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Escitalopram belongs to a group of drugs that act as antidepressants. Other drugs in this group are fluoxetine, paroxetine, sertraline and citalopram. What distinguishes escitalopram from the above-mentioned drugs is the fact that it causes significantly fewer side effects and is equally effective or even greater than the effectiveness of older generation drugs. Escitalopram is recommended as the first line treatment for depression.

Action of escitalopram

SSRI is a group of drugs that are serotonin reuptake inhibitors. Escitalopram is the enantiomer of citalopram so its action is similar to the original. However, escitalopram surpasses its prototype by greater selectivity for serotonin (5-HT) receptors.

For this reason, it is called a selective serotonin reuptake inhibitor. After oral administration, it is almost completely absorbed into the blood.It works by increasing the amount of serotonin in the spaces between synapses, which leads to its increased transmission in the nervous system.

Indications for the use of escitalopram

Escitalopram is used to treat:

  • depressed
  • panic disorder, which may be associated with agoraphobia
  • social anxiety, the so-called social phobia
  • obsessive-compulsive disorder.

As the effects of escitalopram are noticeable relatively quickly after starting treatment, it is recommended for professionally active people who want to return to their daily duties as soon as possible.

Due to its favorable pharmacokinetic profile and selectivity towards the serotonin receptor, escitalopram is recommended for the treatment of the elderly. Its relatively low interaction rate with other medications and the lack of serious side effects make it beneficial for people over 65 who take multiple medications.

Recently, researchers have considered including escitalopram not only to treat anxiety in the elderly, but also to reduce the symptoms of dementia in geriatric patients.

Escitalopram - dosage

The patient should use the drug exactly as prescribed by the psychiatrist.

Escitalopram is available in doses of 5 mg, 10 mg, 15 mg and 20 mg. The maximum doseis 20 mg / day.

Professionals usually start treating a patient with a dose of 10 mg. After observing the patient's reaction to the drug, the psychiatrist may decide to increase the dose or reduce it.

It is important that the patient does not make his own decisions about increasing the dose or discontinuing the drug. If the treated person feels well, the therapy should be continued and any changes should be consulted with a doctor. If you experience side effects, you should first call your doctor and never stop taking the drug suddenly, unless your doctor tells you otherwise. Abrupt termination of therapy may result in drug withdrawal symptoms.

According to numerous clinical studies, the effects of treatment with escitalopram can be seen much faster than with citalopram or other SSRIs. Improvement of the patient's condition can be expected after 1 week of taking the drug. Of course, the speed of reaction depends individually on the patient and the stage of his disease.

Escitalopram - contraindications

Escitalopram should not be used:

  • if you are hypersensitive to escitalopram, citalopram or any other ingredient of the drug.
  • if the patient is already being treated with other SSRI antidepressants or non-selective irreversible monoamine oxidase inhibitors (MAOIs).
  • with the use of other drugs, such as serotonergic drugs, non-selective MAO inhibitors, selective reversible MAO inhibitors, special care should be taken. In all of the above-mentioned cases, the patient is at risk of developing serotonin syndrome. This is a condition where there is too much serotonin in the body. Its symptoms are: agitation, muscle tremors, convulsions, and hyperthermia. It is a very serious and life-threatening condition. If the patient develops such symptoms, the drug should be discontinued and symptomatic treatment should be started in intensive care.
  • in patients with long QT or congenital long QT syndrome. Administration of the drug to patients who are also taking concomitant medications that prolong the QT interval is not recommended.

Escitalopram - precautions

  1. In Poland, treatment with escitalopram has been approved for people over 18 years of age. This is because of the increased risk of suicidal behavior in young people, adolescents and children. These include thoughts of suicide, self-mutilation and attempted suicide. Additionally, in adolescents and children, aggressive behavior, hostility and anger were noticed in clinical trials. As the effects of escitalopram administration to children and adolescents cannot be fully predicted, treatment of these age groups with this substance is recommendedit is not advisable. Not only is it dictated by the risk of suicidal thoughts, but also due to the unpredictable influence of this drug on the mental and emotional development of adolescents and children. Young people presenting with suicidal thoughts before treatment should not take escitalopram as these may be aggravated during the first phase of treatment.
  2. Escitalopram may worsen anxiety in patients being treated for panic disorder or social anxiety disorder during the first period of treatment. The physician should monitor the patient's condition and enable the patient to contact him in the event of a severe anxiety attack.
  3. If the patient has had a history of seizures, suffers from epilepsy, or the seizure occurred after administration of the drug, the drug should be discontinued and the treatment strategy changed with a different substance.
  4. You may experience an increase in appetite while taking escitalopram. Such information is especially important for patients with diabetes. The physician should consider whether this medication is appropriate for the patient if there is a risk of worsening blood glucose levels in diabetics.
  5. One of the side effects of escitalopram is bleeding into the skin. Ecchymosis or purpura may appear. The risk of this side effect is that the patient is taking anticoagulants at the same time. Drugs that also reduce blood clotting include acetylsalicylic acid, non-steroidal anti-inflammatory drugs, and tricyclic antidepressants, TLPD. If a person is taking such drugs, he / she should inform the doctor. Patients with hemorrhagic diathesis should not be treated with escitalopram.
  6. Treatment of patients with heart disease and glaucoma with escitalopram should be done with caution.
  7. Patients who are taking escitalopram should not take the herbal remedies for St. John's wort.
  8. With prolonged therapy or abrupt cessation of treatment, withdrawal symptoms may include dizziness, sensory disturbances, sleep disturbances, anxiety, nausea, sweating, headaches, irritability, emotional lability, and visual disturbances. These symptoms are usually of a transitory nature. In order to avoid such a reaction of the body to the withdrawal of escitalopram, it is recommended that the drug be withdrawn gradually. The decision on how to stop taking the drug is made by the attending physician.
  9. Treatment with escitalopram is not recommended during pregnancy or breastfeeding.

Escitalopram - side effects

Side effects are most severe in the first weeks of treatment. As therapy progresses, they lose their intensity.

The most common side effects of escitalopram include:

  • decreaseappetite
  • anxiety, nervousness
  • libido reduction
  • sleepiness or insomnia
  • dizziness
  • tremors and paresthesias
  • sinusitis
  • yawning
  • diarrhea
  • constipation
  • vomiting
  • dry mouth
  • increased sweating.

If in doubt whether a symptom is an adverse drug reaction, consult a doctor or pharmacist.

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