Escitalopram
Mechanism :
The mechanism of antidepressant action of escitalopram, the S-enantiomer of racemic citalopram, is presumed to be linked to potentiation of serotonergic activity in the central nervous system (CNS) resulting from its inhibition of CNS neuronal reuptake of serotonin (5-HT).
Indication :
Contraindications :
Concomitant use in patients taking monoamine oxidase inhibitors (MAOIs), pimozide is contraindicated. Contraindicated in patients with a hypersensitivity to escitalopram or citalopram or any of the inactive ingredients. It is not recommended in children less than 12 years of age.
Dosing :
Under 12 years:
Safety and efficacy not established.
12 to 17 years:
10 mg orally OD. The dose may be increased to a maximum of 20 mg after 3 weeks.
Adverse Effect :
Palpitation, hypertension, heartburn, abdominal cramp, gastroenteritis, light-headed feeling, migraine, allergy, pain in limb, hot flushes, fever, chest pain, increased weight, arthralgia, myalgia, rash. Increased appetite, lethargy, irritability, impaired concentration, bronchitis, sinus congestion, nasal congestion, blurred vision, tinnitus.
Interaction :
Lithium: Plasma lithium levels should be monitored with appropriate adjustment to the lithium dose in accordance with standard clinical practice. Because lithium may enhance the serotonergic effects of escitalopram, caution should be exercised.
Sumatriptan: Weakness, hyperreflexia, and incoordination following the use of an SSRI and sumatriptan. If concomitant treatment with sumatriptan and an SSRI (e.g., fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram, escitalopram) is clinically warranted, appropriate observation of the patient is advised.
Theophylline: The effect of theophylline on the pharmacokinetics of citalopram was not evaluated.
Warfarin: Prothrombin time was increased by 5%, the clinical significance of which is unknown.
Carbamazepine: Citalopram plasma levels were unaffected, given the enzyme-inducing properties of carbamazepine, the possibility that carbamazepine might increase the clearance of escitalopram should be considered if the two drugs are coadministered.
Metoprolol: Increased metoprolol plasma levels have been associated with decreased cardioselectivity.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 30-50 | Dose as in normal renal function |
| 10-30 | Dose as in normal renal function. Start with a low dose and titrate slowly |
| <10 | Dose as in Dose as in normal renal function. Start with a low dose and titrate slowlyrenal function |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Unlikely to be dialysed. Dose as in GFR<10 mL/min |
| HD | Not dialysed. Dose as in GFR<10 mL/min |
| HDF/High flux | Not dialysed. Dose as in GFR<10 mL/min |
| CAV/VVHD | Unlikely to be dialysed. Dose as in GFR=10–30 mL/min |
Hepatic Dose :
An initial dose of 5 mg daily for the first two weeks of treatment is recommended in patients with mild or moderate hepatic impairment. Depending on individual patient response, the dose may be increased to 10 mg daily. Caution is advised in severe hepatic impairment.