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escitalopram (Rx)Brand and Other Names:Lexapro

 
 
 

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablet

  • 5mg
  • 10mg
  • 20mg

oral solution

  • 5mg/5mL
more...

Major Depressive Disorder

10 mg PO qDay; may increase to 20 mg/day after 1 week

Generalized Anxiety Disorder

10 mg PO qDay; may increase to 20 mg/day after 1 week; maintain at lowest effective dose and assess need of therapy periodically if extended therapy required

Obsessive-Compulsive Disorder (Off-label)

10 mg PO qDay; may increase to 20 mg/day after 1 week; maintain at lowest effective dose and assess need of therapy periodically if extended therapy required

Insomnia (Off-label)

Secondary to Depression: 5-20 mg PO over 8 week period

Secondary to panic disorder in women: 5-10 mg PO over 8 week period

Vasomotor Symptoms Associated with Menopause (Off-label)

10 mg PO qDay; may increase to 20 mg PO qDay after 4 weeks if symptoms not adequately controlled

Dosing Considerations

For extended therapy, maintain at lowest effective dose and assess periodically the need for continued therapy

Dosage Forms & Strengths

tablet

  • 5mg
  • 10mg
  • 20mg

oral solution

  • 5mg/5mL
more...

Major Depressive Disorder

<12 years: Safety and efficacy not established

≥12 years: 10 mg PO qDay; may increase dose after at least 3 weeks; not to exceed 20 mg/day

Major Depressive Disorders/Generalized Anxiety Disorder

10 mg/day is recommended for most elderly; no additional benefits seen at 20 mg/day dose

Dosing Considerations

The elderly are more prone to SSRI/SNRI-induced hyponatremia

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Interactions

Interaction Checker

escitalopram and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Headache (24%)

            Nausea (18%)

            Ejaculation disorder (9-14%)

            Somnolence (4-13%)

            Insomnia (7-12%)

            1-10%

            Xerostomia (4-9%)

            Constipation (3-6%)

            Fatigue (2-8%)

            Libido decrease (3-7%)

            Anorgasmia (2-6%)

            Flatulence (2%)

            Toothache (2%)

            Weight gain (1%)

            Menstrual disorder (2%)

            Neck/shoulder pain (3%)

            Rhinitis (5%)

            Flu-like syndrome (5%)

            Ejaculation disorder (9-14%)

            <1%

            Arthralgia

            Abdominal pain

            Abnormal bleeding

            Abnormal dreams

            Allergy

            Blurred vision

            Bronchitis

            Chest pain

            Constipation

            Decreased appetite

            Decreased concentration

            Disrupts platelets/hemostasis

            Dizziness

            Dyspepsia

            Fever

            Heartburn

            Hot flashes

            Impotence

            Irritability

            Jaw stiffness

            Lethargy

            Lightheadedness

            Menstrual disorder

            Hypertension

            Palpitations

            Migraine

            Myalgia

            Paresthesia

            Rash

            Sweating

            Tinnitus

            Tremor

            Urinary frequency

            Urinary tract infection

            Vertigo

            Vomiting

            Yawning

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            Warnings

            Black Box Warnings

            In short-term studies, antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults (<24 years) taking antidepressants for major depressive disorders and other psychiatric illnesses

            This increase was not seen in patients >24 years; a slight decrease in suicidal thinking was seen in adults >65 years

            Drug is not FDA appored for treatment of bipolar depression

            In children and young adults, the risks must be weighed against the benefits of taking antidepressants

            Patients should be monitored closely for changes in behavior, clinical worsening, and suicidal tendencies; this should be done during initial 1-2 months of therapy and dosage adjustments

            The patient’s family should communicate any abrupt changes in behavior to the health-care provider

            Worsening behavior and suicidal tendencies that are not part of the presenting symptoms may require discontinuation of therapy

            This drug is not approved for use in pediatric patients <12 years

            Contraindications

            Hypersensitivity

            Coadministration with serotonergic drugs

            • Concomitant use or within 14 days of MAOIs increases risk of serotonin syndrome
            • Symptoms include tremor, myoclonus, diaphoresis, nausea, vomiting, flushing, dizziness, hyperthermia with features resembling neuroleptic malignant syndrome, seizures, rigidity, autonomic instability with possible rapid fluctuations of vital signs, and mental status changes that include extreme agitation progressing to delirium and coma
            • Starting escitalopram in a patient who is being treated with linezolid or IV methylene blue is contraindicated because of an increased risk of serotonin syndrome
            • If linezolid or IV methylene blue must be administered, discontinue SSRI immediately and monitor for CNS toxicity; may resume 24 hr after last linezolid or methylene blue dose, or after 2 weeks of monitoring (5 weeks for fluoxetine), whichever comes first

