Escitalopram – action, indications, dosage, contraindications

Proven content

Escitalopram is an active ingredient found in antidepressants. It belongs to the group of inhibitors responsible for the reuptake of serotonin. It is an ingredient found in preparations taken orally. What are the indications and contraindications for the use of drugs with escitalopram? How to dose such preparations? Can their use cause side effects?

Escitalopram – basic information

Escitalopram is the newest, potent drug belonging to the group of selective serotonin reuptake inhibitors (SSRIs). It is the drug most commonly used to treat depression. It is used to treat depression in adults and adolescents aged 12 years and older.

It is worth mentioning that the drugs that are used to treat depression include:

1. serotonin reuptake inhibitors (SSRIs);
2. serotonin-norepinephrine reuptake inhibitors (SNRIs);
3. tricyclic antidepressants (TLPDs);
4. inhibitory monoaminooksydazy (IMAO).

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Escitalopram – drug action

The action of escitalopram is due to its properties. Belonging to the group of serotonin reuptake inhibitors, it helps to block the transport of this neurotransmitter, which results in an increase in the level of this monoamine in the central nervous system. Thus, it helps to fight depressive disorders and many other psychological ailments.

Escitalopram is a substance with no or only low affinity for other types of receptors, including no or minimal binding to serotonergic 5-HT1A and 5-HT2 receptors, dopaminergic D1 and D2, adrenergic a1 receptors. , a2 and ß, histamine H1, muscarinic, benzodiazepine and opioid.

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Escitalopram – indications for use

Medicines containing escitalopram are given to patients in cases of:

1. combating episodes of severe depression;
2. treating obsessive-compulsive disorder;
3. treating panic disorder with or without agoraphobia;
4. generalized anxiety disorder;
5. treating social anxiety disorder.

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Escitalopram – drug dosage

Due to the fact that medicines containing escitalopram are available on prescription, the dosage is decided by the doctor.

Properly selected dose makes the clinical improvement visible after approx. 2-4 weeks. In the treatment of depression, treatment should be continued for 6 months after you feel better. Treatment of social anxiety disorder should last 12 weeks. In the case of anxiety disorders, the maximum effectiveness is achieved after 3 months of using the drug.

It is recommended that treatment with escitalopram be discontinued gradually to avoid discontinuation symptoms.

Following oral administration, escitalopram is almost completely absorbed, and ingested food does not affect the absorption of the drug. Bioavailability is approx. 80%. The maximum serum concentration is reached approximately 4 hours after dosing.

In the liver, escitalopram is converted to its active metabolites, which are serotonin reuptake inhibitors with a shorter and less active effect than escitalopram. The biological half-life of escitalopram is approximately 30 hours and its main metabolites are significantly longer. Elimination is slower in the elderly and in those with impaired liver or kidney function. The drug is excreted by the liver and kidneys.

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Escitalopram – contraindications to use

Contraindications to the use of escitalopram include:

1. hypersensitivity to the active substance and any component of the drug;
2. congenital heart defect: abnormal heart rhythm or episode of abnormal heart rhythm (seen on ECG);
3. taking medications for heart rhythm problems or drugs that can affect the rhythm of the heart muscle;
4. parallel intake of MAO inhibitors.

It is worth emphasizing that there are also additional contraindications related to taking a specific drug. Therefore, please read the information in the appropriate medicine carefully before starting treatment.

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Escitalopram – precautions

Before and during the use of drugs with escitalopram, observe the precautions, which are included in the package leaflets.

Precautions should be taken in the following cases:

1. if you suffer from epilepsy. Treatment with the drug together with escitalopram should be stopped if seizures occur for the first time or their frequency increases;
2. if you have liver or kidney problems. Your doctor may need to adjust your dose;
3. if you have diabetes. Treatment with the drug together with escitalopram may alter blood glucose control. Dosage adjustment of insulin and / or oral blood glucose lowering drugs may be required;
4. if you have low levels of sodium in your blood;
5. if you have an increased bleeding or bruising tendency or if you are pregnant;
6. if you are being treated with electroconvulsive therapy;
7. if you have ischemic heart disease;
8. if you suffer or have suffered from heart disease or have recently had a heart attack;
9. if you have a low heart rate at rest and / or know that you are low in salt due to prolonged, severe diarrhea and vomiting, or if you are taking diuretics (water tablets);
10. if you have a fast or irregular heart rate, fainting, collapse or dizziness when you stand up, which may indicate an abnormal heartbeat;
11. if you have or have had eye problems, such as certain types of glaucoma (increased pressure inside the eye).

