Escitalopram

Escitalopram Brand Name– Lexapro

What is Escitalopram

Escitalopram is an oral selective serotonin reuptake inhibitor (SSRI) that is the active S (+) enantiomer of the SSRI citalopram.

Escitalopram is indicated for the treatment of major depressive disorder and generalized anxiety disorder (GAD) in adults.

Escitalopram was the second SSRI to receive approval for treating major depression in adolescents and is used in pediatric patients 12 to 17 years of age. The primary off-label use of the drug is in the treatment of various anxiety disorders.

Escitalopram, like citalopram, may produce dose-dependent QT prolongation, and precautions apply to patients with cardiac disease or other conditions that may increase the risk of QT prolongation.

Because escitalopram has less inhibitory effects on CYP2D6 than SSRIs such as paroxetine or fluoxetine, clinically significant drug interactions with CYP2D6 substrates are not as likely to occur.

Product labels for all antidepressants contain a boxed warning related to an increased risk of suicidality in children, adolescents, and young adults during the initial stages of therapy when treating depression or other conditions; therefore, the necessity of pharmacologic therapy versus the potential risks should be carefully considered in these populations

Indications

1. autistic disorder
2. depression
3. generalized anxiety disorder (GAD)
4. panic disorder
5. social phobia (social anxiety disorder)

For the treatment of major depression

Side Effects

1. abdominal pain
2. agitation
3. agranulocytosis
4. akathisia
5. alopecia
6. amnesia
7. anaphylactoid reactions
8. anemia
9. angioedema
10. anxiety
11. aplastic anemia
12. arthralgia
13. asthenia
14. ataxia
15. atrial fibrillation
16. back pain
17. bleeding
18. blurred vision
19. bone fractures
20. bradycardia
21. chest pain (unspecified)
22. choreoathetosis
23. confusion
24. constipation
25. cough
26. delirium
27. dental pain
28. depression
29. diabetes mellitus
30. diarrhea
31. diplopia
32. dizziness
33. drowsiness
34. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
35. dysarthria
36. dysmenorrhea
37. dyspepsia
38. dysphagia
39. dyspnea
40. dystonic reaction
41. dysuria
42. ecchymosis
43. edema
44. ejaculation dysfunction
45. elevated hepatic enzymes
46. emotional lability
47. epistaxis
48. erythema multiforme
49. fatigue
50. fever
51. flatulence
52. flushing
53. gastroesophageal reflux
54. GI bleeding
55. growth inhibition
56. hallucinations
57. headache
58. heart failure
59. hematoma
60. hemolytic anemia
61. hepatic failure
62. hepatic necrosis
63. hepatitis
64. hostility
65. hyperbilirubinemia
66. hypercholesterolemia
67. hyperglycemia
68. hyperhidrosis
69. hyperprolactinemia
70. hypertension
71. hypertensive crisis
72. hypoesthesia
73. hypoglycemia
74. hypokalemia
75. hyponatremia
76. hypoprothrombinemia
77. hypotension
78. impotence (erectile dysfunction)
79. increased urinary frequency
80. insomnia
81. irritability
82. lethargy
83. leukopenia
84. libido decrease
85. malaise
86. mania
87. menorrhagia
88. menstrual irregularity
89. migraine
90. muscle cramps
91. myalgia
92. myasthenia
93. mydriasis
94. myocardial infarction
95. myoclonia
96. nasal congestion
97. nausea
98. neonatal abstinence syndrome
99. nightmares
100. nystagmus
101. ocular hypertension
102. orgasm dysfunction
103. orthostatic hypotension
104. osteopenia
105. palpitations
106. pancreatitis
107. paranoia
108. paresthesias
109. peripheral vasodilation
110. persistent pulmonary hypertension of the newborn
111. phlebitis
112. photosensitivity
113. platelet dysfunction
114. priapism
115. pseudoparkinsonism
116. psychosis
117. pulmonary embolism
118. purpura
119. pyrosis (heartburn)
120. QT prolongation
121. rash
122. renal failure (unspecified)
123. restless legs syndrome (RLS)
124. restlessness
125. rhabdomyolysis
126. rhinitis
127. seizures
128. serotonin syndrome
129. SIADH
130. sinus tachycardia
131. sinusitis
132. spontaneous fetal abortion
133. Stevens-Johnson syndrome
134. stroke
135. suicidal ideation
136. syncope
137. tardive dyskinesia
138. thrombocytopenia
139. thrombosis
140. tinnitus
141. torsade de pointes
142. toxic epidermal necrolysis
143. tremor
144. urinary retention
145. urticaria
146. ventricular tachycardia
147. vertigo
148. visual impairment
149. vomiting
150. weight loss
151. withdrawal
152. xerostomia
153. yawning

