Escitalopram

May be taken with or without food.

Known QT interval prolongation or congenital long QT syndrome. Concomitant use with QT interval prolonging agents (e.g. pimozide), linezolid or IV methylthioninium chloride (also known as methylene blue). Concomitant use with or within 14 days of discontinuing MAOIs used to treat psychiatric disorders.

Patient with history of seizure disorder or condition predisposing to seizures (e.g. brain damage, alcoholism), controlled epilepsy; history of mania/hypomania or suicide-related events, significant degree of suicidal ideation; diabetes, known bleeding tendencies, bradycardia, recent acute MI, uncompensated heart failure, electrolyte disturbances (e.g. hypokalaemia, hypomagnesaemia), angle-closure glaucoma or history of glaucoma, metabolic disease. Avoid abrupt withdrawal. Avoid use in patients with unstable epilepsy. Concomitant electroconvulsive therapy. CYP2C19 ultrarapid, intermediate, or poor metabolisers. Hepatic and severe renal (CrCl <30 mL/min) impairment. Children and elderly. Pregnancy and lactation. Patient Counselling This drug may cause drowsiness or impair judgement or skills; if affected, do not drive or operate machinery. Monitoring Parameters Screen patients for bipolar disorder before initiating treatment. Closely monitor for clinical worsening, suicidal behaviour or ideation, or unusual behavioural changes, particularly during the initial 1-2 months of treatment and at times of dosage adjustments. Monitor electrolytes (e.g. K, Mg, Na) and liver and renal function tests at baseline and as clinically indicated. Assess for signs or symptoms of serotonin syndrome (e.g. mental status changes, tachycardia, labile blood pressure, diaphoresis, tremor, rigidity, seizures) during treatment and withdrawal symptoms (e.g. dizziness, sensory disturbances, agitation, irritability, sleep disturbances) upon discontinuation.

Significant: Suicidal ideation or behaviour (particularly in children and young adults), withdrawal symptoms, paradoxical anxiety, seizures; akathisia or psychomotor restlessness; may precipitate hypomania or mania; cutaneous bleeding abnormalities (e.g. ecchymoses, purpura), QT interval prolongation, ventricular arrhythmia (including torsades de pointes), mydriasis, acute angle-closure glaucoma, increased risk of bone fractures, sexual dysfunction (e.g. decreased libido, anorgasmia, ejaculation disorder, impotence). Rarely, hyponatraemia. Gastrointestinal disorders: Nausea, diarrhoea, vomiting, constipation, dry mouth. General disorders and administration site conditions: Fatigue, pyrexia. Investigations: Weight increased. Metabolism and nutrition disorders: Decreased or increased appetite. Musculoskeletal and connective tissue disorders: Arthralgia, myalgia. Nervous system disorders: Headache, dizziness, paraesthesia, tremor, somnolence. Psychiatric disorders: Abnormal dreams, insomnia. Respiratory, thoracic and mediastinal disorders: Sinusitis, yawning. Skin and subcutaneous tissue disorders: Increased sweating.
Potentially Fatal: Serotonin syndrome, haemorrhage.

Increased risk of bleeding with oral anticoagulants (e.g. warfarin), antiplatelet agents (e.g. ticlopidine, aspirin, dipyridamole), atypical antipsychotics, and NSAIDs. May increase the risk of serotonin syndrome with other serotonergic agents (e.g. TCA, triptans, opioids, tryptophan, lithium, buspirone). May increase the risk of seizures with other antidepressants (e.g. other SSRIs), neuroleptics (e.g. thioxanthenes), mefloquine, tramadol, and bupropion. Increased serum concentration with CYP2C19 inhibitors (e.g. omeprazole, fluconazole, fluvoxamine) or cimetidine. May increase the plasma concentrations of CYP2D6 substrates (e.g. metoprolol, desipramine).

Antidepressants / Anxiolytics

N06AB10 - escitalopram ; Belongs to the class of selective serotonin reuptake inhibitors. Used in the management of depression.