Medical Author: Omudhome Ogbru, Pharm.D.
Medical Editor: Jay Marks, M.D.
GENERIC NAME: escitalopram
BRAND NAME: Lexapro
DRUG CLASS AND MECHANISM: Escitalopram is an oral drug that is used
for treating depression and
generalized anxiety disorder. Chemically,
escitalopram is similar to citalopram (Celexa). Both are in the class of drugs
called selective serotonin reuptake inhibitors (SSRIs), a class that also
includes fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft). SSRIs
work by affecting neurotransmitters in the brain, the chemical messengers that
nerves use to communicate with one another. Neurotransmitters are made and
released by nerves and then travel to other nearby nerves where they attach to
receptors on the nerves. Some neurotransmitters that are released do not bind to
receptors and are taken up by the nerves that produced them. This is referred to
as "reuptake." Many experts believe that an imbalance of neurotransmitters is
the cause of depression. Escitalopram prevents the reuptake of one
neurotransmitter, serotonin, by nerves, an action which results in more
serotonin in the brain to attach to receptors. The FDA approved escitalopram in
August 2002.
PRESCRIPTION: Yes
GENERIC AVAILABLE: No
PREPARATIONS: Tablets: 5, 10, and 20 mg. Solution: 1 mg/ml
STORAGE: Escitalopram should be stored at room temperature, 15-30 C
(59-86 F)
PRESCRIBED FOR: Escitalopram is approved for the treatment of
depression and generalized anxiety disorder. Drugs in the SSRI class also have
been studied in persons with obsessive compulsive disorders and
panic disorders,
but escitalopram is not approved for this purpose.
DOSING: The usual starting dose of escitalopram is 10 mg once daily in
the morning or evening. The dose may be increased to 20 mg once daily after 1
week. Benefit may not be seen until treatment has been given for up to 4 weeks.
A daily dose of 20 mg may not be anymore effective than 10 mg daily for
treatment of depression. Escitalopram can be taken with or without food.
DRUG INTERACTIONS: All SSRIs, including escitalopram, should not be
combined with drugs in the monoamine oxidase (MAO) inhibitor class of
antidepressants such as isocarboxazid (Marplan), phenelzine (Nardil),
tranylcypromine (Parnate), selegiline (Eldepryl) and
procarbazine (Matulane).
Such combinations may lead to confusion,
high blood pressure,
high fevers,
tremor or muscle rigidity, and increased activity. At least 14 days should
elapse after discontinuing escitalopram before starting an MAO inhibitor.
Conversely, at least 14 days should elapse after discontinuing an MAO inhibitor
before starting escitalopram.
Tryptophan can cause headaches, nausea, sweating,
and dizziness when taken with any SSRI.
Use of selective serotonin inhibitors may increase the risk of
gastrointestinal bleeding in patients taking
aspirin,
nonsteroidal
antiinflammatory drugs, and other drugs that cause bleeding.
PREGNANCY: The safety of escitalopram during
pregnancy and
breastfeeding 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 unknown 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.
SIDE EFFECTS: The most common side effects associated with
escitalopram are agitation or restlessness, blurred vision, diarrhea, difficulty
sleeping, drowsiness, dry mouth, fever, frequent urination, headache,
indigestion, nausea, increased or decreased appetite, increased sweating, sexual
difficulties (decreased sexual ability or desire, ejaculatory delay), taste
alterations, tremor (shaking), weight changes. Although changes in sexual
desire, sexual performance, and sexual satisfaction often occur as a result of
depression itself, they also may be a consequence of the drugs used to treat
depression. In particular, about one in 11 men given escitalopram report
difficulties ejaculating.
Some patients experience withdrawal reactions upon stopping SSRI therapy.
Symptoms may include dizziness, tingling, tiredness, vivid dreams, irritability,
or poor mood. In order to avoid these symptoms, the dose of SSRI can be slowly
reduced instead of abruptly stopped.
Antidepressants increased the risk of
suicidal thinking and behavior
(suicidality) in short-term studies in
children and
adolescents with depression
and other psychiatric disorders. Anyone considering the use of escitalopram or
any other antidepressant in a child or adolescent must balance this risk with
the clinical need. Short-term studies did not show an increase in the risk of
suicidality with antidepressants compared with placebo in adults beyond 24 years
of age. There was a reduction in risk of suicidality with antidepressants
compared with placebo in adults 65 years of age and older. Depression and
certain other psychiatric disorders are themselves associated with increases in
the risk of suicide. Patients who are started on therapy with antidepressants
should be closely observed for clinical worsening, suicidality, or unusual
changes in behavior.
Last Editorial Review: 12/17/2008
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
- citalopram, Celexa - Defines the medication citalopram (Celexa) an antidepressant drug that affects neurotransmitters. Article includes descriptions, uses, drug interactions, and side effects.
- Depression - Read about depression causes, symptoms, diagnosis, treatment and types, including manic depression (bipolar disorder), postpartum depression and clinical depression.
- Antidepressants - Read about the differnent types of antidepressants (used to treat depression) their side effects, drug interactions, and warnings and precautions.
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