Monitoring Parameters

• blood pressure
• growth rate
• heart rate
• thyroid function tests (TFTs)
• weight

Contraindications

• abrupt discontinuation
• anorexia nervosa
• anticoagulant therapy
• apheresis
• AV block
• bipolar disorder
• bleeding
• bone fractures
• bradycardia
• breast-feeding
• cardiomyopathy
• celiac disease
• children
• citalopram hypersensitivity
• closed-angle glaucoma
• dehydration
• driving or operating machinery
• electroconvulsive therapy (ECT)
• escitalopram hypersensitivity
• ethanol ingestion
• females
• fever
• geriatric
• growth inhibition
• heart failure
• hepatic disease
• human immunodeficiency virus (HIV) infection
• hyperparathyroidism
• hypocalcemia
• hypokalemia
• hypomagnesemia
• hyponatremia
• hypothermia
• hypothyroidism
• hypovolemia
• increased intraocular pressure
• long QT syndrome
• mania
• MAOI therapy
• myocardial infarction
• neonates
• osteoporosis
• pheochromocytoma
• pregnancy
• QT prolongation
• renal failure
• renal impairment
• rheumatoid arthritis
• seizure disorder
• seizures
• sickle cell disease
• sleep deprivation
• stroke
• suicidal ideation
• systemic lupus erythematosus (SLE)
• thrombolytic therapy

