Escitalopram - instructions for use, reviews, analogs and formulations (5 mg, 10 mg and 20 mg tablets) antidepressant medications for the treatment of depression, anxiety, panic disorders in adults, children and pregnancy. Composition and alcohol
In this article, you can read the instructions for using the drug Escitalopram. There are reviews of visitors to the site - consumers of this medication, as well as the opinions of doctors of specialists on the use of the antidepressant Escitalopram in their practice. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Analogues of escitalopram in the presence of existing structural analogues.Use to treat depression, anxiety, panic disorders in adults, children, as well as during pregnancy and lactation. Composition and interaction of the drug with alcohol.
Escitalopram antidepressant. Selectively inhibits the reuptake of serotonin; increases the concentration of the neurotransmitter in the synaptic cleft, enhances and prolongs the action of serotonin on postsynaptic receptors. Escitalopram practically does not bind to serotonin (5-HT), dopamine (D1 and D2) receptors, alpha-adreno, m-cholinergic receptors, as well as to benzodiazepine and opioid receptors.
The antidepressant effect usually develops in 2-4 weeks after the start of treatment. The maximum therapeutic effect of treatment of panic disorders is reached approximately 3 months after the start of treatment.
Composition
Escitalopram (in the form of oxalate) + auxiliary substances.
Pharmacokinetics
Absorption is not dependent on food intake. Bioavailability - 80%. The time to reach Cmax in plasma is 4 hours. The kinetics of escitalopram is linear. Binding to plasma proteins - 80%. Metabolized in the liver to active demethylated and demodetylated metabolites.After repeated use, the average concentration of demethyl- and didemetilmetabolites is 28-31% and less than 5%, respectively, of the concentration of escitalopram. Metabolism of escitalopram with the formation of a demethylated metabolite occurs mainly with the participation of isoenzymes CYP2C19, CYPZA4 and CYP2D6. In persons with a weak activity of the isoenzyme CYP2C19, the concentration of escitalopram can be 2 times higher than in persons with a high activity of this isoenzyme. Significant changes in the concentration of the drug with a weak activity of the isoenzyme CYP2D6 is not observed. Escitalopram and its major metabolites are excreted by the liver and a large part - by the kidneys, partially excreted in the form of glucuronides. T1 / 2 and AUC are increased in elderly patients.
Indications
- depression;
- panic disorders (including with agoraphobia);
- generalized anxiety disorder.
Forms of release
Tablets coated with 5 mg, 10 mg and 20 mg.
Instructions for use and dosage
Is taken orally, regardless of food intake. Depending on the indications, a single dose of 10-20 mg per day. The maximum daily dose is 20 mg. Duration of treatment is several months. When discontinuing treatment, the dose should gradually decrease within 1-2 weeks in order to avoid the occurrence of withdrawal syndrome.
For elderly patients (over 65 years), the recommended dose is 5 mg per day, the maximum daily dose is 10 mg.
If the liver function is disrupted, the recommended initial dose for the first 2 weeks of treatment is 5 mg per day. Depending on the individual reaction, the dose can be increased to 10 mg per day.
For patients with a weak activity of the CYP2C19 isoenzyme, the recommended initial dose for the first 2 weeks of treatment is 5 mg per day. Depending on the individual reaction, the dose can be increased to 10 mg per day.
Side effect
- dizziness;
- weakness;
- insomnia or drowsiness;
- convulsions;
- tremor;
- motor disorders;
- serotonin syndrome (agitation, tremor, myoclonus, hyperthermia);
- hallucinations;
- mania;
- confusion of consciousness;
- agitation;
- anxiety;
- depersonalization;
- panic attacks;
- increased irritability;
- visual impairment;
- nausea, vomiting;
- dryness of the oral mucosa;
- violation of taste;
- decreased appetite;
- diarrhea, constipation;
- change in laboratory parameters of liver function;
- orthostatic hypotension;
- decrease in ADH secretion;
- galactorrhea;
- decreased libido;
- impotence;
- violation of ejaculation;
- anorgasmia (in women);
- retention of urine;
- skin rash;
- itching;
- ecchymosis;
- purpura;
- increased sweating;
- angioedema;
- anaphylactic reactions;
- hyponatremia;
- hyperthermia;
- arthralgia;
- myalgia;
- sinusitis;
- withdrawal syndrome (dizziness, headaches and nausea).
Contraindications
- simultaneous administration of MAO inhibitors;
- children and adolescence up to 15 years;
- pregnancy;
- lactation period;
- increased sensitivity to escitalopram.
Application in pregnancy and lactation
Contraindicated use of the drug Escitalopram in pregnancy and lactation (breastfeeding).
Use in children
Contraindicated in children and adolescents under 15 years.