            Cautions

            Pregnancy: Conflicting evidence regarding use of SSRIs during pregnancy and increased risk of persistent pulmonary hypertension of the newborn, or PPHN (see Pregnancy)

            In neonates exposed to SNRIs/SSRIs late in third trimester: risk of complications such as feeding difficulties, irritability, and respiratory problems

            Caution with seizure disorder, bipolar mania, severe renal impairment; not FDA approved for the treatment of bipolar depression

            NRIs/SSRIs have been associated with the development of SIADH; hyponatremia has been reported rarely

            May worsen psychosis in some patients and precipitate a shift to mania or mypomania in patients with bipolar disorder

            Risk of hyponatremia

            Risk of mydriasis; may trigger angle closure attack in patients with angle closure glaucoma with anatomically narrow angles without a patent iridectomy

            Bone fractures are associated with antidepressant therapy; consider the possibility of a fracture in patients with unexplained bone pain, swelling, or bruising

            Prescriptions should be written for smallest quantity consistent with good patient care and the family or care giver alerted to monitor patient for emergence of suicidality and associated behaviors (anxiety, agitation, panic attacks, insomnia, hostility, akathisia, impulsivity, irritabilty)

            SSRIs/SNRIs increase risk of abnormal bleeding (further increased if concomitant aspirin, NSAIDs or anticoagulants, or hemorrhagic diathesis)

            Prolongation of QT interval and ventricular arrhythmias reported, especially in female patients with preexisting QT prolongation or other risk factors

            Risk of cognitive and motor function impairment; use caution when operating heavy machinery

            Use with caution in patients with history of seizure disorders or or conditions predisposing to seizures including brain damage and alcoholism

            May impair platelet aggregation that can result in increased risk of bleeding events including GI bleeding especially if taken concomitantly with aspiring, warfarin, or NSAIDs

            Risk of serotonin syndrome or neuroleptic malignant syndrome (NMS)-like reactions have been reported with SSRIs alone or with concomitant use of serotonergic drugs, with drugs that impair metabolism of serotonin, or with antipsychotics or other dopamine antagonists

            No additional benefits at 20 mg/day

            May cause or exacerbate sexual dysfunction

            Gradually taper dose before discontinuation; abrupt discontinuation may cause dysphoric mood, dizziness, sensory disturbances, agitation, confusion, anxiety, headache, insomnia, tinnitus, seizures, irritability

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            Pregnancy & Lactation

            Pregnancy

            Pregnancy category: C

            Use late in the third trimester associated with complications in newborns and may require prolonged hospitalization, respiratory support, and tube feeding

            Persistent pulmonary hypertension of the newborn

            • Potential risk of persistent pulmonary hypertension of the newborn when used during pregnancy
            • Initial Public Health Advisory in 2006 was based on a single published study; since then, there have been conflicting findings from new studies, making it unclear whether use of SSRIs during pregnancy can cause PPHN
            • FDA has reviewed the additional new study results and has concluded that, given the conflicting results from different studies, it is premature to reach any conclusion about a possible link between SSRI use in pregnancy and PPHN
            • FDA recommendation: FDA advises health-care professionals not to alter their current clinical practice of treating depression during pregnancy and to report any adverse events to the FDA MedWatch program
            • A meta-analysis of 7 observational studies, found exposure to SSRIs in late pregnancy (ie, >20 weeks' gestation) more than doubled the risk of PPHN that could not be explained by other etiologies (eg, congenital malformations, meconium aspiration) (BMJ 2014;348:f6932)

            Lactation

            Excreted in breast milk; consider risk/benefit ratio

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            S-enantiomer of racemic citalopram; inhibits the reuptake of serotonin, with little or no effect on norepinephrine or dopamine reuptake

            Absorption

            Bioavailability: 80%

            Peak plasma time: 3.5-6.5 hr

            Distribution

            Protein bound: 56%

            Vd: 20 L/kg

            Metabolism

            CYP3A4, CYP2C19

            Metabolites: Insignificant potency

            Enzymes inhibited: CYP2D6

            Elimination

            Half-life: 27-32 hr

            Dialyzable: No

            Renal clearance: 42 mL/min

            Total body clearance: 600 mL/min

            Excretion: Urine (8%)

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            Images

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            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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