es·ci·tal·o·pram oxalate ( s  -t l  -prm)n. A drug of the SSRI class that is an isomer of citalopram and is used primarily to treat depression. |
Escitalopram oxalate
escitalopram oxalate
Cipralex (UK), Lexapro
Pharmacologic class: Selective serotonin reuptake inhibitor
Therapeutic class: Antidepressant
Pregnancy risk category C
FDA Boxed Warning
• Drug may increase risk of suicidal thinking and behavior in children and adolescents with major depressive disorder and other psychiatric disorders. Risk is greater during first few months of treatment, and must be balanced with clinical need, as depression itself increases suicide risk. With patient of any age, observe closely for clinical worsening, suicidality, and unusual behavior changes when therapy begins. Advise family to observe patient closely and communicate with prescriber as needed.
• Drug isn't approved for use in pediatric patients.
Action
Prevents serotonin reuptake by CNS neurons, making more serotonin available in brain and thereby relieving depression
Availability
Oral solution: 5 mg/5 ml
Tablets: 10 mg, 20 mg
⊘Indications and dosages
➣ Major depression
Adults: Initially, 10 mg P.O. daily as a single dose. After at least 1 week, may increase to 20 mg P.O. daily, as needed.
Elderly adults and patients with hepatic impairment: Maximum dosage of 10 mg P.O. daily as a single dose
➣ Generalized anxiety disorder
Adults: 10 mg/day P.O as a single dose in the morning or evening, increased to 20 mg/day P.O. as needed
Contraindications
• Hypersensitivity to drug
• MAO inhibitor use within past 14 days
Precautions
Use cautiously in:
• renal or hepatic impairment, suicidal tendency
• elderly patients
• pregnant or breastfeeding patients.
Administration
• Give with or without food.
☞ Don't give within 14 days of MAO inhibitor.
| Route | Onset | Peak | Duration |
| P.O. | Slow | 3.5-6.5 hr | Unknown |
Adverse reactions
CNS: drowsiness, dizziness, insomnia, fatigue, increased risk of suicide or suicidal ideation (especially in child or adolescent)
EENT: rhinitis, sinusitis
GI: nausea, vomiting, diarrhea, constipation, dyspepsia, abdominal pain, dry mouth
GU: ejaculatory disorders, erectile dysfunction, anorgasmia (in females), decreased libido
Other: increased appetite, flulike symptoms, serotonin syndrome
Interactions
Drug-drug. Carbamazepine, lithium: decreased effects of escitalopram
Citalopram: increased risk of serious toxic effects
MAO inhibitors: increased escitalopram blood level and risk of toxicity
Triptans: weakness, hyperreflexia, incoordination
Drug-herbs. Ginkgo, St. John's wort: increased risk of adverse effects
Drug-behaviors. Alcohol use: increased motor impairment
Patient monitoring
☞ Assess patient's mood closely. Watch for signs and symptoms of increased depression or suicidal ideation (especially in child or adolescent).
• Monitor patient's prescription refills to help detect drug hoarding or overuse.
• Check nutritional and hydration status in light of GI adverse effects.
Patient teaching
• Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids.
• Inform patient that full drug effect may take up to 4 weeks. Caution him not to overuse drug.
☞ Tell patient (and parent or significant other as appropriate) to contact prescriber immediately if depression worsens or suicidal thoughts develop (especially in child or adolescent).
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, herbs, and behaviors mentioned above.
escitalopram oxalate
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