Interactions

• Abciximab
• Acetaminophen; Aspirin, ASA; Caffeine
• Acetaminophen; Butalbital
• Acetaminophen; Butalbital; Caffeine
• Acetaminophen; Butalbital; Caffeine; Codeine
• Acetaminophen; Caffeine; Dihydrocodeine
• Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
• Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Codeine
• Acetaminophen; Dextromethorphan
• Acetaminophen; Dextromethorphan; Doxylamine
• Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
• Acetaminophen; Dextromethorphan; Phenylephrine
• Acetaminophen; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Hydrocodone
• Acetaminophen; Oxycodone
• Acetaminophen; Pentazocine
• Acetaminophen; Propoxyphene
• Acetaminophen; Tramadol
• Alfentanil
• Alfuzosin
• Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
• Aliskiren; Hydrochlorothiazide, HCTZ
• Almotriptan
• Alteplase
• Amiloride
• Amiloride; Hydrochlorothiazide, HCTZ
• Amiodarone
• Amitriptyline
• Amitriptyline; Chlordiazepoxide
• Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
• Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
• Amobarbital
• Amoxicillin; Clarithromycin; Lansoprazole
• Amoxicillin; Clarithromycin; Omeprazole
• Amphetamines
• Anagrelide
• Antithrombin III
• Apixaban
• Apomorphine
• Aprepitant, Fosaprepitant
• Ardeparin
• Aripiprazole
• Armodafinil
• Arsenic Trioxide
• Artemether; Lumefantrine
• Asenapine
• Aspirin, ASA
• Aspirin, ASA; Butalbital; Caffeine
• Aspirin, ASA; Butalbital; Caffeine; Codeine
• Aspirin, ASA; Caffeine; Dihydrocodeine
• Aspirin, ASA; Caffeine; Orphenadrine
• Aspirin, ASA; Carisoprodol
• Aspirin, ASA; Carisoprodol; Codeine
• Aspirin, ASA; Citric Acid; Sodium Bicarbonate
• Aspirin, ASA; Dipyridamole
• Aspirin, ASA; Omeprazole
• Aspirin, ASA; Oxycodone
• Aspirin, ASA; Pravastatin
• Atazanavir; Cobicistat
• Atenolol; Chlorthalidone
• Atomoxetine
• Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
• Atropine; Difenoxin
• Atropine; Diphenoxylate
• Atropine; Hyoscyamine; Phenobarbital; Scopolamine
• Azilsartan; Chlorthalidone
• Azithromycin
• Barbiturates
• Bedaquiline
• Belladonna Alkaloids; Ergotamine; Phenobarbital
• Belladonna; Opium
• Benazepril; Hydrochlorothiazide, HCTZ
• Bendroflumethiazide; Nadolol
• Benzhydrocodone; Acetaminophen
• Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
• Betrixaban
• Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
• Bismuth Subsalicylate
• Bismuth Subsalicylate; Metronidazole; Tetracycline
• Bisoprolol; Hydrochlorothiazide, HCTZ
• Boceprevir
• Brimonidine; Timolol
• Brompheniramine; Dextromethorphan; Guaifenesin
• Brompheniramine; Dextromethorphan; Phenylephrine
• Brompheniramine; Guaifenesin; Hydrocodone
• Brompheniramine; Hydrocodone; Pseudoephedrine
• Bumetanide
• Buprenorphine
• Buprenorphine; Naloxone
• Buspirone
• Butabarbital
• Caffeine; Ergotamine
• Candesartan; Hydrochlorothiazide, HCTZ
• Cangrelor
• Captopril; Hydrochlorothiazide, HCTZ
• Carbamazepine
• Carbinoxamine; Dextromethorphan; Pseudoephedrine
• Carbinoxamine; Hydrocodone; Phenylephrine
• Carbinoxamine; Hydrocodone; Pseudoephedrine
• Carvedilol
• Ceritinib
• Cevimeline
• Chloramphenicol
• Chloroquine
• Chlorothiazide
• Chlorpheniramine; Codeine
• Chlorpheniramine; Dextromethorphan
• Chlorpheniramine; Dextromethorphan; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
• Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Hydrocodone
• Chlorpheniramine; Hydrocodone; Phenylephrine
• Chlorpheniramine; Hydrocodone; Pseudoephedrine
• Chlorpromazine
• Chlorthalidone
• Chlorthalidone; Clonidine
• Choline Salicylate; Magnesium Salicylate
• Cilostazol
• Cimetidine
• Ciprofloxacin
• Cisapride
• Citalopram
• Clarithromycin
