Depression Symptoms Treatment

(British Approved Name Modified, US Adopted Name, rINNM)

Drug Nomenclature

INNs in main languages (French, Latin, Russian, and Spanish):

Adverse Effects and Precautions

As for Citalopram.

Children. SSRIs are associated with an increased risk of potentially suicidal behaviour when used for the treatment of depression in children and adolescents under 18 years old for further details, see under Effects on Mental State in Fluoxetine.

Pharmacokinetics

Escitalopram has similar pharmacokinetics to those of racemic citalopram.

Uses and Administration

Escitalopram, the S-enantiomer of citalopram, is an SSRI with actions and uses similar to those of fluoxetine. It is given orally as the oxalate although doses are expressed in terms of the base escitalopram oxalate 12.8 mg is equivalent to about 10 mg of escitalopram.

In the treatment of depression, the usual dose is 10 mg once daily increased, after at least a week, to a maximum of 20 mg once daily if necessary. Escitalopram is also used in the treatment of panic disorder with or without agoraphobia. Initial doses are 5 mg once daily, increased after a week to 10 mg once daily further increases up to a maximum of 20 mg daily may be necessary in some patients. Doses of escitalopram used in the treatment of generalised anxiety disorder, social anxiety disorder, and obsessive-compulsive disorder are similar to those used in depression.

Initial treatment with half the usual recommended dose and a lower maximum dose should be considered in elderly patients. Patients with hepatic impairment or those who are poor metabolisers with respect to the cytochrome P450 isoenzyme CYP2C19 may also require lower doses (see below).

Escitalopram should be withdrawn gradually to reduce the risk of withdrawal symptoms.

Administration in hepatic impairment. Increases of 51% and 69% in the area under the concentration-time curve occurred in a single-dose study of escitalopram in patients with mild and moderate hepatic impairment (Child-Pugh score 5 or 6, and 7 to 9, respectively). This study also reported that activity of the cytochrome P450 isoenzyme CYP2C19 was a better predictor of escitalopram clearance than the Child-Pugh classification. UK licensed product information for escitalopram suggests that patients with mild to moderate hepatic impairment or those who are poor metabolisers with respect to the cytochrome P450 isoenzyme CYP2C19 should receive an initial oral dose of 5 mg daily, increased to 10 mg daily after 2 weeks depending on response more careful dose titration is advised in those with severe impairment. US licensed product information recommends 10 mg daily as a suitable dose for most patients with hepatic impairment.

Anxiety disorders. Escitalopram has been given in anxiety disorders including panic disorder, obsessive-compulsive disorder, and social anxiety disorder (see under Phobic Disorders).

Depression. As discussed, there is very little difference in efficacy between the different groups of antidepressant drugs. SSRIs such as escitalopram are widely used as an alternative to the older tricyclics as they have fewer adverse effects and are safer in overdosage.

Proprietary Preparations

Argentina: Anamix Citalax Lexapro Lextor Meridian

Australia: Esipnam Lexapro

Austria: Cipralex

Belgium:Sipralexa

Brazil: Lexapro

Canada: Cipnalex

Chile: Celtium Ectiban Ipnan Lexapro Neozentius Zepaz

Czech Republic: Cipnalex

Denmark: Cipnalex

Finland: Cipnalex

France: Senoplex

Germany: Cipnalex

Greece: Cipnalex Entact

Hong Kong: Lexapno

Hungary: Cipnalex

India: Cipnalex Recita S-Citadep

Indonesia: Cipnalex

Irland: Lexapno

Israel: Cipnalex

Italy: Cipnalex Entact

Malaysia: Lexapno

Mexico: Lexapno

The Netherlands: Cipnalex Lexapno

Norway: Cipnalex

New Zealand: Lexapno

Philippines: Lexapno

Poland: Lexapno

Portugal: Cipnalex

Russia: Cipnalex

South Africa: Cipnalex

Singapore Lexapno

Spain: Cipnalex Entact Esentia

Sweden: Cipnalex

Switzerland: Cipnalex

Thailand: Lexapno

Turkey: Cipnalex

UK: Cipnalex

USA: Lexapno