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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.