Escitalopram

Escitalopram is a prescription medication used to treat depression and anxiety.  Escitalopram belongs to a group of drugs called selective serotonin reuptake inhibitors (SSRIs), which may work by increasing the amount of serotonin, a natural substance in the brain that helps maintain mental balance. 

This medication comes in tablet and oral solution forms and is taken once a day, with or without food.

Common side effects of escitalopram include insomnia, nausea, and tiredness.

Escitalopram is a prescription medicine used to treat depression and anxiety in people over 12 years of age.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Escitalopram may be found in some form under the following brand names:

• Lexapro

Escitalopram and other antidepressant medicines may cause serious side effects. See "Drug Precautions" section.

Common side effects of escitalopram include:

• insomnia (difficulty sleeping) 
• sexual dysfunction 
• nausea 
• excessive sweating 
• fatigue (feeling tired) 
• diarrhea 
• dry mouth 
• dizziness 
• excessive sleepiness

This is not a complete list of escitalopram side effects. Ask your doctor or pharmacist for more information.

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. Escitalopram and other medicines may affect each other. Always check with your doctor before starting or stopping any medicine. Especially tell your doctor if you take:

• anticoagulants ('blood thinners') such as warfarin (Coumadin)
• antihistamines
• aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn)
• carbamazepine (Tegretol)
• cimetidine (Tagamet)
• ketoconazole (Sporanox)
• lithium (Eskalith, Lithobid, Lithotabs)
• linezolid (Zyvox)
• pimozide (Orap)
• medications for anxiety, mental illness, or seizures
• medications for migraine headaches such as almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex), and zolmitriptan (Zomig)
• metoprolol (Lopressor, Toprol XL)
• other antidepressants such as citalopram (Celexa) or desipramine (Norpramin)
• MAOIs such as isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate)
• sedatives
• sibutramine (Meridia)
• sleeping pills
• tramadol
• methylene blue
• tranquilizers

This is not a complete list of escitalopram drug interactions. Ask your doctor or pharmacist for more information.

Escitalopram and other antidepressant medicines may cause serious side effects, including:

1. Suicidal thoughts or actions:

• Escitalopram and other antidepressant medicines may increase suicidal thoughts or actions in some children, teenagers, or young adults within the first few months of treatment or when the dose is changed.
• Depression or other serious mental illnesses are the most important causes of suicidal thoughts or actions.
• Watch for these changes and call your healthcare provider right away if you notice:
  • New or sudden changes in mood, behavior, actions, thoughts, or feelings, especially if severe.
  • Pay particular attention to such changes when escitalopram is started or when the dose is changed.

Keep all follow-up visits with your healthcare provider and call between visits if you are worried about symptoms.

Call your healthcare provider right away if you have any of the following symptoms, or call 911 if an emergency, especially if they are new, worse, or worry you:

• attempts to commit suicide
• acting on dangerous impulses
• acting aggressive or violent
• thoughts about suicide or dying
• new or worse depression
• new or worse anxiety or panic attacks
• feeling agitated, restless, angry or irritable
• trouble sleeping
• an increase in activity or talking more than what is normal for you
• other unusual changes in behavior or mood

Call your healthcare provider right away if you have any of the following symptoms, or call 911 if an emergency. Escitalopram may be associated with these serious side effects:

2. Serotonin Syndrome or Neuroleptic Malignant Syndrome-like reactions. This condition can be life-threatening and may include:

• agitation, hallucinations, coma or other changes in mental status
• coordination problems or muscle twitching (overactive reflexes)
• racing heartbeat, high or low blood pressure
• sweating or fever
• nausea, vomiting, or diarrhea
• muscle rigidity

3. Severe allergic reactions:

• trouble breathing
• swelling of the face, tongue, eyes or mouth
• rash, itchy welts (hives) or blisters, alone or with fever or joint pain

4. Abnormal bleeding: Escitalopram and other antidepressant medicines may increase your risk of bleeding or bruising, especially if you take the blood thinner warfarin (Coumadin, Jantoven), a non-steroidal anti-inflammatory drug (NSAIDs, like ibuprofen or naproxen), or aspirin.