Some patients with bipolar disorder may enter a manic phase. It is characterized by unusual and rapidly changing ideas, unreasonable happiness and excessive physical activity. If these symptoms occur, please consult your doctor.

Symptoms such as restlessness or difficulty to sit or stand still can also occur during the first weeks of the treatment. If you experience such symptoms, please inform your doctor immediately.

If you are depressed and / or have anxiety disorders you can sometimes have thoughts of harming or killing yourself. These symptoms or behavior may be increased when first starting antidepressant treatment, since these medicines usually only take about two weeks to work, sometimes later.

However, it’s worth remembering that the likelihood of these episodes increases if:

1. you have previously had thoughts about killing or harming yourself;
2. the patient is an adult at a young age. Information from clinical trials has shown an increased risk of suicidal behavior in adults aged less than 25 years with psychiatric conditions who were treated with an antidepressant.

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Escitalopram – side effects

Medicines containing escitalopram can cause certain side effects.

It is important to report any suspected adverse reactions after authorization of the medicinal product so that the benefit / risk balance of the medicinal product can be monitored.

The frequency classification of adverse body reactions (ADRs) is based on the following principles: very common (≥1 / 10), common (≥1 / 100 to <1/10), uncommon (≥1 / 1 to <000/1), rare (≥ 100 / 1 to <10 / 000), very rare (<1 / 1), not known (cannot be estimated from the available data).

If the following symptoms occur, contact your doctor or go to the hospital right away:

1. Not so often – unusual bleeding, including bleeding from the gastrointestinal tract;
2. rarely – swelling of the skin, tongue, lips, larynx or face, hives or difficulty breathing or swallowing (severe allergic reaction), high fever, agitation, confusion (confusion), tremors and sharp muscle contractions, which can be symptoms of a rare disorder called serotonin syndrome ;
3. frequency unknown Difficulty passing urine, fits, yellowing of the skin and whites of the eyes which is a symptom of liver problems / hepatitis, rapid irregular heartbeat, fainting which could be symptoms of a life-threatening condition called Torsades de Pointes, suicidal ideation and behavior, sudden swelling of the skin or mucous membranes (angioedema).

In addition to the symptoms described above, other side effects have also been reported after the use of drugs with escitalopram.

Very often:

1. nausea;
2. headache.

Often:

1. Blocked or runny nose (sinusitis);
2. decrease or increase in appetite;
3. anxiety, restlessness, abnormal dreams, difficulty falling asleep, sleepiness, dizziness, yawning, tremors, prickling of the skin;
4. diarrhea, constipation, vomiting;
5. dry mouth;
6. increased sweating;
7. pain in muscles and joints;
8. sexual problems (delayed ejaculation, erectile dysfunction, decreased libido, difficulties in achieving orgasm in women);
9. fatigue;
10. fever;
11. weight gain.

Not so often:

1. hives, rash, itching;
2. teeth grinding, agitation, nervousness, anxiety attack, confusion;
3. sleep disturbance, taste disturbance, fainting, dilation of the pupils, visual disturbance, ringing in the ears (tinnitus);
4. hair loss;
5. heavy menstrual bleeding;
6. irregular menstruation;
7. weight loss;
8. fast heartbeat;
9. swelling of the arms or legs;
10. epistaxis;

Rarely:

1. aggression;
2. depersonalization;
3. hallucinations;
4. slow heartbeat.

Not known:

1. low sodium in the blood;
2. dizziness upon standing up due to low blood pressure;
3. abnormal liver function tests;
4. movement disorders (involuntary muscle movements);
5. painful penile erection (priapism);
6. signs of unusual bleeding in the skin and mucous membranes (ecchymosis);
7. low blood platelet count (thrombocytopenia);
8. increased secretion of antidiuretic hormone (ADH) which causes water retention, blood thinning, decreased sodium;
9. galactorrhea in men and women who are not breastfeeding;
10. mania;
11. increased risk of bone fractures;
12. changes in heart rhythm, seen on an EKG;
13. akathisia;
14. loss of appetite.

The occurrence of side effects after the use of drugs with escitalopram can be reported directly to the Department of Monitoring Adverse Effects of Medicinal Products of the Office for Registration of Medicinal Products, Medical Devices and Biocidal Products, Al. Jerozolimskie 181C, 02-222 Warsaw.

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Escitalopram – interactions with other drugs

Before starting treatment with preparations containing escitalopram, the patient should inform the treating physician or pharmacist about all medications that he or she has been taking or has recently taken. You should also inform what medications the patient plans to take in the near future.

