escitalopram, Lexapro (cont.)
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:
PREPARATIONS: Tablets: 5, 10 and 20 mg. Solution: 1 mg/ml
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) or other drugs that inhibit monoamine oxidase such as linezolid (Zyvox) and intravenous methylene blue.
Such combinations may lead to:
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 that increase serotonin in the brain, for example:
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 AND BREASTFEEDING SAFETY: 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.
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.
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.
STORAGE: Escitalopram should be stored at room temperature, 15 C to 30 C (59 F to 86 F)
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 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.
Medically reviewed by Eni Williams, PharmD
Reference: FDA Prescribing Information
Medically Reviewed by a Doctor on 3/28/2016
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