Escitalopram
Lexapro | Cipralex
Overview
Selective serotonin reuptake inhibitor (SSRI). Potently and selectively inhibits neuronal reuptake of serotonin (5-HT), enhancing serotonergic neurotransmission.
Indications
- Major depressive disorder (MDD)
- Generalized anxiety disorder (GAD)
- Social anxiety disorder (off-label)
- Obsessive-compulsive disorder (off-label)
- Panic disorder (off-label)
Contraindications
- Use of MAOIs within 14 days
- Concurrent use with pimozide
- Hypersensitivity to escitalopram or citalopram
Classification
Mechanism of Action
Selective serotonin reuptake inhibitor (SSRI). Potently and selectively inhibits neuronal reuptake of serotonin (5-HT), enhancing serotonergic neurotransmission.
Pharmacodynamics
S-enantiomer of citalopram and the most selective SSRI available. Minimal effects on norepinephrine and dopamine reuptake. Low affinity for histaminic, muscarinic, and adrenergic receptors.
Pharmacokinetics
- Absorption
- Rapidly absorbed. Not affected by food.
- Distribution
- Volume of distribution ~12 L/kg.
- Metabolism
- Hepatic via CYP3A4 and CYP2C19 to demethylated and didemethylated metabolites (less active).
- Excretion
- Renal (8% unchanged) and fecal.
- Half-life
- 27-32 hours
- Bioavailability
- 80%
- Protein Binding
- 56%
Dosage
Typical dosage: 10-20mg once daily
Available Forms
- Tablet
- Oral solution
Side Effects
Common
- Nausea
- Insomnia
- Ejaculation disorder
- Somnolence
- Increased sweating
- Fatigue
Serious
- Serotonin syndrome
- QT prolongation
- Suicidal thoughts (age <25)
- Hyponatremia/SIADH
Rare
- Angle-closure glaucoma
- Bleeding events
- Seizures
Drug Interactions
Risk of serotonin syndrome — potentially fatal. Wait at least 14 days between MAOI discontinuation and escitalopram initiation.
Increased risk of serotonin syndrome and seizures. Use with caution and monitor closely.
Warnings
Antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults (18-24 years) in short-term studies. Monitor closely for clinical worsening and emergence of suicidal thoughts.
Pregnancy
Category C
Toxicity
Not established in humans
Overdose
Symptoms: nausea, vomiting, tremor, drowsiness, tachycardia, seizures, QT prolongation. Treatment: activated charcoal, supportive care, cardiac monitoring.
References
Looking for patient-friendly information? Visit RemedyDoor for easy-to-read guides about this medication.