate craving, carpal tunnel syndrome, chest tightness, chills, confusion, conjunctivitis, crying abnormal, depersonalization, depression aggravated, depression, dermatitis, dry eyes, dry skin, dysequilibrium, dyspepsia, dysuria, ECG abnormal, eczema, edema, emotional lability, excitability, eye infection, eye irritation, faintness, feeling unreal, flushing, folliculitis, forgetfulness, furunculosis, gagging, gastritis, gout, hematoma, hemorrhoids, hypercholesterolemia, hyperglycemia, hyper-reflexia, jaw pain, jaw stiffness, jitteriness, joint stiffness, kidney stone, laryngitis, leg pain, lipoma, malaise, menorrhagia, muscle contractions (involuntary), muscle stiffness, muscle weakness, muscular tone increased, nervousness, nosebleed, panic reaction, pelvic inflammation, pneumonia, pruritus, pupils dilated, restless legs, restlessness aggravated, shaking, shortness of breath, spotting between menses, stool frequency increased, suicidal tendency, suicide attempt, syncope, tachycardia, taste alteration, tics, tracheitis, tremulousness nervous, twitching, urinary frequency, varicose vein, vision abnormal, visual disturbance, weakness
Postmarketing and/or case reports: Acute renal failure, aggression, akathisia, allergic reaction, angioedema, atrial fibrillation, choreoathetosis, delirium, dyskinesia, ecchymosis, epidermal necrolysis, erythema multiforme, grand mal seizure, hallucination, hemolytic anemia, hepatic necrosis, hepatitis, nystagmus, pancreatitis, priapism, prolactinemia, prothrombin decreased, pulmonary embolism, QT prolonged, rhabdomyolysis, serotonin syndrome, SIADH, spontaneous abortion, thrombocytopenia, thrombosis, torsade de pointes, ventricular arrhythmia, withdrawal syndrome
Metabolism/Transport Effects
Substrate (major) of CYP2C19, 3A4; Inhibits CYP2D6 (weak)
Drug Interactions
Alcohol (Ethyl): CNS Depressants may enhance the CNS depressant effect of Alcohol (Ethyl). Risk C: Monitor therapy
Alpha-/Beta-Blockers: Selective Serotonin Reuptake Inhibitors may decrease the metabolism of Alpha-/Beta-Blockers. Risk C: Monitor therapy
Analgesics (Opioid): May enhance the serotonergic effect of Selective Serotonin Reuptake Inhibitors. This may cause serotonin syndrome. Risk C: Monitor therapy
Anticoagulants: Antiplatelet Agents may enhance the anticoagulant effect of Anticoagulants. Risk C: Monitor therapy
Antidepressants (Serotonin Reuptake Inhibitor/Antagonist): Selective Serotonin Reuptake Inhibitors may enhance the serotonergic effect of Antidepressants (Serotonin Reuptake Inhibitor/Antagonist). This may cause serotonin syndrome. Risk C: Monitor therapy
Antiplatelet Agents: May enhance the anticoagulant effect of other Antiplatelet Agents. Risk C: Monitor therapy
Aspirin: Selective Serotonin Reuptake Inhibitors may enhance the antiplatelet effect of Aspirin. Risk C: Monitor therapy
Beta-Blockers: Selective Serotonin Reuptake Inhibitors may enhance the bradycardic effect of Beta-Blockers. Exceptions: Acebutolol; Atenolol; Carteolol; Esmolol; Levobunolol; Metipranolol; Nadolol; Penbutolol. Risk C: Monitor therapy
BusPIRone: May enhance the serotonergic effect of Selective Serotonin Reuptake Inhibitors. This may cause serotonin syndrome. Selective Serotonin Reuptake Inhibitors may decrease the metabolism of BusPIRone. Risk C: Monitor therapy
Carbamazepine: Selective Serotonin Reuptake Inhibitors may decrease the metabolism of Carbamazepine. Specifically those SSRIs that inhibit CYP3A4 isoenzymes. Carbamazepine may increase the metabolism of Selective Serotonin Reuptake Inhibitors. Specifically those agents metabolized via CYP1A2, 2C, and/or 3A4 isoenzymes. Risk D: Consider therapy modification
Cimetidine: May decrease the metabolism of Selective Serotonin Reuptake Inhibitors. Risk D: Consider therapy modification
Clozapine: Selective Serotonin Reuptake Inhibitors may decrease the metabolism of Clozapine. Risk D: Consider therapy modification
CNS Depressants: May enhance the adverse/toxic effect of other CNS Depressants. Risk C: Monitor therapy
Coumarin Derivatives: Selective Serotonin Reuptake Inhibitors may enhance the anticoagulant effect of Coumarin Derivatives. Risk C: Monitor therapy
CYP2C19 Inducers (Strong): May increase the metabolism of CYP2C19 Substrates. Risk C: Monitor therapy
CYP2C19 Inhibitors (Moderate): May decrease the metabolism of CYP2C19 Substrates. Risk C: Monitor therapy
CYP2C19 Inhibitors (Strong): May decrease the metabolism of CYP2C19 Substrates. Risk D: Consider therapy modification
CYP3A4 Inducers (Strong): May increase the metabolism of CYP3A4 Substrates. Risk C: Monitor therapy
CYP3A4 Inhibitors (Moderate): May decrease the metabolism of CYP3A4 Substrates. Risk C: Monitor therapy
CYP3A4 Inhibitors (Strong): May decrease the metabolism of CYP3A4 Substrates. Risk D: Consider therapy modification