• Clofazimine
• Clomipramine
• Clopidogrel
• Clozapine
• Cobicistat
• Cocaine
• Codeine
• Codeine; Guaifenesin
• Codeine; Phenylephrine; Promethazine
• Codeine; Promethazine
• Crizotinib
• Cyclobenzaprine
• Cyproheptadine
• Dabigatran
• Dalteparin
• Danaparoid
• Darifenacin
• Darunavir; Cobicistat
• Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
• Dasatinib
• Degarelix
• Delavirdine
• Desflurane
• Desipramine
• Desmopressin
• Desvenlafaxine
• Deutetrabenazine
• Dexamethasone
• Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
• Dexmethylphenidate
• Dextromethorphan
• Dextromethorphan; Diphenhydramine; Phenylephrine
• Dextromethorphan; Guaifenesin
• Dextromethorphan; Guaifenesin; Phenylephrine
• Dextromethorphan; Guaifenesin; Potassium Guaiacolsulfonate
• Dextromethorphan; Guaifenesin; Pseudoephedrine
• Dextromethorphan; Promethazine
• Dextromethorphan; Quinidine
• Diazepam
• Dihydrocodeine; Guaifenesin; Pseudoephedrine
• Dihydroergotamine
• Diltiazem
• Diphenhydramine; Hydrocodone; Phenylephrine
• Dipyridamole
• Disopyramide
• Diuretics
• Dofetilide
• Dolasetron
• Dolutegravir; Rilpivirine
• Donepezil
• Donepezil; Memantine
• Dorzolamide; Timolol
• Doxepin
• Doxercalciferol
• Doxorubicin
• Dronedarone
• Droperidol
• Duloxetine
• Dutasteride; Tamsulosin
• Edoxaban
• Efavirenz
• Efavirenz; Emtricitabine; Tenofovir
• Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
• Elbasvir; Grazoprevir
• Eletriptan
• Eliglustat
• Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
• Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
• Emtricitabine; Rilpivirine; Tenofovir alafenamide
• Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
• Enalapril; Hydrochlorothiazide, HCTZ
• Encainide
• Encorafenib
• Enflurane
• Enoxaparin
• Entrectinib
• Eprosartan; Hydrochlorothiazide, HCTZ
• Eptifibatide
• Ergoloid Mesylates
• Ergonovine
• Ergot alkaloids
• Ergotamine
• Eribulin
• Erythromycin
• Erythromycin; Sulfisoxazole
• Eslicarbazepine
• Esomeprazole
• Esomeprazole; Naproxen
• Ethacrynic Acid
• Ethanol
• Etravirine
• Ezogabine
• Felbamate
• Fenfluramine
• Fenofibric Acid
• Fentanyl
• Fingolimod
• Flecainide
• Fluconazole
• Fluoxetine
• Fluoxetine; Olanzapine
• Fluphenazine
• Fluvoxamine
• Fondaparinux
• Foscarnet
• Fosinopril; Hydrochlorothiazide, HCTZ
• Fosphenytoin
• Frovatriptan
• Furosemide
• Gefitinib
• Gemifloxacin
• Gemtuzumab Ozogamicin
• Gilteritinib
• Glasdegib
• Goserelin
• Granisetron
• grapefruit juice
• Guaifenesin; Hydrocodone
• Guaifenesin; Hydrocodone; Pseudoephedrine
• Halogenated Anesthetics
• Haloperidol
• Halothane
• Heparin
• Histrelin
• Homatropine; Hydrocodone
• Hydralazine; Hydrochlorothiazide, HCTZ
• Hydrochlorothiazide, HCTZ
• Hydrochlorothiazide, HCTZ; Irbesartan
• Hydrochlorothiazide, HCTZ; Lisinopril
• Hydrochlorothiazide, HCTZ; Losartan
• Hydrochlorothiazide, HCTZ; Methyldopa
• Hydrochlorothiazide, HCTZ; Metoprolol
• Hydrochlorothiazide, HCTZ; Moexipril
• Hydrochlorothiazide, HCTZ; Olmesartan
• Hydrochlorothiazide, HCTZ; Propranolol
• Hydrochlorothiazide, HCTZ; Quinapril
• Hydrochlorothiazide, HCTZ; Spironolactone
• Hydrochlorothiazide, HCTZ; Telmisartan
• Hydrochlorothiazide, HCTZ; Triamterene
• Hydrochlorothiazide, HCTZ; Valsartan
• Hydrocodone
• Hydrocodone; Ibuprofen
• Hydrocodone; Phenylephrine
• Hydrocodone; Potassium Guaiacolsulfonate
• Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
• Hydrocodone; Pseudoephedrine
• Hydromorphone
• Hydroxychloroquine
• Hydroxyzine
• Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
• Ibuprofen; Oxycodone
• Ibutilide
• Idelalisib
• Iloperidone
• Imipramine
• Indapamide
• Inotuzumab Ozogamicin
• Isavuconazonium
• Isocarboxazid
