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 Sweating
*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 drugs
*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.