Escitalopram (Lexapro, Cipralex, Esertia)
Escitalopram is a highly selective serotonin reuptake inhibitor (SSRI) used to treat depression and anxiety. Escitalopram was developed collaboratively by Forest Pharmaceuticals and Lundbeck, the developer of citalopram and was approved for use in the US in 2003.
Some people assert that escitalopram is an example of "lifecycle management"-finding new ways to use or market a drug to preserve the patent or the market share of the drug. Because escitalopram is an isomer of citalopram, it took less time and money to develop and was ready for marketing by the time the patent on citalopram expired. Some people assert that the two drugs are virtually identical and that escitalopram should not be patented. In court challenges, however, Forest Pharmaceuticals demonstrated that there are significant differences between the drugs, and the patent for escitalopram has been upheld.
The Bottom Line: What You Really Need to Know
- Escitalopram (Lexapro) is used to treat depression, anxiety, OCD, body dysmorphic disorder and pervasive developmental disorders.
- The usual dose of escitalopram is 10 mg/day for depression and 10-20 mg/day for anxiety. Be sure to take it exactly as your doctor directs.
- Escitalopram interacts with many different medications. Make sure you tell your physician and pharmacist about all medications that you take, including herbal remedies and teas, over the counter medications, homeopathic and alternative treatments, vitamins, supplements and medications you only take occasionally.
- Escitalopram may interact with grapefruit, so you should not eat it or drink grapefruit juice while you are taking it.
- If you have surgery, make sure your surgeon knows you take escitalopram. It can interact with anesthetics.
- It may take two weeks or more before you start feeling better.
- Talk to your doctor before you stop taking escitalopram. Your dose may need to be tapered down slowly to prevent uncomfortable withdrawal symptoms.
- Most people experience a few mild side effects, like dry mouth or constipation, when they begin taking escitalopram. They usually go away with time.
- If you experience loss of interest in sex or diminished sexual ability, talk to your doctor about it.
- Escitalopram should be used with caution in pregnancy.
- Have a friend or family member check in with you every day for the first few weeks that you take escitalopram. Ask him or her to help you monitor your condition for:
- Worsening depression
- Restlessness, irritability, agitation, hostility or aggression
- Unusual thoughts or thoughts of suicide
- Report any serious or unusual side effects to your doctor.
Uses of escitalopram
Escitalopram is approved for the treatment of Major Depressive Disorder (MDD) and General Anxiety Disorder (GAD) in adults. It is also used to treat other anxiety disorders and obsessive compulsive disorder. It may be helpful in treating other problems such as body dysmorphic disorder and pervasive developmental disorder.
Dosage and instructions
The usual dose of escitalopram is 10 mg/day for depression and 10-20 mg/day for anxiety. The dose may need to be decreased in the elderly and in people with liver problems. Escitalopram is taken once a day and can be taken either in the morning or evening, with or without food.
How escitalopram works
Although no one is certain what causes depression and anxiety, one probable cause is an imbalance of chemicals called neurotransmitters, which help carry messages between nerve cells. Neurotransmitters are found at the junction between two nerve cells; they are released by one cell and absorbed by the other one. Some serotonin is also reabsorbed by the first cell.
SSRI medications block the reabsorption of neurotransmitters by the first cell, which allows them to accumulate and restores chemical balance. Dopamine, norepinephrine and serotonin are the neurotransmitters most often affected by SSRI medications.
Serotonin is thought to be the neurotransmitter most responsible for depression and anxiety, and pharmaceutical companies have been trying to develop drugs that only block serotonin reuptake without affecting dopamine or norepinephrine. Escitalopram is the most serotonin selective medication that has been developed to date.
Neurotransmitters and other biochemicals work by binding to receptor sites on cells. It works much like a lock and key-the receptor site is the lock, and only the right key will fit into it. When the key is in the lock, the site is blocked and no other key can access that lock.
Most neurotransmitters, medications and other organic chemicals have different isomers. Isomers are different forms, or shapes, of the molecules of a chemical. Because they are shaped differently, they may react with receptor sites differently. That's what makes escitalopram different from other SSRIs, including it's parent medication, citalopram. Escitalopram contains only one isomer of the compound-the one that fits best into the receptor. That's why it is more powerful than citalopram and has fewer side effects and drug interactions than other SSRI medications.
Side effects of escitalopram
In studies that compared escitalopram to other medications, it had fewer side effects than either paroxetine or venlafaxine. Still, many people experience mild to moderate side effects when taking escitalopram. Most resolve after taking the medication for a few weeks. The most common side effects are dry mouth, nausea, sleep difficulties, sweating, fatigue and sexual problems.
