Escitalopram

Pharmacodynamics and pharmacokinetics

serotonin reuptake , increasing the concentration of the neurotransmitter in the synaptic cleft, increasing and prolonging the effect of serotonin on postsynaptic receptors. The substance almost does not bind to dopamine and serotonin receptors, as well as α-adrenergic, m-cholinergic receptors, opioid and benzodiazepine receptors.

The development of an antidepressant effect is observed after a therapeutic course of 2-4 weeks. The maximum effect is achieved 3 months after the start of treatment.

Eating food does not affect the absorption of the drug. At the same time, the bioavailability of the substance and binding to proteins is 80% each. The concentration of the substance in plasma is achieved within 4 hours.

As a result of the metabolism of escitalopram, a demethylated metabolite , with the participation of the isoenzymes CYP3A4, CYP2D6 and CYP2C19. The drug is predominantly eliminated from the body in the form of main metabolites by the liver and kidneys.

Special patient groups

◊ Patients with kidney problems

Use caution if the patient has severe kidney disease [1].

◊ Patients with liver disease

The recommended dose is 10 mg/day [1].

◊ Patients with heart disease

There are no systematic data on the use of escitalopram in people with pathology of the cardiovascular system. Supposedly safe. Useful in recovery after a heart attack [1].

◊ Elderly patients

For elderly patients, a dose of 10 mg is recommended [1].

◊ Children and teenagers

• Recommended for the treatment of depression aged 12-17 years
• It is necessary to regularly and personally check the patient's condition, especially in the first weeks of treatment.
• Use with caution due to the risk of undiagnosed bipolar disorder and suicidality.
• Inform adults about the risks.

◊ Pregnant women

• There have been no adequate studies in pregnant women [1].
• Not recommended for pregnant women, especially in the first trimester
• All risks should be weighed and compared
• Bleeding can be expected during childbirth

◊ Breastfeeding

• The medicine passes into breast milk.
• If the infant shows signs of irritation or sedation, discontinue feeding or escitalopram
• However, treatment after childbirth may be necessary, so the risks should be weighed.

Side effects

When treated with Escitalopram, side effects associated with the activity of the nervous, endocrine, reproductive, digestive, cardiovascular and urinary systems occur. Therefore, it is possible to develop symptoms such as dizziness, weakness , sleep problems, convulsions, movement disorders, tremors, serotonin syndrome , mania, hallucinations, nausea, vomiting, diarrhea, constipation, decreased libido , ejaculation disorders, impotence , urinary retention, etc. Further.

allergic reactions is also possible : skin rash, itching , ecchymosis, purpura, increased sweating, angioedema , anaphylactic reactions.

Sometimes there are: hyponatremia, hyperthermia, arthralgia, myalgia, sinusitis and “treatment withdrawal” syndrome.

Indications

◊ Recommendations of the Russian Ministry of Health

F32 Depressive episode

F33 Recurrent depressive disorder

F40.0 Agoraphobia

F41.0 Panic disorder (episodic paroxysmal anxiety)

◊ FDA recommendations

• Major depressive disorder (adults and children over 12 years of age)
• GTR

◊ Recommendations from UK Medicines and Healthcare Products Regulatory Agency

• Major depressive episode
• Panic disorder with/without agoraphobia
• Social phobia
• GTR
• OCD

◊ Using Off-label

• Vasomotor symptoms during menopause
• Insomnia
• Dysmorphophobia
• Bulimia [5].

Interaction

Combination with MAO inhibitors, serotonergic drugs, Stramadol and triptans may increase the risk of serotonin syndrome and other complex adverse reactions.

Concomitant use with anticonvulsants may increase the risk of developing seizures.

It is possible to enhance the effects of lithium and tryptophan , increasing the toxicity of St. John's wort and drugs that affect blood clotting.

Escitalopram can significantly increase plasma concentrations of Desipramine and Metoprolol.

How to take Escitalopram

Always take the drug strictly as prescribed by your doctor. If you have any doubts about taking the drug, you should consult your doctor or pharmacist.

