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Pharmacologic class: Selective serotonin reuptake inhibitor
Therapeutic class: Antidepressant
Pregnancy risk category C
Prevents serotonin reuptake by CNS neurons, making more serotonin available in brain and thereby relieving depression
Oral solution: 5 mg/5 ml
Tablets: 5 mg, 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.
Adolescents ages 12 to 17: Initially, 10 mg P.O. daily. After at least 3 weeks, 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: 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.
• Hepatic impairment
• Elderly patients
• Hypersensitivity to drug
• Concurrent use of pimozide
• MAO inhibitor use within past 14 days
Use cautiously in:
• renal or hepatic impairment, other conditions that cause altered metabolism or hemodynamic responses, history of mania or seizures, suicidal tendency
• concomitant use of nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, warfarin, or other drugs that affect coagulation
• elderly patients
• pregnant or breastfeeding patients
• children younger than age 12 with major depression and younger than age 18 with generalized anxiety disorder (safety and efficacy not established).
• Give with or without food in the morning or evening.
☞ Don't give within 14 days of MAO inhibitor.
CNS: drowsiness, dizziness, insomnia, fatigue, neuroleptic malignant syndrome-like reactions, 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
Metabolic: hyponatremia (in association with syndrome of inappropriate antidiuretic hormone secretion)
Other: increased appetite, flulike symptoms, serotonin syndrome
Drug-drug. Aspirin, NSAIDs, warfarin: increased risk of bleeding
Carbamazepine, lithium: decreased effects of escitalopram
Citalopram: increased risk of serious toxic effects
MAO inhibitors: increased escitalopram blood level and risk of toxicity
Pimozide: prolonged QT interval
Triptans: weakness, hyperreflexia, incoordination
Drug-diagnostic tests. Sodium: decreased level
Drug-herbs. Ginkgo, St. John's wort: increased risk of adverse effects
Drug-behaviors. Alcohol use: increased motor impairment
☞ Assess patient's mood closely. Watch for signs and symptoms of increased depression or suicidal ideation (especially in child or adolescent).
☞ Monitor patient closely for serotonin syndrome or neuroleptic malignant syndrome-like reactions; immediately discontinue drug if these occur.
• Be aware that gradual dosage reduction rather than abrupt cessation is recommended. When drug is discontinued, monitor for dysphoric mood, irritability, agitation, dizziness, sensory disturbances, anxiety, confusion, headache, lethargy, emotional lability, and insomnia.
• 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 or stop drug abruptly.
☞ 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).
☞ Instruct patient to immediately discontinue drug and notify prescriber if the following symptoms occur: overheating, muscle rigidity, altered mental status, irregular pulse or blood pressure, rapid or irregular heart beat, excessive sweating, involuntary muscle movements, fever, or seizures.
• 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, tests, herbs, and behaviors mentioned above.