• Isoflurane
• Isoniazid, INH
• Isoniazid, INH; Pyrazinamide, PZA; Rifampin
• Isoniazid, INH; Rifampin
• Itraconazole
• Ivosidenib
• Ketoconazole
• Lansoprazole
• Lansoprazole; Naproxen
• Lapatinib
• Lasmiditan
• Lefamulin
• Lenvatinib
• Leuprolide
• Leuprolide; Norethindrone
• Levofloxacin
• Levomethadyl
• Levomilnacipran
• Levorphanol
• Linezolid
• Lithium
• Lofexidine
• Long-acting beta-agonists
• Loperamide
• Loperamide; Simethicone
• Lopinavir; Ritonavir
• Lorcaserin
• Low Molecular Weight Heparins
• Luliconazole
• Lumacaftor; Ivacaftor
• Lumacaftor; Ivacaftor
• Macimorelin
• Magnesium Salicylate
• Maprotiline
• Mefloquine
• Meperidine
• Meperidine; Promethazine
• Mephobarbital
• Mesoridazine
• Methadone
• Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
• Methohexital
• Methyclothiazide
• Methylene Blue
• Methylergonovine
• Methylphenidate
• Methysergide
• Metolazone
• Metoprolol
• Metronidazole
• Mexiletine
• Midostaurin
• Mifepristone
• Milnacipran
• Mirtazapine
• Mitotane
• Modafinil
• Monoamine oxidase inhibitors
• Morphine
• Morphine; Naltrexone
• Moxifloxacin
• Naproxen; Sumatriptan
• Naratriptan
• Nebivolol
• Nebivolol; Valsartan
• Nefazodone
• Netupitant, Fosnetupitant; Palonosetron
• Nicardipine
• Nilotinib
• Nitroglycerin
• Nonsteroidal antiinflammatory drugs
• Norfloxacin
• Nortriptyline
• Octreotide
• Ofloxacin
• Olanzapine
• Omeprazole
• Omeprazole; Amoxicillin; Rifabutin
• Omeprazole; Sodium Bicarbonate
• Ondansetron
• Oritavancin
• Osilodrostat
• Osimertinib
• Oxaliplatin
• Oxycodone
• Oxymorphone
• Ozanimod
• Paliperidone
• Palonosetron
• Panobinostat
• Paroxetine
• Pasireotide
• Pazopanib
• Pentamidine
• Pentazocine
• Pentazocine; Naloxone
• Pentobarbital
• Pentosan
• Pergolide
• Perphenazine
• Perphenazine; Amitriptyline
• Phenelzine
• Phenobarbital
• Phentermine
• Phentermine; Topiramate
• Phenylephrine; Promethazine
• Phenytoin
• Pimavanserin
• Pimozide
• Pitolisant
• Posaconazole
• Prasugrel
• Primaquine
• Primidone
• Procainamide
• Procarbazine
• Prochlorperazine
• Promethazine
• Propafenone
• Propoxyphene
• Propranolol
• Protriptyline
• Quetiapine
• Quinidine
• Quinine
• Rabeprazole
• Ranolazine
• Rasagiline
• Remifentanil
• Reteplase, r-PA
• Ribociclib
• Ribociclib; Letrozole
• Rifabutin
• Rifampin
• Rilpivirine
• Risperidone
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• Rizatriptan
• Romidepsin
• Safinamide
• Salsalate
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• Secobarbital
• Selegiline
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• Sertraline
• Sevoflurane
• Short-acting beta-agonists
• Sibutramine
• Simeprevir
• Siponimod
• Sodium picosulfate; Magnesium oxide; Anhydrous citric acid
• Solifenacin
• Sorafenib
• Sotalol
• Spironolactone
• St. John’s Wort, Hypericum perforatum
• Streptokinase
• Sufentanil
• Sumatriptan
• Sunitinib
• Tacrolimus
• Tamoxifen
• Tamsulosin
• Tapentadol
• Tedizolid
• Telaprevir
• Telavancin
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• Telotristat Ethyl
• Tenecteplase
• Terbinafine
• Tetrabenazine
• Thiopental
• Thioridazine
• Thrombin Inhibitors
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• Ticagrelor
• Ticlopidine
• Timolol
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• Tirofiban
• Tolterodine
• Toremifene
• Torsemide
• Tramadol
• Tranylcypromine
• Trazodone
• Triamterene
• Triclabendazole
• Trifluoperazine
• Trimipramine
• Triptorelin
• Urokinase
• Valerian, Valeriana officinalis
• Vandetanib
• Vardenafil
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• Venlafaxine
• Vilazodone
• Vorapaxar
• Voriconazole
• Vorinostat
• Vortioxetine
• Warfarin
• Ziprasidone
• Zolmitriptan
• Zolpidem