Sexual problems are a common problem with antidepressants. Escitalopram is associated with decreased libido, ejaculatory dysfunction and female anorgasmia (inability to experience orgasm). If you experience sexual side effects while taking escitalopram, it is important to discuss them with your doctor to determine what treatment options are available. Do not discontinue taking the medication; abrupt discontinuation can cause withdrawal symptoms.
Less frequently experienced side effects of escitalopram include:
- Headache, dizziness, irritability and lethargy
- Vivid dreams
- Difficulty concentrating
- Chest pain, high blood pressure or erratic heart rhythm
- Diarrhea, constipation, increased or decreased appetite, bleeding from the gastrointestinal tract
- Joint and muscle pain, muscle cramps, flu-like syndrome, tremors
- Runny nose, sinus problems and cough
- Agitation, hallucinations
- Hyponatremia (a condition similar to water intoxication)
There are few direct interactions between escitalopram and other medications, but many interactions related to co-action and co-metabolism. Make sure your doctor and pharmacist know what medications you take, including over the counter drugs, herbal and naturopathic remedies, vitamins and minerals, supplements and medications you only take occasionally. Some medications that interact with escitalopram are:
- Other antidepressants, especially other SSRIs and MAOIs. These should not be taken with escitalopram because the combination could cause serotonin syndrome (discussed later in this article).
- Blood thinners (warfarin)
- Aspirin and NSAIDs (non-steroidal anti-inflammatory medications) (ibuprofen, naproxen, etc)
- Antibiotics and antiviral medications
- Antiseizure medications
- Medications for mental health problems
- Medications for migraine headaches
- Medications for weight reduction
- Medications for Parkinson's disease
- Heart medictions
Sometimes you can continue to take escitalopram while taking other medications, but will need to have the dose adjusted.
Escitalopram interacts with some herbal treatments, including grapefruit extract or juice, St. John's Wort and kava kava.
Amphetamines and other recreational drugs may also interact with escitalopram.
Like other SSRI medications, escitalopram must be withdrawn gradually. Abrupt discontinuation can cause severe symptoms such as:
- Weird, vivid dreams
- Electrical sensations
- Nausea and vomiting
- Irritability, agitation, mood changes
Warnings, precautions and contraindications
Suicide risk: SSRI medications have been implicated in increased suicide risk in children, adolescents and young adults. Anyone who starts taking these medications should be monitored closely during the first several weeks of therapy. This includes at least weekly appointments with a physician or therapist and daily monitoring by friends or family. Friends and family should be instructed to ask the individual if he or she is having thoughts of harming or killing himself. The patient or family member should notify the doctor immediately if they notice:
- Thoughts of suicide or self-harm
- Deepening depression
- Agitation, restlessness, aggression or mood instability
- Any unusual thoughts or changes in mental status.
Pregnancy risk: Escitalopram has not been tested in pregnant or lactating women. The drug does cross the placental barrier and is excreted in breast milk. SSRI medications have been implicated in birth defects, including heart defects and pulmonary hypertension of the newborn. Babies born to mothers who are taking SSRIs have exhibited symptoms of SSRI withdrawal and serotonin syndrome. SSRIs are not recommended for women who are pregnant or who wish to become pregnant.
Serotonin Syndrome: Serotonin syndrome is a toxic syndrome. It occasionally occurs with SSRI overdose, but is more common when SSRIs are taken with other "serotoninergic" medications. Symptoms can be mild, moderate or severe.
- Mild symptoms are rapid heart rate, shivering, twitching and tremors, anxiety and agitation, excessive sweating.
- Moderate toxicity can produce high blood pressure, high fever and increased agitation.
- Symptoms of severe toxicity include cardiovascular collapse and shock, muscle rigidity and seizures, very high fevers (over 104°F) and delirium. Multiorgan failure and death may follow.
The symptoms of serotonin syndrome come on quickly, within minutes or hours of taking a serotonergic medication. Self-medicating with over-the-counter drugs, alternative therapies or recreational drugs can cause serotonin syndrome. Serotonin syndrome is very similar to neuroleptic malignant syndrome (NMS) and may be difficult to differentiate from it.
MAOIs and escitalopram: MAOI antidepressants have a serotoninergic effect and should not be taken with SSRIs. Both MAOIs and SSRIs are highly bound to plasma and remain in the body for days to weeks after you stop taking them. You should not start taking one type of medication for at least two weeks after stopping the other one to make sure the first medication has been completely eliminated from your body.blog comments powered by Disqus