Escitalopram: Comprehensive Guide
Drug Name
Generic Name
Escitalopram
Brand Name(s)
Pakistan: Lexapro, Cipralex
India: Nexito, Cipralex
US: Lexapro
UK: Cipralex
Pharmacological Class
Class
Antidepressant
Subclass
Selective Serotonin Reuptake Inhibitor (SSRI)
Mechanism of Action
Escitalopram works by selectively inhibiting the reuptake of serotonin (5-HT) into presynaptic neurons, increasing the amount of serotonin available to bind to postsynaptic receptors. This enhances serotoninergic neurotransmission and helps alleviate symptoms of depression and anxiety.
Indications
Primary Indications
- Major Depressive Disorder (MDD)
- Generalized Anxiety Disorder (GAD)
Off-label Uses
- Panic Disorder
- Obsessive-Compulsive Disorder (OCD)
- Social Anxiety Disorder
Dosage and Administration
Standard Dosage
The typical starting dose for adults is 10 mg once daily, which may be increased to a maximum of 20 mg per day based on the patient's response and tolerability.
Route of Administration
Oral
Special Populations
Pediatric: Approved for use in adolescents aged 12-17 for depression, starting dose 10 mg daily.
Geriatric: Lower doses may be required due to increased sensitivity and risk of adverse effects.
Pharmacokinetics
Absorption
Well absorbed, with peak plasma concentrations occurring 3-4 hours after administration.
Distribution
Distributed throughout the body, with about 56% bound to plasma proteins.
Metabolism
Primarily metabolized in the liver by CYP2C19, CYP3A4, and CYP2D6 enzymes.
Excretion
Excreted mainly in urine as metabolites.
Half-life
Approximately 27-32 hours in healthy adults.
Contraindications
Escitalopram is contraindicated in patients with known hypersensitivity to the drug or other SSRIs. It should not be used in patients taking monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing an MAOI.
Warnings and Precautions
Escitalopram carries a black box warning for increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults. Caution is advised in patients with a history of bipolar disorder, seizures, or liver impairment. It may also cause QT prolongation.
Side Effects
Common Side Effects
- Nausea
- Insomnia
- Dry mouth
- Fatigue
- Increased sweating
- Diarrhea
Serious Side Effects
- Severe allergic reactions
- Seizures
- QT prolongation
- Serotonin syndrome
- Hyponatremia
Drug Interactions
Major Interactions
- Monoamine oxidase inhibitors (MAOIs)
- Pimozide
- Other SSRIs or SNRIs
Moderate Interactions
- Tricyclic antidepressants
- Anticoagulants
- NSAIDs
Minor Interactions
- Alcohol
- Herbal supplements (e.g., St. John's Wort)
Pregnancy and Lactation
Pregnancy Category
Category C: Risk cannot be ruled out. Escitalopram should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
Breastfeeding Considerations
Escitalopram is excreted in breast milk. Caution should be exercised when administered to a nursing woman, considering the benefits of breastfeeding and the potential risks to the infant.
Patient Counseling Information
Key Points for Patients
- Inform patients about the risk of suicidal thoughts and behaviors.
- Advise patients to report any unusual changes in mood or behavior.
- Discuss the importance of adherence to prescribed dosing regimen.
- Inform patients about the potential side effects and drug interactions.