Application in elderly patients
Caution should be used in elderly patients.
special instructions
Caution should be used in patients with renal insufficiency (CC less than 30 ml / min), hypomania, mania, with pharmacologically uncontrolled epilepsy, with depression with suicide attempts, diabetes, in elderly patients, with cirrhosis, with a tendency to bleeding, simultaneously with taking medications,reducing the threshold of convulsive readiness, causing hyponatremia, with ethanol, with drugs metabolized with the participation of isoenzymes of the CYP2C19 system.
Escitalopram should be administered only 2 weeks after the cancellation of irreversible MAO inhibitors and 24 hours after discontinuation of therapy with a reversible MAO inhibitor. Non-selective MAO inhibitors can be prescribed no earlier than 7 days after the withdrawal of escitalopram.
In some patients with panic disorder, early on with the treatment with escitalopram, anxiety may increase, which usually disappears during the next 2 weeks of treatment. To reduce the likelihood of an alarm, it is recommended to use low initial doses.
Escitalopram should be withdrawn in the event of epileptic seizures or their increase in pharmacologically uncontrolled epilepsy.
When developing the manic state of escitalopram should be discarded.
Escitalopram is able to increase the concentration of glucose in the blood in diabetes mellitus, which may require correction of doses of hypoglycemic drugs.
The clinical experience of the use of escitalopram indicates a possible increase in the risk of suicide attempts inthe first weeks of therapy, in connection with which it is very important to carry out careful monitoring of patients during this period.
Hyponatremia, associated with a decrease in ADH secretion, against the background of escitalopram is rare and usually disappears when it is withdrawn.
With the development of serotonin syndrome, escitalopram should be immediately withdrawn and symptomatic treatment should be prescribed.
Studies conducted on animals indicate a low ability of escitalopram to cause addiction. Systematic observations in humans to assess the potential ability of escitalopram to cause abuse, tolerance, physical dependence is not carried out. However, careful monitoring of patients with a history of drug abuse is required.
During the clinical trials of escitalopram, there were cases of seizures. In this regard, it is necessary to prescribe with caution the drug to patients with an indication of convulsive fits in the anamnesis. If the seizure develops, stop taking the drug.
Impact on the ability to drive vehicles and manage mechanisms
During the period of treatment, patients should avoid driving motor vehicles and other activities that require a high concentration of attention and speed of psychomotor reactions.
Drug Interactions
When used simultaneously with MAO inhibitors, the risk of developing serotonin syndrome and serious adverse reactions increases.
Joint application with serotonergic drugs (including tramadol, triptans) may lead to the development of serotonin syndrome.
With simultaneous use with drugs that reduce the threshold of convulsive readiness, increases the risk of seizures.
Escitalopram enhances the effects of tryptophan and lithium preparations, increases the toxicity of St. John's wort preparations, the effects of drugs that affect blood clotting (monitoring of blood coagulation indices is necessary).
Although Escitalopram does not potentiate the effects of alcohol (clinical research data), as with other psychotropic drugs, simultaneous use with alcohol is not recommended.
Drugs metabolized with the participation of the isoenzyme CYP2S19 (including omeprazole), and also are potent inhibitors of CYPZA4 and CYP2D6 (incl.flecainide, propafenone, metoprolol, desipramine, clomipramine, nortriptyline, risperidone, thioridazine, haloperidol), escitalopram increase the concentration in plasma.
Escitalopram increases the plasma concentration of desipramine and Metoprolol by a factor of 2.
Analogues of the drug Escitalopram
Structural analogs for the active substance:
- Lenuksin;
- Miracitol;
- Selektra;
- Cipralex;
- Elicia;
- Escitalopram Canon;
- Escitalopram Sandoz;
- Escitalopram Teva;
- Escitalopram oxalate.
Analogues for the pharmacological group (antidepressants):
- Agomelatine;
- Adress;
- Azafen;
- Alventa;
- Aleval;
- Amizole;
- Amide;
- Amitriptyline;
- Asentra;
- Valdoxane;
- Velaxin;
- Velafax;
- Venlaksor;
- Venlafaxine;
- Heptor;
- Heptral;
- Depres;
- Depenone;
- Deprim;
- Doxepine;
- Duloxetine;
- Zoloft;
- Ixelles;
- Kaliksta;
- Clominal;
- Clomipramine;
- Coaxyl;
- Lerivon;
- Maprotibene;
- Maprotiline;
- Mirtazapine;
- Mirtazonal;
- Nerustin;
- Neuroplant;
- Noxibel;
- Oprah;
- Paxil;
- Paroxetine;
- Prodep;
- Prozac;
- Rexetin;
- Selektra;
- Sirleft;
- Sinekwan;
- Stimuloton;
- Tianeptine;
- Trittico;
- Févarine;
- Fluxonil;
- Fluoxetine;
- Framex;
- Cipramyl;
- Citalopram;
- Elivel;
- Ephevelone;
- Epevelon retard.
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