ESCITALOPRAM OXALATE
(es-ci-tal'o-pram)
Lexapro
Classifications: central nervous system (cns) agent; psychotherapeutic agent; selective serotonin-reuptake inhibitor (ssri)
Prototype: Fluoxetine
Pregnancy Category: C
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5 mg, 10 mg, 20 mg tablets; 5 mg/5 mL liquid
Selective serotonin reuptake inhibitor (SSRI) in the CNS. Antidepressant effect is presumed to be linked to its inhibition
of CNS presynaptic neuronal uptake of serotonin which results in antidepressant activity. Does not produce any sympathomimetic
response or anticholinergic activity.
Does not inhibit MAOIS. Selective serotonin reuptake inhibition mechanism results in the antidepressant activity of escitalopram.
Depression, generalized anxiety disorder.
Treatment of panic disorders.
Hypersensitivity to citalopram; concurrent use of MAOIS or use within 14 d of discontinuing MAOIS; pregnancy (category C); volume depleted; lactation; children <18 y.
Hypersensitivity to other SSRIs; suicidal ideations, depression, mania, hyponatremia, ethanol intoxication, ECT, dehydration,
renal or hepatic insufficiency; older adults; concurrent use of diuretics, cardiovascular disease (e.g., dysrhythmias, conduction
defects, myocardial ischemia); history of seizure disorders or suicidal tendencies.
Depression, Generalized Anxiety
Adult: PO 10 q.d., may increase to 20 mg q.d. if needed after 1 wk
Geriatric: PO 10 mg q.d.
Panic Disorder
Adult: PO 5 q.d., may increase to 20 mg q.d. if needed after 1 wk
Hepatic Impairment
Adult: PO 10 q.d.
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Oral
- Do not begin this drug within 14 d of stopping an MAOI.
- Reduced doses are advised for the older adult and those with hepatic or renal impairment.
- Dose increments should be separated by at least 1 wk.
- Store at 15°–30° C (59°–86° F) in tightly closed container and protect from light.
Body as a Whole: Fatigue, fever, arthralgia, myalgia. CV: Palpitation, hypertension. GI:
Nausea, diarrhea, dyspepsia, abdominal pain, dry mouth, vomiting, flatulence, reflux. CNS: Dizziness, insomnia, somnolence, paresthesia, migraine, tremor, vertigo. Metabolic: Increased or decreased weight. Respiratory: URI, rhinitis, sinusitis. Skin: Increased sweating. Urogenital: Dysmenorrhea, decreased libido, ejaculation disorder, impotence, menstrual cramps.
Drug: Combination with maoi could result in hypertensive crisis, hyperthermia, rigidity, myoclonus, autonomic instability; cimetidine may increase escitalopram levels; linezolid may cause serotonin syndrome. Herbal:
St. John's wort may cause serotonin syndrome.
Absorption: Rapidly absorbed from GI tract. Onset: Approximately 1 wk. Peak: 3 h. Distribution: 80% protein bound; crosses placenta; distributed into breast milk. Metabolism: Metabolized in liver by CYP3A4 2C19 and 2D6 enzymes. Elimination: 20% excreted in urine, 80% in bile. Half-Life: 25 h.
Assessment & Drug Effects
- Monitor for therapeutic effectiveness: Indicated by elevation of mood; 1–4 wk may be needed before improvement is noted.
- Closely observe for worsening of depression or emergence of suicidality.
- Lab tests: Monitor periodically hepatic functions, CBC, serum sodium, and lithium levels when the two drugs are given concurrently.
- Monitor periodically HR and BP, and carefully monitor complete cardiac status in person with known or suspected cardiac disease.
- Monitor closely older adult patients for adverse effects, especially with doses >20 mg/d.
Patient & Family Education
- Do not engage in hazardous activities until reaction to this drug is known.
- Avoid using alcohol while taking escitalopram.
- Inform physician of commonly used OTC drugs as there is potential for drug interactions.
- Report distressing adverse effects including any changes in sexual functioning or response.
- Periodic ophthalmology exams are advised with long-term treatment.
- Do not breast feed while taking this drug.
1%)
Canadian drug name; 
Prototype drug