Formulary
Escitalopram: Indications, Dosing, Side Effects and Interactions
For all selective serotonin re-uptake inhibitors Selectively inhibit the re-uptake of serotonin (5-hydroxytryptamine, 5-HT).
MedNext Academy | 5 min read
Escitalopram: Indications, Dosing, Side Effects and Interactions
For all selective serotonin re-uptake inhibitors Selectively inhibit the re-uptake of serotonin (5-hydroxytryptamine, 5-HT).
Drug action
For all selective serotonin re-uptake inhibitors Selectively inhibit the re-uptake of serotonin (5-hydroxytryptamine, 5-HT). Drug action For escitalopram Escitalopram is the active enantiomer of citalopram.
Indications and dose
**Depressive illness,Generalised anxiety disorder,Obsessive-compulsive disorder**
- **Adult** (By Mouth): Initially 10 mg once daily, increased if necessary up to 20 mg once daily.
- **Elderly** (By Mouth): Initially 5 mg once daily, increased if necessary up to 10 mg once daily.
**Depressive illness [known CYP2C19 poor metabolisers],Generalised anxiety disorder [known CYP2C19 poor metabolisers],Obsessive-compulsive disorder [known CYP2C19 poor metabolisers]**
- **Adult** (By Mouth): Initially 5 mg once daily, increased if necessary up to 10 mg once daily, dose may be increased after 2 weeks of initial dose.
**Panic disorder**
- **Adult** (By Mouth): Initially 5 mg once daily for 7 days, then increased to 10 mg once daily, increased if necessary up to 20 mg once daily.
- **Elderly** (By Mouth): Initially 5 mg once daily, increased if necessary up to 10 mg once daily.
**Panic disorder [known CYP2C19 poor metabolisers]**
- **Adult** (By Mouth): Initially 5 mg once daily, increased if necessary up to 10 mg once daily, dose may be increased after 2 weeks of initial dose.
**Social anxiety disorder**
- **Adult** (By Mouth): Initially 10 mg once daily for 2-4 weeks, dose to be adjusted after 2-4 weeks of treatment; usual maintenance 5-20 mg once daily.
**Social anxiety disorder [known CYP2C19 poor metabolisers]**
- **Adult** (By Mouth): Initially 5 mg once daily, increased if necessary up to 10 mg once daily, dose may be increased after 2 weeks of initial dose.
Cautions
For all selective serotonin re-uptake inhibitors Cardiac disease; concurrent electroconvulsive therapy; diabetes mellitus; epilepsy (discontinue if convulsions develop); history of bleeding disorders (especially gastro-intestinal bleeding); history of mania; susceptibility to angle-closure glaucoma Cautions, further information Elderly Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information): potentially inappropriate with current or recent significant hyponatraemia i.e. serum sodium less than 130 mmol/L (risk of exacerbating or precipitating hyponatraemia). Cautions For escitalopram General cautions: Susceptibility to QT-interval prolongation Specific cautions: When used for Social anxiety disorder Elderly (no information on efficacy)
Contraindications
For all selective serotonin re-uptake inhibitors Poorly controlled epilepsy; SSRIs should not be used if the patient enters a manic phase Contra-indications For escitalopram QT-interval prolongation
Side effects
For all selective serotonin re-uptake inhibitors Common or very common Anxiety; appetite abnormal; arrhythmias; arthralgia; asthenia; concentration impaired; confusion; constipation; depersonalisation; diarrhoea; dizziness; drowsiness; dry mouth; fever; gastrointestinal discomfort; haemorrhage; headache; hyperhidrosis; malaise; memory loss; menstrual cycle irregularities; myalgia; mydriasis; nausea (dose-related); palpitations; paraesthesia; QT interval prolongation; sexual dysfunction; skin reactions; sleep disorders; taste altered; tinnitus; tremor; urinary disorders; visual impairment; vomiting; weight changes; yawning Uncommon Alopecia; angioedema; behaviour abnormal; hallucination; leucopenia; mania; movement disorders; photosensitivity reaction; postural hypotension; seizure; suicidal behaviours; syncope Rare or very rare Galactorrhoea; hepatitis; hyperprolactinaemia; hyponatraemia; serotonin syndrome; severe cutaneous adverse reactions (SCARs); SIADH; thrombocytopenia Frequency not known Increased risk of fracture; withdrawal syndrome Side-effects, further information Symptoms of sexual dysfunction may persist after treatment has stopped. Overdose Symptoms of poisoning by selective serotonin re-uptake inhibitors include nausea, vomiting, agitation, tremor, nystagmus, drowsiness, and sinus tachycardia; convulsions may occur. Rarely, severe poisoning results in the serotonin syndrome, with marked neuropsychiatric effects, neuromuscular hyperactivity, and autonomic instability; hyperthermia, rhabdomyolysis, renal failure, and coagulopathies may develop. For details on the management of poisoning, see Selective serotonin re-uptake inhibitors, under Emergency treatment of poisoning . Side-effects For escitalopram Common or very common Sinusitis Uncommon Oedema
Interactions
**Other interactions (5):**
- Tricyclic antidepressants (TCAs) Trazodone Selective serotonin reuptake inhibitors (SSRIs) Escitalopram Interaction not studied with any of the components of...