Pay special attention to simultaneous use of drugs with escitalopram z:

1. non-selective monoamine oxidase inhibitors (MAOIs) containing active substances such as phenelzine, iproniazid, isocarboxazid, nialamide and tranylcypromine – if you have taken any of these drugs, you should wait 14 days before taking drugs with escitalopram, and after stopping taking the drug, wait 7 days before taking any of these drugs
2. reversible, selective monoamine oxidase A (MAO-A) inhibitors containing moclobemide – a drug used to treat depression;
3. irreversible monoamine oxidase B (MAO-B) inhibitors containing selegiline – used to treat Parkinson’s disease;
4. linezolid – an antibiotic;
5. lithium – used to treat bipolar disorder and tryptophan;
6. imipramine and desipramine – used to treat depression;
7. sumatriptan and similar medicines – used to treat migraine;
8. tramadol – used for severe pain;
9. cimetidine, lansoprazole, omeprazole and esomeprazole – used to treat stomach ulcers;
10. fluconazole – a drug used to treat fungal infections;
11. fluvoxamine – an antidepressant drug;
12. ticlopidine – used to reduce the risk of stroke)
13. St. John’s wort (Hypericum perforatum) – a herbal remedy used for depression;
14. acetylsalicylic acid and non-steroidal anti-inflammatory drugs – medicines used to relieve pain or to thin the blood, so called anticoagulants;
15. warfarin, dipyridamole and phenprocoumon – medicines used to thin the blood called anticoagulants;
16. mefloquine – used to treat malaria;
17. bupropion – used to treat depression;
18. flecainide, propafenone and metoprolol – used in cardiovascular diseases;
19. desptamine, clomipramine, and nortriptyline – antidepressants;
20. risperidone, thioridazine and haloperidol – antipsychotics;
21. medicines for heart problems or medicines that can affect the rhythm of the heart;
22. sparfloxacin, moxifloxacin, intravenous erythromycin – antibacterial drugs;
23. halofantrine – antimalarial drugs;
24. astemizole, mizolastine – antihistamines.

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Escitalopram and pregnancy and breastfeeding

The use of any medications or dietary supplements during pregnancy requires consultation with the attending physician. If you are pregnant or breastfeeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking medicines with escitalopram.

If you are taking this medicine with escitalopram in the last 3 months of your pregnancy, be aware that your newborn baby may have the following symptoms: difficulty breathing, bluish skin, fits, fluctuations in body temperature, difficulty feeding, vomiting, low blood sugar , muscle stiffness or laxity, reflexes, tremors, nervousness, irritability, lethargy, crying, sleepiness and difficulty sleeping.

Taking medications with escitalopram during pregnancy especially in the last three months of pregnancy, it may increase the risk of a serious complication in the newborn called persistent pulmonary hypertension of the newborn (PPHN). This condition presents with rapid breathing and cyanosis and usually occurs during the first XNUMX hours after the baby is born.

Taking medications with escitalopram at the end of pregnancy may increase the risk of serious vaginal haemorrhage shortly after birth, especially if you have a history of bleeding disorders.

Escitalopram is expected to be excreted in human milk. Citalopram, a medicine like escitalopram, has been shown to affect sperm quality in animal studies. Theoretically this may have an effect on fertility, however, no effects on fertility in humans have been observed so far.

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Escitalopram — preparations

There are several preparations available on the pharmaceutical market, the main ingredient of which is escitalopram. Among the most popular are:

1. Aciprex – coated tablets;
2. ApoEscitaxin ORO – orodispersible tablets;
3. Betesda – oral drops, solution;
4. Betesda-tabletki powlekane;
5. Depralin – coated tablets;
6. Depralin ODT – orodispersible tablets;
7. Elicea – coated tablets;
8. Elicea Q-Tab – orodispersible tablets;
9. Escipram – coated tablets;
10. Escitalopram Actavis – coated tablets;
11. Escitalopram Aurovitas – coated tablets;
12. Escitalopram Bluefish – coated tablets;
13. Escitalopram Genoptim – coated tablets;
14. Escitil – coated tablets;
15. Lexapro – coated tablets;
16. Mozarin – coated tablets;
17. Mozarin Swift – orodispersible tablets;
18. Nexpram – coated tablets;
19. Oroes – coated tablets;
20. Pralex – coated tablets;
21. Pramatis – coated tablets;
22. Servenon – coated tablets;
23. Symescital – coated tablets.

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