Escitalopram

Escitalopram is an active ingredient for the treatment of depression, anxiety, panic and obsessive-compulsive disorders. It belongs to the group of serotonin reuptake inhibitors (SSRIs). Escitalopram is the S-enantiomer of citalopram. Escitalopram is 150 times more potent than citalopram and has the highest serotonin transporter selectivity. It is usually present as escitalopram oxalate and is a white to slightly yellowish powder. Escitalopram is very poorly soluble in water and is a bicyclic phthalan derivative.

Escitalopram works by inhibiting the reuptake of serotonin in the presynaptic nerve endings. It binds to the serotonin transporter (SERT) and blocks the binding site there so that serotonin cannot bind. This prevents the reuptake of serotonin into the presynaptic nerve endings. It is assumed that depression is caused by an uneven distribution of messenger substances (neurotransmitters) in the brain. By inhibiting reuptake, more serotonin can be transmitted and thus sufficient serotonin is available again for transmission.

Escitalopram is broken down via the liver, mainly via the CYP2C19, CYP3A4 and CYP2D6 enzymes. It is then excreted by the kidneys. The bioavailability of escitalopram, i.e. the percentage of the active substance available in the blood, is 80%. The half-life, i.e. the time the body needs to excrete half of the active substance, is around 30 hours. The maximum plasma concentration (Cmax), i.e. the maximum concentration of the active substance in the blood plasma (liquid cell-free part of the blood) is reached after about 4 hours.

Always take escitalopram exactly as described in the package leaflet or as advised by your doctor.

The usual recommended starting dose is 10 mg per day.

The recommended maintenance dose is 10-20 mg per day.

The maximum daily dose is 20 mg .

The dose should be adjusted for smokers, as elimination may be accelerated in smokers.

Escitalopram should preferably always be taken at the same time of day to avoid dose fluctuations.

It can take up to 4 weeks for the optimum effect to occur.

Escitalopram should not be discontinued abruptly under any circumstances, as this can lead to severe withdrawal symptoms.

The following side effects may occur:

Very common:

• Nausea
• Headache

Common:

• Stuffy or runny nose
• Decreased or increased appetite
• Anxiety, restlessness, abnormal dreams
• Difficulty sleeping
• Dizziness
• trembling
• Tingling
• diarrhea
• constipation
• vomiting
• dry mouth
• Increased sweating
• Pain in muscles and joints
• Disorders of sexual function
• Fever

Occasionally:

• Unusual bleeding including gastrointestinal bleeding
• Hives
• Itching
• Teeth grinding
• Dilated pupils
• Visual disturbances
• Ringing in the ears (tinnitus)
• hair loss
• Increased menstrual bleeding
• Rapid heartbeat
• Swelling of the arms and legs
• nosebleeds (epistaxis)

Rarely:

• allergic reactions
• aggression
• hallucination
• slow heartbeat

Frequency unknown:

• Difficulty urinating
• seizures
• Liver dysfunction/hepatitis
• Cardiac arrhythmias including torsades de pointes arrhythmias
• suicidal thoughts
• Decreased sodium concentration in the blood
• orthostatic hypotension
• movement disorders
• painful erection
• bleeding disorders
• increased urination
• secretion of milk from the breast
• mania
• Increased risk of bone fractures
• heavy vaginal bleeding

Interactions may occur if the following medicines are taken at the same time:

• non-selective monoamine oxidase inhibitors (MAO inhibitors) such as phenelzine, iproniazid, isocarboxazid, nialamide and tranylcypromine
• moclobemide
• selegiline
• linezolid
• lithium
• tryptophan
• imipramine
• desipramine
• Sumatriptan and similar drugs for the treatment of migraine
• tramadol
• cimetidine
• Lansoprazole and omeprazole
• fluconazole
• fluvoxamine
• Ticlopidine
• St. John's wort
• Acetylsalicylic acid (aspirin) and other NSAIDs
• warfarin
• Dipyridamole
• Phenprocoumon
• mefloquine
• Neuroleptics
• flecainide
• propafenone
• metoprolol
• Clomipramine
• Nortriptyline
• risperidone
• thioridazine
• haloperidol
• potassium
• magnesium
• Medications for cardiac arrhythmias and those that affect the heart rhythm (sparfloxacin, erythromycin, astemizole,...)

Escitalopram must NOT be taken in the following cases

• if you are allergic to escitalopram
• when taking MAO inhibitors(selegiline, moclobemide and linezolid)
• in case of cardiac arrhythmia
• if you are taking medication for cardiac arrhythmia or medication that affects the heart rhythm

Escitalopram can be taken from the age of 12, but is only recommended from the age of 18, as the risk of side effects such as suicide attempts or suicidal thoughts is significantly higher in children than in adults.

It should only be taken under the age of 18 if your doctor deems it absolutely necessary .

Pregnancy

No clear study results are available for pregnancy. Studies on the group of SSRIs, which includes escitalopram, were unable to provide any clear evidence of an increased rate of malformations. On the other hand, an increased risk of malformation after taking SSRIs could not be refuted.

Taking escitalopram in the 2nd trimester of pregnancy can lead to functional effects in the newborn such as tremor, drinking disorders, respiratory distress, hypoglycaemia,... may occur. These symptoms can last up to a month, but usually go away after a few weeks.

If there is a history of bleeding disorders, severe vaginal bleeding may occur during childbirth after taking the drug during late pregnancy. However, if the patient is stable, treatment should not be changed or stopped during pregnancy, as this can lead to dangerous crises due to withdrawal symptoms. If no treatment has been prescribed prior to pregnancy, the more suitable alternatives citalopram and sertraline can be used.

If escitalopram is taken during pregnancy, the baby should be delivered in a neonatal clinic and the newborn should be closely monitored in the first days to weeks of life.

Lactation

No clear study results are available for breastfeeding. It is suspected that escitalopram passes into breast milk. If treatment has been ongoing since pregnancy, treatment is also acceptable during breastfeeding. If new symptoms such as restlessness, difficulty drinking or sedation occur in the infant, a pediatrician should be consulted immediately. The same applies to breastfeeding: if no treatment has been given before breastfeeding, the alternatives citalopram and sertraline should be taken.