Adults

Depression

The recommended optimal dose of Escitalopram is 10 mg once daily. Then, as prescribed by the doctor, the dose can be increased to 20 mg per day.

Panic disorders

The recommended starting dose of Escitalopram is 5 mg once daily for the first week before increasing the dose to 10 mg daily. The dose can be increased by the doctor to 20 mg per day.

Social anxiety disorder

The recommended optimal dose of Escitalopram is 10 mg once daily. Your doctor may either reduce the dose to 5 mg per day or increase the dose to 20 mg per day, depending on your body's response.

Generalized anxiety disorder

The recommended optimal dose of Escitalopram is 10 mg once daily. Then, as prescribed by the doctor, the dose can be increased to 20 mg per day.

Obsessive-compulsive disorder

The recommended optimal dose of Escitalopram is 10 mg once daily. Then, as prescribed by the doctor, the dose can be increased to 20 mg per day.

Elderly patients (over 65 years old)

The recommended starting dose of Escitalopram is 5 mg once daily. Then, as prescribed by the doctor, the dose can be increased to 10 mg per day.

Children and teenagers (up to 18 years old)

Escitalopram should not be prescribed to children and adolescents. For more information, please see “What you need to know before you take Escitalopram.”

Escitalopram can be taken with or without food. The tablets should be swallowed with water. The tablets should not be chewed as they have a bitter taste.

Duration of use

It may take several weeks before you start to feel better. You need to continue using Escitalopram even if it takes some time before you feel any improvement in your condition.

Do not change the dosage of your medication without talking to your doctor.

The length of treatment with Escitalopram depends on what your doctor advises you to do. If you stop treatment too early, your symptoms may return. It is recommended that treatment be continued for at least 6 months after the first signs of improvement in your condition.

If you take more Escitalopram than recommended

If you accidentally swallow too many tablets, contact your doctor or the nearest hospital emergency room. Tell your doctor immediately, even if there are no signs of discomfort. In case of an overdose, dizziness, tremor, agitation, convulsions, coma, nausea, vomiting, changes in heart rate, decreased blood pressure and changes in the balance of fluid and salt in the body are noted. Take a packet of Escitalopram with you when you go to the doctor or hospital.

If you forget to take Escitalopram

Do not take a double dose to make up for a missed dose.

If you forget to take the next dose of the drug and remember before going to bed, take it immediately. The next day, continue taking it as usual.

If you remember to take the drug only at night or the next day, do not take the missed dose and continue taking it as usual.

If you stop taking Escitalopram

You should not stop taking Escitalopram unless directed by your doctor. If you plan to complete your course of treatment, it is generally recommended that you reduce your escitalopram dosage gradually over several weeks.

Abruptly stopping the drug may lead to withdrawal syndrome. This is often observed when Escitalopram is discontinued. The risk increases when used for a long time or at high doses or when the dose is sharply reduced. Most people find withdrawal symptoms to be mild and resolve on their own within two weeks. However, in some patients they may be severe in intensity or may be prolonged (2-3 months or more). If you experience withdrawal symptoms when you stop taking it, please consult your doctor. Your doctor may ask you to start taking the pills again and stop them gradually.

Withdrawal symptoms: dizziness (staggering or imbalance), tingling sensations, burning sensations and (less commonly) electric shock sensations, including in the head, sleep disturbances (vivid dreams, nightmares, sleep disturbances), anxiety, headaches, nausea , sweating (including night sweats), restlessness or agitation, tremors (shaking), confusion and disorientation, emotionality or irritability, diarrhea (loose stools), visual disturbances, palpitations.

If you have any further questions about the use of Escitalopram, ask your doctor or pharmacist.

Possible side effects

Like other medicines, Escitalopram can cause side effects, although not everyone gets them.

Side effects usually disappear within a few weeks of starting treatment. Please note that many of the effects may also be symptoms of your illness and will therefore improve as you begin to recover.

If any of the following adverse reactions occur after taking the drug, you should immediately contact your doctor or hospital emergency department.

