Lexapro (escitalopram)
Lexapro is indicated for the treatment of major depressive disorder. A major depressive episode implies a prominent and relatively persistent (nearly every day for at least 2 weeks) depressed or dysphoric mood that usually interferes with daily functioning, and includes at least five of the following nine symptoms: depressed mood, loss of interest in usual activities, significant change in weight and/or appetite, insomnia or hypersomnia, psychomotor agitation or retardation, increased fatigue, feelings of guilt or worthlessness, slowed thinking or impaired concentration, a suicide attempt or suicidal ideation.
Side Effects:
Common side effects include:
*Body as a Whole: Flu-like Symptoms, Fatigue
*Digestive System: Nausea, Diarrhea, Constipation, Indigestion, Abdominal Pain *Psychiatric Disorders: Insomnia, Somnolence, Appetite Decreased, Libido Decreased
*Nervous System: Dizziness, Dry Mouth, Increased Sweatin
*Respiratory System Disorders: Rhinitis (inflammation of the nasal lining), Sinusitis (inflammation of the sinuses)
*Urogenital: Ejaculation Disorder, Impotence, Anorgasmia (inability to achieve climax)
Drug Abuse and Dependence
Lexapro is not a controlled substance. While Lexapro has not been systematically studied in clinical trials for its potential for abuse, there was no indication of drug-seeking behavior in the clinical trials.
However, physicians should carefully evaluate patients for history of drug abuse and follow such patients closely, observing them for signs of misuse or abuse.
Precautions and Drug Interactions:
*MAOI'S - Adverse reactions, some of which were serious, have been reported in patients who have recently been discontinued from a monoamine oxidase inhibitor (MAOI) and started on Lexapro, or who have recently had Lexapro therapy discontinued prior to initiation of an MAOI. These reactions have included hyperthermia, rigidity, myoclonus (muscle spasms) and mental status changes that include extreme agitation progressing to delirium and coma.
*Other anti-depressant drug
*CNS Drugs - Given the primary CNS effects of Lexapro, caution should be used when it is taken in combination with other centrally acting drugs. (Pain killers, sleeping pills, tranquilizers, etc)
*Alcohol - The use of alcohol by patients taking Lexapro is not recommended.
*Drugs That Interfere with blood clotting (NSAID's, Aspirin, Warfarin, etc.)
Other Precautions
In depressed patients, the possibility of suicide should always be considered and adequate precautions taken. It is recommended that careful observations of patients undergoing Lexapro treatment be maintained until control of depression is achieved. If necessary, additional measures (ECT, hospitalization, etc) should be instituted.
Discontinuation of Treatment with Lexapro: During marketing of Lexapro there have been spontaneous reports of adverse events occurring upon discontinuation of these drugs, particularly when abrupt, including the following: dysphoric mood, irritability, agitation, dizziness, sensory disturbances (e.g., paresthesias such as electric shock sensations), anxiety, confusion, headache, lethargy, emotional liability, insomnia, and hypomania. While these events are generally self-limiting, there have been reports of serious discontinuation symptoms.
Patients should be monitored for these symptoms when discontinuing treatment with Lexapro. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered.
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Pregnancy and Nursing Mothers
There are no adequate and well-controlled studies in pregnant women. Because of this, the drug should be used during pregnancy only if clearly needed. Lexapro has been reported to be excreted in human milk. Because of the potential for serious adverse reactions in nursing infants from Lexapro, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
Pediatric Use
Safety and effectiveness in pediatric patients have not been established.
Geriatric Use
There has not been adequate testing in the elderly, however this drug is known to be substantially excreted by the kidney and the risk of decreased clearance of this drug is greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection. Sedating drugs may cause confusion and over-sedation in the elderly.
Recommended Dosage
Lexapro should be administered once daily, in the morning or evening, with or without food. The recommended dose of Lexapro is 10 mg once daily.
Overdose
There have been five reports of Lexapro overdose involving doses of up to 600 mg. All five patients recovered and no symptoms associated with the overdoses were reported.