Rhea Escitalopram

Major depressive episodes, panic disorder w/ or w/o agoraphobia, social & generalized anxiety disorder, obsessive-compulsive disorder.

Major depressive episodes 10 mg once daily, may be increased to max of 20 mg daily. Panic disorder w/ or w/o agoraphobia Initially 5 mg for the 1st wk before increasing to 10 mg daily. Max: 20 mg daily. Social & generalized anxiety disorder 10 mg once daily. Max: 20 mg daily. Obsessive-compulsive disorder 10 mg once daily. May be increased to 20 mg daily depending on individual patient response. Reduced hepatic function, poor metabolisers CYP2C19 Initially 5 mg daily for the 1st 2 wk, may be increased to 10 mg daily depending on individual patient response. Elderly >65 yr Initially half the usual dose & lower max dose.

May be taken with or without food.

Hypersensitivity. Concomitant use w/ non-selective irreversible MAOIs & w/ pimozide.

Avoid possible discontinuation symptoms by gradually reduce dose over a period of at least 1-2 wk. Paradoxical anxiety. Discontinue use if patient develops seizures for the 1st time or increase in seizure frequency in previous diagnosis of epilepsy; in any patient entering manic phase; serotonin syndrome. Avoid use in patients w/ unstable epilepsy, & closely monitor patients w/ controlled epilepsy. History of mania/hypomania. May alter glycemic control in patients w/ diabetes. Closely monitor patients w/ increased risk of suicide/suicidal thoughts or clinical worsening, unusual changes in & suicidal behavior. Akathisia/psychomotor restlessness. Patients at risk or w/ cirrhosis, or if concomitant use w/ other medications which may cause hyponatremia. Hemorrhage; concomitant use w/ anticoagulants; atypical antipsychotics & phenothiazines, most TCAs, acetylsalicylic acid & NSAIDs, ticlopidine & dipyridamole; & patients w/ known bleeding tendencies. Electroconvulsive therapy. Not recommended in combination w/ reversible, selective MAO A inhibitors. Concomitant use w/ sumatriptan or other triptans, tramadol & tryptophan; St. John's wort. May impair ability to drive & use machines. Patients w/ severely reduced renal function (CrCl <30 mL/min). Pregnancy. Not recommended during lactation. Not to be used in childn & adolescent <18 yr. Elderly.

Nausea. Decreased/increased appetite, increase wt; anxiety, restlessness, abnormal dreams, decreased libido, female: anorgasmia; insomnia, somnolence, dizziness, paraesthesia, tremor; sinusitis, yawning; diarrhea, constipation, vomiting, dry mouth; increased sweating; arthralgia, myalgia; male: ejaculation disorder, impotence; fatigue, pyrexia.

Development of serotonin syndrome w/ non-selective, irreversible MAOIs; reversible, selective MAO A inhibitor (moclobemide); selegiline (irreversible MAO B inhibitor); serotonergic medicinal products (eg, tramadol, sumatriptan & other triptans). Mean increase in QTc interval w/ pimozide. Capable of lowering seizure threshold w/ antidepressants (tricyclics, SSRIs), neuroleptics (phenothiazines, thioxanthenes, butyrophenones), mefloquine, bupropion & tramadol. Enhanced effects w/ lithium or tryptophan. Increased incidence of adverse reactions w/ St. John's wort. Altered anti-coagulant effects w/ oral anticoagulants. May increase bleeding tendency w/ NSAIDs. Not advisable w/ alcohol. Moderate increase in plasma conc w/ CYP2C19 inhibitors (eg, omeprazole, fluoxetine, fluvoxamine, lansoprazole, ticlopidine) & w/ cimetidine. Increase in plasma levels of medicinal products that are mainly metabolised by enzyme CYP2D6, & that have narrow therapeutic index eg, flecainide, propafenone & metoprolol; or some CNS acting medicinal products eg, desipramine, clomipramine & nortriptyline; or antipsychotics like risperidone, thioridazine & haloperidol. Concomitant use w/ medicinal products that are metabolised by CY2C19.

Antidepressants

N06AB10 - escitalopram ; Belongs to the class of selective serotonin reuptake inhibitors. Used in the management of depression.

Rx