Pharmacologic: selective serotonin reuptake inhibitors ssris
Time/action profile (antidepressant effect)
|PO||within 1–4 wk||unknown||unknown|
Adverse Reactions/Side Effects
Central nervous system
- neuroleptic malignant syndrome (life-threatening)
- suicidal thoughts (life-threatening)
- insomnia (most frequent)
- diarrhea (most frequent)
- nausea (most frequent)
- abdominal pain
- dry mouth
- ↓ libido
- ejaculatory delay
- erectile dysfunction
- syndrome on inappropriate secretion of antidiuretic hormone (SIADH)
Fluid and Electrolyte
- serotonin syndrome (life-threatening)
- ↑ appetite
Drug-Drug interactionMay cause serious, potentially fatal reactions when used with MAO inhibitors ; allow at least 14 days between escitalopram and MAO inhibitors.Concurrent use with MAO-inhibitor-like drugs, such as linezolid or methylene blue may ↑ risk of serotonin syndrome; concurrent use contraindicated; do not start therapy in patients receiving linezolid or methylene blue ; if linezolid or methylene blue need to be started in a patient receiving escitalopram, immediately discontinue escitalopram and monitor for signs/symptoms of serotonin syndrome for 2 wk or until 24 hr after last dose of linezolid or methylene blue, whichever comes first (may resume escitalopram therapy 24 hr after last dose of linezolid or methylene blue)Concurrent use with pimozide may result in prolongation of the QTc interval and is contraindicated.Use cautiously with other centrally acting drugs (including alcohol, antihistamines, opioid analgesics, and sedative/hypnotics ; concurrent use with alcohol is not recommended).Drugs that affect serotonergic neurotransmitter systems, including tricyclic antidepressants, SNRIs, fentanyl, buspirone, tramadol, and triptans ↑ risk of serotonin syndromeCimetidine may ↑ levels.Serotonergic effects may be ↑ by lithium (concurrent use should be carefully monitored).Carbamazepine may ↓ levels.May ↑ levels of metoprolol.Use cautiously with tricyclic antidepressants due to unpredictable effects on serotonin and norepinephrine reuptake.↑ risk of bleeding with aspirin, NSAIDs, clopidogrel, or warfarin.↑ risk of serotonin syndrome with St. John's wort and SAMe.
Hepatic ImpairmentOral (Adults) 10 mg once daily.
Availability (generic available)
- Monitor mood changes and level of anxiety during therapy.
- Assess for suicidal tendencies, especially during early therapy. Restrict amount of drug available to patient. Risk may be increased in children, adolescents, and adults ≤24 yr. After starting therapy, children, adolescents, and young adults should be seen by health care professional at least weekly for 4 wk, every 3 wk for next 4 wk, and on advice of health care professional thereafter.
- Assess for sexual dysfunction (erectile dysfunction; decreased libido).
- Assess for serotonin syndrome (mental changes [agitation, hallucinations, coma], autonomic instability [tachycardia, labile BP, hyperthermia], neuromuscular aberrations [hyperreflexia, incoordination], and/or GI symptoms [nausea, vomiting, diarrhea]), especially in patients taking other serotonergic drugs (SSRIs, SNRIs, triptans).
Potential Nursing DiagnosesIneffective coping (Indications)
Risk for injury (Side Effects)
Sexual dysfunction (Side Effects)
- Do not confuse Lexapro with Loxitane (loxapine).
- Do not administer escitalopram and citalopram concomitantly. Taper to avoid potential withdrawal reactions. Reduce dose by 50% for 3 days, then again by 50% for 3 days, then discontinue.
- Oral: Administer as a single dose in the morning or evening without regard to meals.
- Instruct patient to take escitalopram as directed. Take missed doses on the same day as soon as remembered and consult health care professional. Resume regular dosing schedule next day. Do not double doses. Do not stop abruptly; should be discontinued gradually. Instruct patient to read Medication Guide before starting and with each Rx refill in case of changes.
- May cause dizziness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
- Advise patient, family, and caregivers to look for suicidality, especially during early therapy or dose changes. Notify health care professional immediately if thoughts about suicide or dying, attempts to commit suicide, new or worse depression or anxiety, agitation or restlessness, panic attacks, insomnia, new or worse irritability, aggressiveness, acting on dangerous impulses, mania, or other changes in mood or behavior or if rash or symptoms of serotonin syndrome occur.
- Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking any other Rx, OTC, or herbal products, especially alcohol or other CNS depressants.
- Instruct female patients to notify health care professional if pregnancy is planned or suspected or if they plan to breast feed. If used during pregnancy, should be tapered during 3rd trimester to avoid neonatal serotonin syndrome.
- Emphasize importance of follow-up exams to monitor progress.
- Increased sense of well-being.
- Renewed interest in surroundings. May require 1–4 wk of therapy to obtain antidepressant effects. Full antidepressant effects occur in 4–6 wk.
- Decrease in anxiety.