Uncommon (may affect 1 in 100 people):

• unclear bleeding, including gastrointestinal bleeding.

Rare (may affect 1 in 1000 people):

• swelling of the skin, tongue, lips or face, or difficulty breathing or swallowing (allergic reaction),
• Fever, agitation, confusion, shaking and sudden muscle contractions are symptoms of a rare condition called serotonin syndrome.

Unknown (frequency cannot be estimated from available data):

• difficulty urinating,
• convulsions (fits), see “Special instructions and precautions”,
• yellowing of the skin and sclera of the eyes, symptoms of deteriorating liver function (hepatitis),
• fast, irregular heartbeat, fainting, which can be life-threatening symptoms, a condition known as “dot dancing”,
• suicidal thoughts, see “Special Instructions and Precautions.”

In addition to the above, the following side effects may also occur:

Very common (may affect more than 1 in 10 people):

• nausea,
• headache.

Common (may affect 1 in 10 people):

• runny nose (sinusitis),
• decreased or increased appetite,
• anxiety, restlessness, abnormal dreams, difficulty falling asleep, drowsiness, dizziness, yawning, tremors, tingling of the skin,
• diarrhea, constipation, vomiting, dry mouth,
• increased sweating,
• muscle and joint pain (arthralgia and myalgia),
• sexual disorders (delayed ejaculation, erectile dysfunction, sexual dysfunction, difficulty achieving orgasm in women),
• fatigue, fever,
• increase in body weight.

Uncommon (may affect 1 in 100 people):

• hives, rash, itching,
• teeth grinding, psychomotor agitation, nervousness, panic disorders, confusion,
• sleep disturbance, taste disturbance, fainting,
• dilated pupils (mydriasis), visual disturbances, ringing in the ears (tinnitus),
• hair loss,
• increased menstrual bleeding,
• irregular menstrual cycle,
• weight loss,
• fast heartbeat,
• swelling of the arms or legs,
• nosebleeds.

Rare (may affect 1 in 1,000 people):

• aggression, depersonalization, hallucinations,
• slow heartbeat.

Unknown (frequency cannot be estimated from available data):

• decreased sodium levels in the blood (symptoms of feeling unwell and unwell with muscle weakness or confusion),
• orthostatic hypotension,
• liver dysfunction (increased levels of liver enzymes in the blood),
• movement disorders (reflexive muscle movements),
• painful erection (priapism),
• signs of increased bleeding, for example, of the skin and mucous membranes (ecchymosis),
• unexpected swelling of the skin or mucous membrane (angioedema),
• increased amount of urine excreted (antidiuretic hormone insufficient secretion syndrome),
• milk secretion in non-breastfeeding women,
• mania,
• an increased risk of bone fractures was observed in patients taking drugs of this group,
• changes in heart rhythm (called “QT prolongation”, recorded on an ECG, a measurement of the electrical activity of the heart).

In addition, a number of side effects are known to occur with drugs that act by a similar mechanism to escitalopram.

This:

• motor restlessness (akathisia),
• lack of appetite.

Side Effect Reporting:

If you notice any side effects, tell your doctor, pharmacist or pharmacist, including any side effects not listed in this leaflet. You can also report side effects by going to the website www.arpimed.com and filling out the appropriate form “Report a side effect or ineffectiveness of a drug” and to the Scientific Center for Expertise of Medicines and Medical Technologies named after. Academician E. Gabrielyan by going to the website www.pharm.am to the “Report a side effect of a drug” section and fill out the form “Card of reporting a side effect of a drug.” Scientific center hotline phone number: +37410237665; +37498773368.

How to store Escitalopram

• Store out of reach of children, protected from moisture and light at a temperature of 15-25º C.
• Shelf life – 3 years. Do not take Escitalopram after the expiration date indicated on the drug package. When indicating the expiration date, we mean the last day of the specified month.

Medicines should not be disposed of in wastewater or sewer systems. Ask your pharmacist how to dispose of any medicine you no longer need. These measures are aimed at protecting the environment.

