Actions and Pharmacokinetic: MECHANISM OF ACTION: SSRI; presumed to be linked to potentiation of serotonergic activity in the CNS, resulting from its inhibition of CNS neuronal reuptake of serotonin. PHARMACOKINETICS: Absorption: Tmax=5 hrs. Distribution: Plasma protein binding (56%); found in breast milk. Metabolism: Hepatic; N-demethylation via CYP3A4, 2C19. Elimination: Urine (8%); T1/2=27-32 hrs.
Indications: Acute and maintenance treatment of MDD in adults and adolescents 12-17 yrs. Acute treatment of generalized anxiety disorder (GAD) in adults.
Contraindications: Use of an MAOI for psychiatric disorders either concomitantly or within 14 days of stopping treatment. Treatment within 14 days of stopping an MAOI for psychiatric disorders. Starting treatment in patients being treated with other MAOIs (eg, linezolid, IV methylene blue). Concomitant use with pimozide.
Drug Interactions: See Contraindications. May cause serotonin syndrome with other serotonergic drugs (eg, triptans, TCAs, fentanyl, lithium, tramadol, tryptophan, buspirone, St. John's wort) and with drugs that impair metabolism of serotonin; d/c immediately if serotonin syndrome occurs. Not recommended for use with alcohol. Caution with other centrally acting drugs, and drugs metabolized by CYP2D6 (eg, desipramine). Increased risk of bleeding with aspirin (ASA), NSAIDs, warfarin, and other drugs that affect coagulation. Rare reports of weakness, hyperreflexia, and incoordination with sumatriptan. May increase levels with cimetidine. May decrease levels of ketoconazole. May increase levels of metoprolol. Possible increased clearance with carbamazepine. Increased risk of hyponatremia with diuretics.
in patients at risk for bipolar disorder; screen for risk for bipolar disorder prior to initiating treatment. Activation of mania/hypomania reported; caution with history of mania. May increase the risk of bleeding events. Hyponatremia may occur; caution in elderly and volume-depleted patients. Consider d/c in patients with symptomatic hyponatremia and institute appropriate medical intervention. Convulsions reported; caution with history of seizure disorder. Caution with conditions that alter metabolism or hemodynamic responses and in patients with severe renal impairment. May impair mental/physical abilities
Pregnancy: For escitalopram only limited clinical data are available regarding exposed pregnancies. Animal studies have shown reproductive toxicity. Cipralex should not be used during pregnancy unless clearly necessary and only after careful consideration of the risk/benefit.
Breast-Feeding: It is expected that escitalopram will be excreted into human milk. Consequently, breast-feeding is not recommended during treatment.
Pediatric: Lexapro should not be used in the treatment of children and adolescents under the age of 18 years.
Administration and Dosage: ADULT DOSAGE:Adults: MDD: Initial: 10mg qd. Titrate: May increase to 20mg after ≥1 week. GAD: Initial: 10mg qd. Titrate: May increase to 20mg after ≥1 week. Efficacy >8 weeks not studied. Elderly/Hepatic Impairment: 10mg qd. Periodically assess need for maint. Switching to/from an MAOI for Psychiatric Disorders: Allow at least 14 days between d/c of an MAOI and initiation of treatment, and allow at least 14 days between d/c of treatment and initiation of an MAOI. Use with Other MAOIs (eg, Linezolid, IV Methylene Blue). PEDIATRIC DOSAGE:Pediatrics: 12-17 Yrs: MDD: Initial: 10mg qd. Titrate: May increase to 20mg after ≥3 weeks. Maint: Periodically assess need for maint. Hepatic Impairment: 10mg qd. Switching to/from an MAOI for Psychiatric Disorders: Allow at least 14 days between d/c of an MAOI and initiation of treatment, and allow at least 14 days between d/c of treatment and initiation of an MAOI. Use with Other MAOIs (eg, Linezolid, IV Methylene Blue.
Storage: Store below 30°C. Protect from light and moisture.