Cyproheptadine: May diminish the therapeutic effect of Selective Serotonin Reuptake Inhibitors. Risk C: Monitor therapy
Dasatinib: May enhance the anticoagulant effect of Antiplatelet Agents. Risk C: Monitor therapy
Dextromethorphan: Selective Serotonin Reuptake Inhibitors may enhance the adverse/toxic effect of Dextromethorphan. Risk D: Consider therapy modification
Drotrecogin Alfa: Antiplatelet Agents may enhance the adverse/toxic effect of Drotrecogin Alfa. Bleeding may occur. Risk D: Consider therapy modification
Haloperidol: Selective Serotonin Reuptake Inhibitors may decrease the metabolism of Haloperidol. Risk C: Monitor therapy
Herbs (Anticoagulant/Antiplatelet Properties) (eg, Alfalfa, Anise, Bilberry): May enhance the adverse/toxic effect of Antiplatelet Agents. Bleeding may occur. Risk D: Consider therapy modification
Herbs (CYP3A4 Inducers): May increase the metabolism of CYP3A4 Substrates. Risk C: Monitor therapy
Ibritumomab: Antiplatelet Agents may enhance the adverse/toxic effect of Ibritumomab. Both agents may contribute to impaired platelet function and an increased risk of bleeding. Risk C: Monitor therapy
Lithium: Selective Serotonin Reuptake Inhibitors may enhance the adverse/toxic effect of Lithium. Risk C: Monitor therapy
Macrolide Antibiotics: May decrease the metabolism of Selective Serotonin Reuptake Inhibitors. Exceptions: Azithromycin; Dirithromycin [Off Market]; Spiramycin. Risk C: Monitor therapy
MAO Inhibitors: May enhance the serotonergic effect of Selective Serotonin Reuptake Inhibitors. This may cause serotonin syndrome. Risk X: Avoid combination
Methadone: Selective Serotonin Reuptake Inhibitors may decrease the metabolism of Methadone. Fluvoxamine appears to be the only interacting SSRI. Risk D: Consider therapy modification
Mexiletine: Selective Serotonin Reuptake Inhibitors may decrease the metabolism of Mexiletine. Risk D: Consider therapy modification
NSAID (COX-2 Inhibitor): Selective Serotonin Reuptake Inhibitors may enhance the antiplatelet effect of NSAID (COX-2 Inhibitor). Risk D: Consider therapy modification
NSAID (Nonselective): Selective Serotonin Reuptake Inhibitors may enhance the antiplatelet effect of NSAID (Nonselective). Risk D: Consider therapy modification
Omega-3-Acid Ethyl Esters: May enhance the antiplatelet effect of Antiplatelet Agents. Risk C: Monitor therapy
Pentosan Polysulfate Sodium: May enhance the adverse/toxic effect of Antiplatelet Agents. Specifically, the risk of bleeding may be increased by concurrent use of these agents. Risk C: Monitor therapy
Phenytoin: Selective Serotonin Reuptake Inhibitors may decrease the metabolism of Phenytoin. Risk D: Consider therapy modification
Pimozide: Selective Serotonin Reuptake Inhibitors may enhance the adverse/toxic effect of Pimozide. Management: Use of pimozide with fluvoxamine, paroxetine, and sertraline is contraindicated. Risk D: Consider therapy modification
Propafenone: Selective Serotonin Reuptake Inhibitors may decrease the metabolism of Propafenone. Risk D: Consider therapy modification
Prostacyclin Analogues: May enhance the antiplatelet effect of Antiplatelet Agents. Risk C: Monitor therapy
Risperidone: Selective Serotonin Reuptake Inhibitors may decrease the metabolism of Risperidone. Risk C: Monitor therapy
Salicylates: Antiplatelet Agents may enhance the adverse/toxic effect of Salicylates. Increased risk of bleeding may result. Risk C: Monitor therapy
Serotonin Modulators: May enhance the adverse/toxic effect of other Serotonin Modulators. The development of serotonin syndrome may occur. Risk D: Consider therapy modification
Sibutramine: May enhance the serotonergic effect of Serotonin Modulators. This may cause serotonin syndrome. Risk X: Avoid combination
Tositumomab and Iodine I 131 Tositumomab: Antiplatelet Agents may enhance the adverse/toxic effect of Tositumomab and Iodine I 131 Tositumomab. Specifically, the risk of bleeding-related adverse events may be increased. Risk C: Monitor therapy
Tramadol: Selective Serotonin Reuptake Inhibitors may enhance the neuroexcitatory and/or seizure-potentiating effect of Tramadol. Tramadol may enhance the serotonergic effect of Selective Serotonin Reuptake Inhibitors. This may cause serotonin syndrome. Risk D: Consider therapy modification
Tricyclic Antidepressants: Selective Serotonin Reuptake Inhibitors may decrease the metabolism of Tricyclic Antidepressants. Risk D: Consider therapy modification
Tryptophan: May enhance the serotonergic effect of Selective Serotonin Reuptake Inhibitors. This may cause serotonin syndrome. Risk D: Consider therapy modification
Ethanol/Nutrition/Herb Interactions
Ethanol: Avoid ethanol (may increase CNS depression).
