Indications
Major depressive disorder. Generalized anxiety disorder
(GAD). Unlabeled Use: Panic disorder. Obsessive-
compulsive disorder (OCD). Post-traumatic stress
disorder (PTSD). Social anxiety disorder (social phobia).
Premenstrual dysphoric disorder (PMDD).
Action
Selectively inhibits the reuptake of serotonin in the CNS.
Therapeutic Effects: Antidepressant action.
Pharmacokinetics
Absorption: 80% absorbed following oral administration.
Distribution: Enters breast milk.
Metabolism and Excretion: Mostly metabolized
by the liver (primarily CYP3A4 and CYP2C19 isoenzymes);
7% excreted unchanged by kidneys.
Half-life:qin elderly and patients with hepatic impairment.
TIME/ACTION PROFILE (antidepressant effect)
ROUTE ONSET PEAK DURATION
PO within 1–4 wk unknown unknown
Contraindications/Precautions
Contraindicated in: Hypersensitivity; Concurrent
pimozide; Concurrent use of MAO inhibitors or MAOlike
drugs (linezolid or methylene blue); Concurrent
use of citalopram; Angle-closure glaucoma.
Use Cautiously in: History of mania (may activate
mania/hypomania); History of seizures; Patients at risk
for suicide; Hepatic impairment (doseprecommended);
Severe renal impairment; OB: Neonates exposed
to SSRIs in the 3rd trimester may develop drug
discontinuation syndrome manifested by respiratory
distress, feeding difficulty, and irritability; Lactation:
May cause adverse effects in infant; consider risk/benefit;
Pedi: Mayqrisk of suicide attempt/ideation especially
during early treatment or dose adjustment; safety
not established in children 12 yr; Geri:pdoses recommended
due topdrug clearance in older patients.
Adverse Reactions/Side Effects
CNS: NEUROLEPTIC MALIGNANT SYNDROME, SUICIDAL
THOUGHTS, insomnia, dizziness, drowsiness, fatigue.
GI: diarrhea, nausea, abdominal pain, constipation,
dry mouth, indigestion. GU: anorgasmia,plibido,
ejaculatory delay, erectile dysfunction. Derm: sweating.
Endo: syndrome on inappropriate secretion of
antidiuretic hormone (SIADH). F and E: hyponatremia.
Metab: SEROTONIN SYNDROME,qappetite.
Interactions
Drug-Drug: May 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 mayqrisk 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, amphetamines, and triptansq
risk of serotonin syndrome. Cimetidine mayqlevels.
Serotonergic effects may beqby lithium (concurrent
use should be carefully monitored). Carbamazepine
mayplevels. Mayqlevels of metoprolol. Use cautiously
with tricyclic antidepressants due to unpredictable
effects on serotonin and norepinephrine reuptake.
qrisk of bleeding with aspirin, NSAIDs,
clopidogrel, or warfarin.
Drug-Natural Products:qrisk of serotonin syndrome
with St. John’s wort and SAMe.
Route/Dosage
PO (Adults): Depression and GAD—10 mg once
daily, may beqto 20 mg once daily after 1 wk.
Hepatic Impairment
PO (Adults): 10 mg once daily.
PO (Geriatric Patients): 10 mg once daily.
PO (Children 12 yr): Depression—10 mg once
daily, may beqto 20 mg once daily after 3 wk.
Availability (generic available)
Tablets: 5 mg, 10 mg, 20 mg. Cost: Generic—5 mg
$13.16/100, 10 mg $13.87/100, 20 mg $18.01/100.
Orally disintegrating tablets: 10 mg, 20 mg.
Oral solution (peppermint flavor): 1 mg/mL. Cost:
Generic—$190.20/240 mL.
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