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Mania: Escitalopram Tablets should be discontinued in any patient entering a manic phase. Escitalopram Tablets should be used with caution in patients with a history of mania/hypomania.
Paradoxical anxiety: Some patients with panic disorder may experience increased anxiety symptoms at the start of treatment with antidepressants. This paradoxical reaction usually subsides within two weeks during continued treatment. A low starting dose is advised to reduce the likelihood of a paradoxical anxiogenic effect.
Seizures: Escitalopram Tablets should be discontinued in any patient who develops seizures. Escitalopram Tablets should be avoided in patients with unstable epilepsy and patients with controlled epilepsy should be carefully monitored. Escitalopram Tablets should be discontinued if there is an increase in seizure frequency.
Diabetes mellitus: In patients with diabetes mellitus, treatment with Escitalopram Tablets may alter glycaemic control, possibly due to improvement of depressive symptoms. Insulin and/or oral hypoglycaemic dosage may need to be adjusted.
Suicide: As improvement may not occur during the first few weeks or more of treatment, patients should be closely monitored during this period. The possibility of a suicide attempt is inherent in depression and may persist until significant therapeutic effect is achieved.
Haemorrhage: There have been reports of cutaneous bleeding abnormalities, such as ecchymoses and purpura with Escitalopram Tablets. Caution is advised in patients taking Escitalopram Tablets, particularly in concomitant use with medicines known to affect platelet function (e.g. atypical anti-psychotics and phenothiazines, most tricyclic antidepressants, aspirin and non-steroidal anti-inflammatory medicines (NSAIDs)), as well as in patients with a history of bleeding disorders.
ECT (electroconvulsive therapy): There is limited published clinical experience of concurrent administration of Escitalopram Tablets and ECT, therefore caution is advisable.