Herb/Nutraceutical: Avoid valerian, St John's wort, SAMe, kava kava, and gotu kola (may increase CNS depression).
Storage
Store at 25°C (77°F).
Mechanism of Action
Escitalopram is the S-enantiomer of the racemic derivative citalopram, which selectively inhibits the reuptake of serotonin with little to no effect on norepinephrine or dopamine reuptake. It has no or very low affinity for 5-HT1-7, alpha- and beta-adrenergic, D1-5, H1-3, M1-5, and benzodiazepine receptors. Escitalopram does not bind or has low affinity for Na+, K+, Cl-, and Ca++ ion channels.
Pharmacodynamics/Kinetics
Onset of action: Depression: The onset of action is within a week, however, individual response varies greatly and full response may not be seen until 8-12 weeks after initiation of treatment.
Protein binding: 56% to plasma proteins
Metabolism: Hepatic via CYP2C19 and 3A4 to an active metabolite, S-desmethylcitalopram (S-DCT; 1/7 the activity); S-DCT is metabolized to S-didesmethylcitalopram (S-DDCT; active; 1/27 the activity) via CYP2D6
Half-life elimination: Escitalopram: 27-32 hours; S-desmethylcitalopram: 59 hours
Time to peak: Escitalopram: 5 ± 1.5 hours; S-desmethylcitalopram: 14 hours
Excretion: Urine (Escitalopram: 8%; S-DCT: 10%)
Clearance: Total body: 37-40 L/hour; Renal: Escitalopram: 2.7 L/hour; S-desmethylcitalopram: 6.9 L/hour
Dosage
Oral:
Adults: Depression, generalized anxiety disorder: Initial: 10 mg/day; dose may be increased to 20 mg/day after at least 1 week
Elderly: 10 mg/day; bioavailability and half-life are increased by 50% in the elderly
Dosage adjustment in renal impairment:
Mild-to-moderate impairment: No dosage adjustment needed
Severe impairment: Clcr <20 mL/minute: Use caution
Dosage adjustment in hepatic impairment: 10 mg/day
Administration: Oral
Administer once daily (morning or evening), with or without food.
Monitoring Parameters
Mental status for depression, suicidal ideation (especially at the beginning of therapy or when doses are increased or decreased), anxiety, social functioning, mania, panic attacks; akathisia
Dietary Considerations
May be taken with or without food.
Patient Education
Do not take any new medication during therapy without consulting prescriber. Take exactly as directed; do not alter dose or discontinue without consulting prescriber (effects of medication may take up to 3 weeks to occur). Avoid other stimulants: caffeine or alcohol. May cause dizziness, lightheadedness, insomnia, impaired concentration, headache (use caution when driving or engaging in tasks requiring alertness until response to drug is known); nausea, vomiting, loss or increase of appetite, indigestion, or heartburn (small frequent meals, frequent mouth care, sucking lozenges, or chewing gum may help); constipation (increased dietary fluid, fruit, fiber, and increased exercise may help); sexual dysfunction (reversible when drug is discontinued); hot flashes or menstrual cramps; or muscle pain, cramps, or tremor (consult prescriber for approved analgesia). Report immediately any CNS changes such as increased depression, confusion, impaired concentration, severe headache, insomnia, nightmares, irritability, acute anxiety, panic attacks, or thoughts of suicide; persistent GI changes; chest pain or palpitations; blurred vision or vision changes; ringing in ears; unusual cough; or other persistent adverse effects. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to become pregnant. Breast-feeding is not recommended.
