Omudhome Ogbru, PharmD
Omudhome Ogbru, PharmD
Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Medical and Pharmacy Editor:
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 a 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. Not all of the neurotransmitter that is released binds to receptors and, instead, is 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, an action which results in more serotonin in the brain to attach to receptors. The FDA approved escitalopram in August 2002.
GENERIC AVAILABLE: Yes
PREPARATIONS: Tablets: 5, 10 and 20 mg. Solution: 1 mg/ml
STORAGE: Escitalopram should be stored at room temperature, 15 C to 30 C (59 F to 86 F)
PRESCRIBED FOR: Escitalopram is approved for the treatment of depression and generalized anxiety disorder. Drugs in the SSRI class also are used for treating obsessive compulsive disorders and panic disorders, although escitalopram is not approved for these purposes.
DOSING: The usual starting dose of escitalopram for treating depression in adults or adolescents 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 more effective than 10 mg daily for treatment of depression. The dose for treating generalized anxiety disorder is 10 mg once daily. 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. Similar reactions occur when SSRIs are combined with other drugs, for example, tryptophan, St. John's wort, meperidine (Demerol), lithium (Lithobid, Eskalith), triptans (for example, sumatriptan [Imitrex, Alsuma]), and tramadol (Ultram) that increase serotonin in the brain.
Use of selective serotonin inhibitors may increase the risk of gastrointestinal bleeding in patients taking warfarin (Coumadin), 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 a patient outweigh unknown hazards to the fetus.
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