- Examples include: Class IA antiarrhythmics (e.g.
- When weak inhibitors of CYP3A4 (e.g.
- Examples include: Class IA antiarrhythmics (e.g.
- This is particularly true for anti-depressants such as venlafaxine, fluvoxamine, clomipramine, citalopram, escitalopram, paroxetine and sertraline.
Pregnancy
For all selective serotonin re-uptake inhibitors Specialist sources indicate SSRIs may be suitable for use in pregnancy, but the risks and benefits of use must be considered, and the lowest effective dose should be used. The available data regarding malformation risk for all SSRIs are conflicting and confounded, and a causal association between the use of SSRIs in pregnancy, and spontaneous miscarriage, preterm delivery, low birth weight, and adverse effects on infant neurodevelopment remains unconfirmed. Published data on first trimester use of fluoxetine and paroxetine are contradictory. Some studies suggest a small increased risk of cardiovascular malformations with the use of fluoxetine, and congenital malformations (particularly cardiovascular) with the use of paroxetine, however other studies do not support an association. There may be a small increased risk of persistent pulmonary hypertension in the newborn with the use of SSRIs beyond 20 weeks' gestation, and use in the later stages of pregnancy may result in neonatal withdrawal syndrome-neonates should be monitored for associated central nervous system, motor, respiratory, and gastro-intestinal symptoms. There may also be a small increased risk of postpartum haemorrhage when used in the month before delivery (see Important safety information ).
Breast feeding
For all selective serotonin re-uptake inhibitors Specialist sources indicate that sertraline and paroxetine are the SSRIs of choice in breast-feeding based on passage into milk, half-life, and published evidence of safety. However, all SSRIs can be used in breast-feeding with caution, and since there are risks with switching an SSRI, it may be more clinically appropriate to continue treatment with an SSRI that has been effective, or restart treatment with an SSRI that has previously been effective. With all SSRIs, infants should be monitored for drowsiness, poor feeding, adequate weight gain, gastro-intestinal disturbances, irritability, and restlessness. Breast feeding For escitalopram Specialist sources indicate use with caution. Present in milk in small amounts; long half-life increases risk of accumulation in the infant.
Hepatic impairment
For all selective serotonin re-uptake inhibitors In general, manufacturers advise caution (prolonged half-life). Hepatic impairment For escitalopram Dose adjustments Manufacturer advises initially 5 mg once daily for 2 weeks in mild to moderate impairment, thereafter increased to 10 mg once daily according to response; titrate dose with extra caution in severe impairment.
Renal impairment
Use with caution if creatinine clearance less than 30 mL/minute, M see Prescribing in renal impairment .
Medicinal forms
Tablet,Tablet,Drops
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
Inside MedNext for this topic
- 411 MedNext-authored chapters
- 80,000+ MCQ bank
- 15 study modes
- Growing visual cheat sheets
Study modes
- Notes
- MCQ
- Audio
- Video
- Visual
- 3D Anatomy
- Trace
- Flashcards
- Mnemonics
- Image Bank
- Clinical
- Microscopy
- Audio QBank
- Cadaver
- Book Match
Continue reading
Subject HubPharmacology Hub
All pharmacology resources in one place.
Drug SchedulesIndian Drug Schedules
Schedule H, H1, X and G classifications.
FormularyBrowse all drugs
Search 1,850+ drug profiles.
Study Escitalopram in the MedNext app
Challenge yourself with targeted pharmacology MCQs on this drug class. Every explanation links back to the chapter that teaches the concept.
Start drug challengeExplore the full formulary