Geriatric Considerations
Bioavailability and half-life are increased by 50% in the elderly.
Additional Information
The tablet and oral solution dosage forms are bioequivalent. Clinically, escitalopram 20 mg is equipotent to citalopram 40 mg. Do not coadminister with citalopram.
Dental Health: Effects on Dental Treatment
Key adverse event(s) related to dental treatment: Xerostomia (normal salivary flow resumes upon discontinuation) and toothache
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
Although caution should be used in patients taking tricyclic antidepressants, no interactions have been reported with vasoconstrictors and escitalopram, a nontricyclic antidepressant which acts to increase serotonin; no precautions appear to be needed
Mental Health: Comment
The SSRIs as a class are generally considered to be safe and equally effective. For the management of depression, these drugs display a flat dose-response curve. Allow sufficient dose-response time (6-12 weeks). Differences lie in approved indications, receptor profiles, pharmacokinetics, and cytochrome P450 activity profile. Subtle differences exist in adverse effect profiles. All SSRIs have the potential to cause sexual dysfunction. Escitalopram is the s-isomer of citalopram and therefore, similar to citalopram. Among the SSRIs, escitalopram possesses the lowest effects on CYP isoenzymes.
Nursing: Physical Assessment/Monitoring
Assess potential for interactions with other prescriptions, OTC medications, or herbal products patient may be taking (eg, MAO inhibitors and other SSRIs). Assess therapeutic effectiveness and adverse reactions at the beginning of therapy and on a regular basis throughout therapy (eg, suicidal ideation, mania, hypomania, anxiety, or panic attacks). Teach patient proper use, possible side effects, interventions to reduce side effects, and adverse symptoms to report.
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, oral: 1 mg/mL (240 mL) [peppermint flavor]
Tablet: 5 mg, 10 mg, 20 mg
Note: Cipralex® [CAN] is available only in 10 mg and 20 mg strengths.
Pricing: U.S. (www.drugstore.com)
Solution (Lexapro)
5 mg/5 mL (240): $140.86
Tablets (Lexapro)
5 mg (30): $82.99
10 mg (30): $85.99
20 mg (30): $89.99
References
American College of Obstetricians and Gynecologists, "ACOG Practice Bulletin No. 87 November 2007: Use of Psychiatric Medications During Pregnancy and Lactation" Obstet Gynecol, 2007, 110(5):1179-98.
Bernard L, Stern R, Lew D, et al, “Serotonin Syndrome After Concomitant Treatment With Linezolid and Citalopram,” Clin Infect Dis, 2003, 36(9):1197.
Boyer EW and Shannon M, “The Serotonin Syndrome,” N Engl J Med, 2005, 352:1112-20.
Chambers CD, Hernandez-Diaz S, Van Marter LJ, et al, “Selective Serotonin-Reuptake Inhibitors and Risk of Persistent Pulmonary Hypertension of the Newborn,” N Engl J Med, 2006, 354(6):579-87.
Mahlberg R, Kunz D, Sasse J, et al, “Serotonin Syndrome With Tramadol and Citalopram,” Am J Psychiatry, 2004, 161(6):1129.
Mokhlesi B, Leikin JB, Murray P, et al, “Adult Toxicology in Critical Care: Part II: Specific Poisonings,” Chest, 2003, 123(3):897-922.
Montgomery SA, Loft H, Sanchez C, et al, “Escitalopram (S-Enantiomer of Citalopram): Clinical Efficacy and Onset of Action Predicted From a Rat Model,” Pharmacol Toxicol, 2001, 88(5):282-6.
Pass SE and Simpson RW, “Discontinuation and Reinstitution of Medications During the Perioperative Period,” Am J Health Syst Pharm, 2004, 61(9):899-912.
Rabins PV, Blacker D, Rovner BW, et al, “Practice Guideline for the Treatment of Patients With Alzheimer's Disease and Other Dementias,” October, 2007. Available at http://www.psych.org/psych_pract/treatg/pg/prac_guide.cfm
Tahir N, “Serotonin Syndrome as a Consequence of Drug-Resistant Infections: An Interaction Between Linezolid and Citalopram, J Am Med Dir Assoc, 2004, 5(2):111-3.
Von Moltke LL, Greenblatt DJ, Giancarlo GM, et al, “Escitalopram (S-Citalopram) and its Metabolites in vitro: Cytochromes Mediating Biotransformation, Inhibitory Effects, and Comparison to R-Citalopram,” Drug Metab Dispos, 2001, 29(8):1102-9.
International Brand Names
Lexi-Comp.com
Last full review/revision August 2008
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