Escitalopram

Antidepressant Drug

Drug class: Selective Serotonin Reuptake Inhibitor

Escitalopram (LEXAPRO)（中文：艾司西酞普蘭）

Pronunciation

Escitalopram 20mg

Common Strengths of Escitalopram Tablet

• Tablets: 5 mg, 10 mg, 20 mg
• Oral solution: 5 mg/5 mL

Drug Trade Names of Escitalopram Tablet

Lexapro

Drug Usage

• Major depressive disorder (MDD) in adults and adolescents (ages 12 to 17)
• Generalized anxiety disorder (GAD) in adults and children aged 7 and older

Mechanism of Action

It works by increasing serotonin levels in the brain by inhibiting its reuptake into presynaptic neurons, thereby enhancing serotonergic activity

Route of Administration

Oral (tablets and solution)

Dosages

• MDD and GAD: Start with 10 mg once daily; may increase to 20 mg/day after one week
• Elderly: Recommended dose is 10 mg/day

Side Effects

Frequency	Adverse reactions
Common	Nausea
	Dry mouth
	Increased sweating
	Drowsiness
	Insomnia
	Dizziness
	Fatigue
	Weakness
	Tremor (shaking)
	Sexual dysfunction (e.g., decreased libido, difficulty achieving orgasm, erectile dysfunction)
	Diarrhea or constipation
	Loss of appetite
	These side effects are generally mild and often subside as the body adjusts to the medication.
Serious	Allergic reactions: Symptoms such as hives, difficulty breathing, and swelling of the face, lips, tongue, or throat
	Serotonin syndrome: Symptoms include agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea
	QT prolongation: A dangerous heart rhythm condition that can lead to torsades de pointes. Symptoms may include fainting, dizziness, or irregular heartbeat
	Suicidal thoughts or behaviors: Particularly in young adults, teenagers, and children, especially when starting the medication or adjusting the dose
	Manic episodes: Symptoms include racing thoughts, increased energy, decreased need for sleep, risk-taking behavior, and being unusually talkative or agitated
	Severe nervous system reactions: Symptoms include very stiff muscles, high fever, sweating, confusion, fast or uneven heartbeats, and tremors
	Unusual bleeding: Including nosebleeds, bleeding gums, abnormal vaginal bleeding, or any bleeding that does not stop
	Low blood sodium (hyponatremia): Symptoms include headache, confusion, problems with thinking or memory, weakness, and feeling unsteady
	Seizures
	Vision problems (eye pain, changes in vision)
	Though less common, require immediate medical attention.

Pharmacokinetics

• Metabolism: Metabolized primarily by CYP2C19, CYP2D6, and CYP3A4.
• Elimination: Half-life approximately 27 to 33 hours.

Onset Time and Duration of Drug Action:

• Onset: Therapeutic effects typically observed within 1 to 4 weeks
• Duration: Steady-state achieved within 7 to 10 days

Drug Precautions

Pregnancy

Use only if the potential benefit justifies the risk. May cause complications such as preterm delivery.

Breastfeeding

Use with caution.

Children and Elderly

• Children: Approved for MDD in children aged 12 and older, and GAD in children aged 7 and older
• Elderly: The recommended dose is 10 mg/day due to increased sensitivity

Renal Impairment

No dosage adjustment necessary for mild-to-moderate impairment; use with caution in severe impairment

Monitoring Requirements

Escitalopram, a selective serotonin reuptake inhibitor (SSRI), requires careful monitoring and management to ensure patient safety and therapeutic efficacy. Here are the key aspects of monitoring and management:

Before Treatment

• Electrolytes:
  • Monitor and evaluate baseline levels of potassium and sodium
  • Correct any hypokalemia or hypomagnesmia before starting treatment
  • Periodically re-evaluate electrolytes, especially in patients at risk for electrolyte disturbances
• ECG Monitoring:
  • Perform an ECG to check for QT prolongation in patients with congenital long QT syndrome, bradycardia, hypokalemia, hypomagnesemia, recent acute myocardial infarction, or uncompensated hearty failure.
  • Avoid citalopram or use with caution in patients taking other QT-prolonging drugs

During Treatment

• Mental Health Monitoring:
  • Assess and monitor for worsening depression, suicidality, or unusual changes in behavior, particularly during the initial few months of therapy or when adjusting doses.
  • Weekly face-to-face contact is recommended during the first month, followed by bi-weekly visits for the next month, and then at 3-month intervals
• Weight and Growth:
  • Regularly monitor weight and growth in children and adolescents undergoing treatment
• Psychiatric Assessment:
  • Use standardized scales to screen for anxiety and depression and to monitor response to therapy, such as:
    • Patient Health Questionnaire (PHQ-9)
    • Generalized Anxiety Disorder 7 score (GAD-7)
    • Hamilton Anxiety Scale (HAM-A)
• Toxicity and Overdose Management
  • Serotonin Syndrome
    • Be vigilant for signs of serotonin syndrome, especially if the patient is on other serotonergic medications.
    • Symptoms include agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrgea
  • Patient Education:
    • Educate patients about the risks of combining citalopram with alcohol, sedatives, and other antidepressants.
• Sepecial Considerations:
  • Elderly Patients:
    • The maximum recommended dose patients older than 60 years is 20 mg per day due to increased risk of QT prolongation
    • Monitor for persistent QT_c measurements greater than 500 ms and discontinue citalopram if necessary
  • Monitor for abnormal bleeding

Drug Interactions

Major Drug Interactions

• Serotonergic Drugs
  • Drugs: Other SSRIs, SNRIs, triptans, tricyclic antidepressant, opioids, lithium, buspirone, amphetamines, tryptophan, St.John's Wort
  • Risk: Increased risk of serotonin syndrome
  • Management:
    • Monitor for signs and symptoms of serotonin syndrome, especially during initiation or dose changes
• QT-Prolonging Medications
  • Risk: Increased risk of QT prolongation and life-threatning arrhythmias
  • Management:
    • Perform ECG before starting treatment, especially in high-risk patients
    • Avoid combination if possibele, or use with caution and close monitoring
    • Monitor electrolytes, particularly potassium and magnesium
• Anticogulants and Antiplatelet Agents
  • Risk: Increased risk of bleeding
  • Management:
    • Inform patients of increased bleeding risk
    • Monitor closely, especially INR for patients on warfarin
• Other Significant Interactions
  • NSAIDs: May increase bleeding risk; use with caution
  • CYP2C19 inhibitors: May increase citalopram levels; dose adjustment may be necessary

FAQ

How Should I Take the Tablet?

Take once daily, with or without food.

What Should I Avoid While Taking?

Avoid alcohol and activites requiring mental alertness until you know how trifluoperazine affects you.

What Happens if I Miss a Dose?

Take the missed dose as soon as you remember unless it is almost time for your next dose. Do not double doses.