What it's for (Indications)
- Escitalopram is indicated for the treatment of Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD).
- Symptoms of condition start improving in a week or two, however, it takes 4 to 6 weeks of therapy before full benefits are seen.
Dosage Information
| Type | Guideline |
|---|---|
| Standard | Escitalopram tablets should be administered once daily, in the morning or evening, with or without food. To maintain an even level of medication, try to take it at the same time each day. Swallow the tablet with water; do not crush, chew, or break it. Do not discontinue taking Escitalopram without first consulting your doctor; a gradual dose reduction is recommended. **Recommended Doses:** - **Major Depressive Disorder (MDD) - Adults and Adolescents:** Initial: 10 mg once daily. Recommended: 10 mg once daily. Maximum: 20 mg once daily. - **Generalized Anxiety Disorder (GAD) - Adults:** Initial: 10 mg once daily. Recommended: 10 mg once daily. No additional benefits are typically seen at 20 mg/day for GAD. **Special Populations:** - **Elderly Patients:** Recommended dose is 10 mg/day. - **Patients with Hepatic Impairment:** An initial dose of 5 mg/day may be started, with a recommended dose of 10 mg/day. Consultation with a doctor is advised. - **Patients with Renal Impairment:** No dosage adjustment is needed for mild or moderate renal impairment. Use caution in patients with severe renal impairment. **Treatment Duration:** Symptoms begin improving in 1 to 2 weeks, with full benefits appearing in 4 to 6 weeks. It is generally taken for a period of 8 weeks in MDD but should be used for longer periods to achieve maximum effect. **Storage:** Store at room temperature (between 15 to 30 degrees Celsius) away from direct heat and sunlight. Keep it out of the reach of children and pets. |
Safety & Warnings
Common Side Effects
- Commonly observed adverse reactions (incidence ≥ 5% and at least twice the incidence of placebo patients) include: nausea, dry mouth, sweating (increased), fatigue, somnolence (drowsiness), insomnia, dizziness, weakness, headache, loss of appetite, anxiety, tremor (shaking), myalgia (muscle pain), arthralgia (joint pain), weight gain (initial reduction in appetite and weight loss may occur, followed by regain to usual weight with continued use), abnormal dreams, gastrointestinal upset (diarrhea, constipation, vomiting, excessive gas/air in stomach), fever, and sinus infections.
- Sexual dysfunction is also common and may include ejaculation disorder (primarily ejaculatory delay), decreased libido, anorgasmia, painful erection, problems getting an erection, and vaginal bleeding.
- Abrupt discontinuation can lead to withdrawal symptoms such as irritability, nightmares, vomiting/nausea, headache, paresthesia's (tingling sensation on skin), anxiety, confusion, low mood, electric shock-like sensations, and restlessness.
- Rare but serious side effects include severe allergic reactions, Serotonin Syndrome, worsening of depression, seizures, decreased urine output, rapid heartbeat, bleeding, incoordination, and QT prolongation (a heart rhythm disorder that can induce dangerous irregular/fast heartbeat, extreme dizziness, and fainting requiring immediate medical intervention).
Serious Warnings
- Black Box Warning: WARNINGS: SUICIDALITY AND ANTIDEPRESSANT DRUGS Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of Escitalopram or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality in adults over 24 years of age.
- Patients, their families, and caregivers should be informed about the benefits and risks of treatment with Escitalopram.
- **Suicidality:** Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders.
- This risk must be balanced with the clinical need.
- Short-term studies did not show an increased risk of suicidality in adults over 24 years of age.
- **Pregnancy:** Escitalopram should be taken only when absolutely necessary during pregnancy, as it has the potential to cause harm to an unborn child.
- Babies born to women who used Escitalopram in the last trimester of pregnancy may experience symptoms of withdrawal such as feeding difficulties, breathing difficulties, seizures, muscular rigidity, or continuous crying.
- Pregnant females should consult their doctors regarding the benefits and risks.
- **Lactation:** Escitalopram enters breast milk and can have adverse effects on a nursing baby.
- Lactating females should consult their doctor before use.
- **Cardiovascular Risks:** Escitalopram has been linked to a heart rhythm disorder (QT prolongation) which can induce dangerous (occasionally fatal) irregular/fast heartbeat, extreme dizziness, and fainting.
- The risk of QT prolongation may be increased in patients with specific medical problems (e.
- g.
- , heart failure, sluggish heartbeat, recent heart attack, prolonged QT on EKG), a family history of specific heart conditions (prolonged QT on EKG, sudden cardiac death), or low magnesium and potassium levels in the blood (e.
- g.
- , due to certain medicines like diuretics, excessive perspiration, diarrhea, or vomiting).
- Inform your doctor about all medical conditions and medications.
- **Medical History:** Inform your doctor about any personal or family history of bipolar/manic-depressive disorder, suicidal attempts, liver problems, seizures, low blood sodium (hyponatremia), intestinal bleeding/ulcers or bleeding disorders, and glaucoma.
- **Liver and Kidney Impairment:** Patients with liver or kidney diseases should consult their doctors.
- Dosage adjustments may be necessary, and caution is advised in severe renal impairment.
- **Alcohol:** Avoid consuming alcohol while taking this medication, as it can exacerbate adverse effects like dizziness and concentrating difficulties.
- **Driving and Operating Machinery:** Escitalopram may impair one's ability to make decisions and react quickly.
- Exercise extreme caution when driving vehicles or operating machinery.
- **Abrupt Discontinuation:** Do not stop taking Escitalopram abruptly without consulting a doctor, as this can lead to withdrawal symptoms (e.
- g.
- , irritability, anxiety, sweating, headache, dizziness, confusion, low mood, electric shock-like sensations, restlessness, nightmares, vomiting/nausea, paresthesia's).
- A gradual dose reduction is recommended.
- **Hypersensitivity:** Inform your doctor if you are hypersensitive to Escitalopram, citalopram, or any other components, as inactive ingredients may trigger allergic reactions.
- **Older Persons:** Adverse effects such as bleeding, incoordination, and QT prolongation may be more severe in older persons.
- They may also be more prone to salt imbalances (hyponatremia), particularly if taking diuretics.
- Falls can be exacerbated by a loss of coordination.
- **Children:** Children are more sensitive to negative effects, including lack of hunger and weight loss.
- Height and weight should be monitored in pediatric patients.
- **Surgery:** Inform your doctor or dentist about all medicines (prescription, nonprescription, and herbal) you consume before undergoing surgery.
How it Works (Mechanism of Action)
The antidepressant action of escitalopram, the S-enantiomer of racemic citalopram, is presumed to be linked to the potentiation of serotonergic activity in the central nervous system (CNS) resulting from its inhibition of CNS neuronal reuptake of serotonin (5-HT). This influences the availability of serotonin neurotransmitters in the brain and produces major changes in connectivity between functional networks.