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GENERIC NAME: escitalopram

BRAND NAME: Lexapro

DRUG CLASS AND MECHANISM: Escitalopram is an oral drug that is used for treating depression and generalized anxiety disorder. It works by affecting neurotransmitters in the brain, the chemical messengers that nerves use to communicate with one another. Neurotransmitters are made and released by nerves and then travel to other nearby nerves where they attach to receptors on the nerves. Some neurotransmitters that are released do not bind to receptors and are taken up by the nerves that produced them. This is referred to as "reuptake."
Many experts believe that an imbalance of neurotransmitters is the cause of depression. Escitalopram prevents the reuptake of one neurotransmitter, serotonin, by nerves, an action which results in more serotonin in the brain to attach to receptors. Chemically, escitalopram is very similar to citalopram. Both are in the class of drugs called selective serotonin reuptake inhibitors (SSRIs), a class that also includes fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft).

PREPARATIONS: White to off-white, round tablets of 5, 10, and 20 mg.

STORAGE: Escitalopram tablets should be stored at controlled room temperature, 59-86°F (15-30°C.)

PRESCRIBED FOR: Escitalopram is approved for the treatment of depression and generalized anxiety disorder. Drugs in the SSRI class also have been studied in persons with obsessive-compulsive disorders and panic disorders.

DOSING: The usual starting dose of escitalopram is 10 mg once daily. Benefit may not be seen until treatment has been given for up to 4 weeks. Escitalopram can be taken with or without food. Older and younger persons require similar doses.

DRUG INTERACTIONS: All SSRIs, including escitalopram, should not be taken together with any drugs of the MAO (mono-amine oxidase) inhibitor-class of antidepressants, for example, isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), and procarbazine (Matulane). Such combinations may lead to confusion, high blood pressure, high fevers, tremor or muscle rigidity, and increased activity. This same type of interaction also may occur with selegiline (Eldepryl), fenfluramine (Pondimin), and dexfenfluramine (Redux). Tryptophan can cause headaches, nausea, sweating, and dizziness when taken with any SSRI. At least 14 days should elapse after discontinuing escitalopram before starting a MAO inhibitor.

PREGNANCY: The safety of escitalopram during pregnancy and lactation has not been established. Therefore, escitalopram should not be used during pregnancy unless, in the opinion of the physician, the expected benefits to the patient outweigh the possible hazards to the fetus.

NURSING MOTHERS: Escitalopram is excreted in human milk. Escitalopram should not be given to nursing mothers unless, in the opinion of the physician, the expected benefits to the patient outweigh the possible hazards to the child.

SIDE EFFECTS: The most commonly-noted side effects associated with escitalopram are agitation or restlessness, blurred vision, diarrhea, difficulty sleeping, drowsiness, dry mouth, fever, frequent urination, headache, indigestion, nausea, increased or decreased appetite, increased sweating, sexual difficulties (decreased sexual ability or desire, ejaculatory delay), taste alterations, tremor (shaking), weight changes. Although changes in sexual desire, sexual performance and sexual satisfaction often occur as a result of depression itself, they also may be a consequence of the drugs used to treat depression. In particular, about one in 11 men given escitalopram report difficulties experiencing ejaculation.
Some patients may experience withdrawal reactions upon stopping SSRI therapy. Symptoms may include dizziness, tingling, tiredness, vivid dreams, irritability, or poor mood. In order to avoid these symptoms, the dose of SSRI can be slowly reduced instead of abruptly stopped.
It has been suggested that SSRIs may cause depression to worsen and even lead to suicide in a small number of patients. These potential side effects are difficult to evaluate in depressed patients because depression can progress with or without treatment, and suicide is itself a consequence of depression. Moreover, the evidence supporting these potential side effects is weak. Therefore, no conclusions can yet be drawn about the relationship between SSRIs and worsening depression and suicide. Until better information is available, patients receiving SSRIs should be monitored for worsening depression and suicidal tendencies.