Package contents and additional information

What Escitalopram contains

Active substance: Escitalopram oxalate equivalent to 10 mg escitalopram base

Other components: core - microcrystalline cellulose, lactose monohydrate, povidone, corn starch, magnesium stearate, sodium starch glycolate; o shell - titanium dioxide, hypromellose, purified talc, propylene glycol, red dye (E124)

What Escitalopram looks like and contents of the pack:

Oval, biconvex, film-coated, pink tablets with a score on one side; without smell.

Description of packaging

10 film-coated tablets in blister packs (PVC/aluminum). 3 blister packs (30 tablets), together with the leaflet, placed in a cardboard package.

Vacation conditions

Available with prescription

Analogues of Escitalopram

Level 4 ATC code matches:
Actaparoxetine

Plizil

Fluxen

Paroxin

Surlift

Asentra

Elycea

Fluoxetine

Lenuksin

Adepress

Selectra

Stimuloton

Citalopram

Cipramil

Zoloft

Paroxetine

Prozac

Paxil

Rexetine

Fevarin

Main analogues: Lenuxin, Miracitol, Sancipam, Selectra, Cipralex and Elitseya .

Reviews of Escitalopram

On medical forums you can find many discussions about the effectiveness of various antidepressants. As for this drug, reviews of Escitalopram report that its therapeutic effect appears only after taking it for several weeks.

Quite often this medicine is prescribed to treat panic attacks. In such cases, the treatment course can last several months. Patients also say that experts usually recommend a course of Escitalopram Teva, which provides a significant improvement in their condition and a lasting effect.

In this case, you can find reports of side effects. Usually these are: drowsiness and dizziness . But some people, on the contrary, develop insomnia . As a rule, adverse events occur at the beginning of treatment and gradually disappear on their own.

One way or another, drugs with similar effects are of great importance in clinical medicine. Thanks to timely treatment, many patients were able to completely get rid of depression and panic attacks , which negatively affected the general condition of the body and quality of life. Taking this antidepressant provides powerful support to the functions of the nervous system and speeds up recovery.

Expert advice

• The best antidepressant in terms of tolerability
• Lowest sexual impact compared to other SSRIs
• Lack of response to escitalopram in elderly patients may indicate Alzheimer's disease
• In postmenopausal women, escitalopram works better in combination with estrogen [1]
• Escitalopram and fluoxetine show similar effects in the treatment of depression. The only difference noted is that escitalopram significantly improves microinflammation in the patient’s body [6].

Escitalopram price, where to buy

The price of Escitalopram in pharmacies for 28 pieces is from 300 rubles.

• Online pharmacies in RussiaRussia
• Online pharmacies in UkraineUkraine

ZdravCity

• Escitalopram tablets p.p.o.
  10 mg 28 pcs. Berezovsky Pharm. plant ZAO RUR 292 order
• Escitalopram tab. p.p.o. 0.01g 30pcsPranafarm LLC

  RUB 208 order

• Escitalopram-SZ tablets p.p.o 0.01g 30pcsNAO Northern Star

  RUB 252 order

• Escitalopram-Alsi tab. p/o captivity. 10mg 30pcsALSI Pharma ZAO

  RUB 284 order

• Escitalopram Canon tab. p/o captivity. 20 mg No. 28 ZAO Kanonpharma Production

  605 rub. order

Pharmacy Dialogue

• Escitalopram tablets 10 mg No. 30 Alsi Pharm

  RUB 249 order

• Escitalopram-SZ (tab.p.pl.vol.10mg No. 30)Northern Star Nenets Autonomous Okrug

  230 rub. order

• Escitalopram (tab. ppl/vol. 10 mg No. 28) Berezovsky plant

  RUB 266 order

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Pharmacy24

• Escitalopram Teva 20 mg N28 tablets TOV Teva Operations Poland, Poland
  275 UAH order
• Escitalopram Teva 10 mg No. 28 tablets TOV Teva Operations Poland, Poland

  170 UAH order