Escitalopram 20mg

Selective Serotonin Reuptake Inhibitor; Antidepressant

“ALERT: US Boxed Warning

Suicidality and antidepressant drugs:

Antidepressants increased the risk compared with placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of escitalopram or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared with placebo in adults older than 24 years; there was a reduction in risk with antidepressants compared with placebo in adults 65 years and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Appropriately monitor patients of all ages who are started on antidepressant therapy and closely observe for clinical worsening, suicidality, or unusual changes in behavior. Advise families and caregivers of the need for close observation and communication with the health care provider. Escitalopram is not approved for use in pediatric patients younger than 12 years.”

CSA NA – FDA Approved – REMS (N) – Can Ship

Cipralex/Escitalopram selectively inhibits serotonin uptake.  It exhibits only weak affinity for alpha, beta, histaminic, muscarinic and serotonin receptors as well as has weak anticholinergic effects.

Escitalopram/Cipralex is officially indicated for major depressive disorder and generalized anxiety disorder.  It is also prescribed off-label for use in binge-eating disorder, body dysmorphic disorder, bulimia nervosa, obsessive-compulsive disorder, panic disorder, posttraumatic stress disorder, premenstrual dysphoric disorder, vasomotor symptoms associated with menopause, and premature ejaculation.

Premature ejaculation (PE) is also known as rapid or early ejaculation and is characterized by the following features:

• Ejaculation that always or nearly always occurs prior to or within approximately one minute of vaginal penetration.
• The inability to delay ejaculation on all or nearly all vaginal penetrations.
• Personal feelings of distress, frustration, anxiety, and/or the avoidance of sexual intimacy.

Do not use in patients receiving monoamine oxidase inhibitors currently or within 2 weeks because of the risk of serotonin syndrome.

Use with caution in patients with liver disease.

Use with caution in patients with a history of seizures.

Has been rarely associated with platelet dysfunction, use cautiously in patients with underlying coagulation (platelet) defects.

Premature ejaculation (off-label use)

Initial dose is 10mg daily, can increase the dose based on response and tolerability after 1 week (some experts suggest dose titration intervals of 3 to 4 weeks).  Can increase to a maximum daily dose of 20mg once daily due to the risk of QT prolongation.  In patients with anxiety, who are more sensitive to overstimulation (i.e. anxiety, insomnia) with antidepressants a lower starting dose of 5mg daily is recommended.

How to Take Escitalopram, Lexapro/Cipralex: Can be taken with or without food and taken regularly as prescribed.

How to Manage Common Side Effects of Escitalopram, Lexapro/Cipralex: Majority of side effects are mild and transient and disappear over time.  However, if you develop a rash, hives or experience undesirable weight loss contact your doctor.  

You Need to Avoid Escitalopram, Lexapro/Cipralex: If you have hypersensitivity to escitalopram or any of its components in the formulation; use of MAO inhibitors, linezolid, or intravenous methylene blue, pimozide or thioridazine. 

Contact Your Doctor if You Ever Experience: Stop taking this medication and contact your doctor if you experience a rash (particularly in combination with facial swelling, breathing difficulties or flu-like symptoms); severe agitation, anxiety or excitation, major sleep disturbance or unusual change mood, muscle twitching or convulsions.

Well tolerated, most side effects are transient and mild to moderate in nature.  The most common side effects include:

>10%

Central nervous system: Headache (24%), insomnia (7% to 14%), drowsiness (4% to 13%)

Gastrointestinal: Nausea (15% to 18%), diarrhea (6% to 14%)

Genitourinary: Ejaculatory disorder (9% to 14%)

1. Do you take Escitalopram, Lexapro/Cipralex with food or on an empty stomach?
   You can take Cipralex/Escitalopram with an empty stomach or with food.  However, if you experience nausea or an upset of stomach you can take with food. 
2. Can you drink alcohol when you are on Escitalopram, Lexapro/Cipralex?
   You should limit or completely avoid alcohol consumption when taking Cipralex, Lexapro/Escitalopram because it may increase your risk of psychomotor impairment.
3. What if you miss a dose?
   If you miss taking a dose, take it as soon as you remember.  However, if it is almost time for your next dose, skip the missed dose and continue with your regular schedule.  Do not take two doses to make for a missed dose.
4. How quickly will you experience an improvement?
   If you are taking this medication it may take up to 2 weeks before you notice any improvement.