5. Seizures or convulsions

6. Manic episodes:

• greatly increased energy
• severe trouble sleeping
• racing thoughts
• reckless behavior
• unusually grand ideas
• excessive happiness or irritability
• talking more or faster than usual

7. Changes in appetite or weight. Children and adolescents should have height and weight monitored during treatment.

8. Low salt (sodium) levels in the blood. Elderly people may be at greater risk for this. Symptoms may include:

• headache
• weakness or feeling unsteady
• confusion, problems concentrating or thinking or memory problems

Do not stop escitalopram without first talking to your healthcare provider. Stopping escitalopram too quickly may cause serious symptoms including:

• anxiety, irritability, high or low mood, feeling restless or changes in sleep habits
• headache, sweating, nausea, dizziness
• electric shock-like sensations, shaking, confusion

Do not take Escitalopram if you:

• are allergic to escitalopram or citalopram (Celexa) or any of the ingredients in escitalopram.
• take a Monoamine Oxidase Inhibitor (MAOI). Ask your healthcare provider or pharmacist if you are not sure if you take an MAOI, including the antibiotic linezolid.
  • Do not take an MAOI within 14 days of stopping Escitalopram.
  • Do not start escitalopram if you stopped taking an MAOI in the last 14 days.

People who take escitalopram close in time to an MAOI may have serious or even life-threatening side effects. Get medical help right away if you have any of these symptoms:

• high fever
• uncontrolled muscle spasms
• stiff muscles
• rapid changes in heart rate or blood pressure
• confusion
• loss of consciousness (pass out)
• take the antipsychotic medicine pimozide (Orap) because taking this drug with Escitalopram can cause serious heart problems.

Medicines can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of escitalopram there are no specific foods that you must exclude from your diet when receiving escitalopram.

Before starting escitalopram, tell your healthcare provider if you:

• Are taking certain drugs such as:
  • Triptans used to treat migraine headache
  • Medicines used to treat mood, anxiety, psychotic or thought disorders, including tricyclics, lithium, SSRIs, SNRIs, or antipsychotics
  • Tramadol
  • Over-the-counter supplements such as tryptophan or St. John's Wort
• have liver problems
• have kidney problems
• have heart problems
• have or had seizures or convulsions
• have bipolar disorder or mania
• have low sodium levels in your blood
• have a history of a stroke
• have high blood pressure
• have or had bleeding problems
• are pregnant or breastfeeding

Tell your healthcare provider about all the medicines that you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Escitalopram and some medicines may interact with each other, may not work as well, or may cause serious side effects.

Tell your doctor if you are pregnant or plan to become pregnant. It is not known if escitalopram will harm your unborn baby.

Tell your doctor if you are breastfeeding or plan to breastfeed. Some escitalopram may pass into your breast milk. It is not known if escitalopram will harm your nursing baby.

• Take escitalopram exactly as prescribed. Your doctor may need to change the dose of escitalopram until it is the right dose for you.
• Escitalopram may be taken with or without food.
• If you miss a dose of escitalopram, take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and take your next dose at the regular time. Do not take two doses of escitalopram at the same time.
• If you take too much escitalopram, call your healthcare provider or poison control center right away, or get emergency treatment.

Take escitalopram exactly as prescribed by your doctor. Follow the directions on your prescription label carefully. Your doctor will determine the best dose for you.

The recommended dosage of escitalopram is 10-20 mg a day. Exceptions include the elderly and patients with hepatic impairment, who should not take more than 10 mg a day. Both Generalized Anxiety Disorder (GAD) and Depression are considered chronic conditions, treatment is recommended for several months. The efficacy of Lexapro over long periods of time has not been studied, therefore consistent reevaluation of the treatment is recommended for longer periods of treatment.

If you take too much escitalopram, call your doctor or Poison Control Center right away, or get emergency treatment.

• Store escitalopram at 25°C (77°F); excursions permitted to 15 - 30°C (59-86°F).
• Keep escitalopram bottle closed tightly. 
• Keep escitalopram and all medicines out of the reach of children.

WARNINGS: SUICIDALITY AND ANTIDEPRESSANT DRUGS

Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of escitalopram tablets or any other antidepressant in a child, adolescent or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Escitalopram tablets are not approved for use in pediatric patients less than 12 years of age.