Brand name
- Cipralex®
Drug Class
- Antidepressant
- Anxiolytic
- Antiobsessional
Preparations
- Tablets 10 and 20 mg
Indications
- Major Depressive Disorder (MDD)
- Generalized Anxiety Disorder (GAD)
- Obsessive-compulsive disorder (OCD)
Pharmacology
- Escitalopram is a very weak or negligible inhibitor of human hepatic isoenzyme CYP1A2, 2C9, 2C19, 2E1, and 3A4, and a weak inhibitor of 2D6.
- Although escitalopram has a low potential for clinically significant drug interactions, caution is recommended, when escitalopram is co-administered with drugs that are mainly metabolized by CYP2D6, and that have a narrow therapeutic index.
Dosing
- Start at 5 mg po once daily and titrate up another 5 mg in a week
- Maximum dose: 30 mg once daily
Drug Interactions
- MAOi
- Pimozide
Adverse Effects
- The most frequent adverse events (10%): nausea, headache and insomnia.
- Akathisia, agitation, emotional lability, hostility, aggression, depersonalization. In some cases, the events occurred within several weeks of starting treatment.
- Abnormal Bleeding
- Sexual dysfunction
- Anaemia
- Lymphadenopathy
- chest discomfort, chest pain
- feeling jittery,
- Influenza like illness
- Malaise, oedema
- Pain
- Sluggishness
- Thirst
Contraindications
- Cipralex is contraindicated in patients with known hypersensitivity to escitalopram
- Cipralex is contraindicated in patients with known QT interval prolongation or congenital long QT syndrome.
- Monoamine Oxidase Inhibitors: Cipralex should not be used in combination with a MAOI or within 14 days of discontinuing treatment with a MAOI. Similarly, at least 14 days should elapse after discontinuing Cipralex treatment before starting a MAOI.
- Pimozide: Cipralex should not be used in combination with the antipsychotic drug pimozide, as the concomitant use is associated with an increased risk of QTc prolongation compared to pimozide alone.
Pregnancy and Breastfeeding
- Pregnant Women: Cipralex should not be used during pregnancy, unless the potential benefit to the patient outweighs the possible risk to the foetus.
- Nursing Women: Cipralex should not be administered to nursing mothers unless the expected benefits to the patient outweigh the possible risk to the child; in which case the infant should be closely monitored.
Precautions
- Pediatrics (<18 years of age):
- Cipralex is not indicated for use in patients below the age of 18.
- Geriatrics (≥65 years of age):
- Elderly patients should be administered lower doses and a lower maximum dose
- Discontinuation Symptoms
- Patients currently taking Cipralex should NOT be discontinued abruptly, due to risk of discontinuation symptoms. A gradual reduction in the dose over weeks rather than an abrupt cessation is recommended and patients should be monitored for symptoms such as dizziness, abnormal dreams, sensory disturbances [including paraesthesias and electric shock sensations], agitation, anxiety, emotional indifference, impaired concentration, headache, migraine, tremor, nausea, vomiting and sweating) or other symptoms that may be of clinical significance.
- If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, dose titration should be managed on the basis of the patient’s clinical response.
- Serotonin Syndrome/Neuroleptic Malignant Syndrome (NMS)-Like Events:
- particularly when given in combination with other serotonergic and/or neuroleptic drugs.
- Hyponatraemia:
- As with other antidepressants
- Glaucoma:
- As with other SSRIs/SNRIs, Cipralex can cause mydriasis and should be used with caution in patients with raised intraocular pressure or those with narrow-angle glaucoma.
- Diabetic Patients:
- Cipralex should be used with caution in diabetic patients on insulin or oral hypoglycaemic drugs.
- Abnormal Bleedings:
- Cipralex, may increase the risk of bleeding events by causing abnormal platelet aggregation.
- Seizures:
- Cipralex and other SSRIs should be used with caution in patients with a history of seizure disorder.
- Activation of mania/hypomania has also been reported in some patients
Warning
- Heart: QT Interval Prolongation: Escitalopram has been found to cause a dose-dependent prolongation of the QT interval.
- Liver failure: the half-life approximately doubles in individuals with normal liver function. Consequently, the use of Cipralex in hepatically impaired patients should be approached with caution and a lower dosage is recommended.
Section
This document is prepared by the “Mental Health for All” team. This document is provided for information purposes only and does not necessarily represent endorsement by or an official position of the Essentials of Medicine. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient’s medical history.
Brand name
- Cipralex®
Drug Class
- Antidepressant
- Anxiolytic
- Antiobsessional
Preparations
- Tablets 10 and 20 mg
Indications
- Major Depressive Disorder (MDD)
- Generalized Anxiety Disorder (GAD)
- Obsessive-compulsive disorder (OCD)
Pharmacology
- Escitalopram is a very weak or negligible inhibitor of human hepatic isoenzyme CYP1A2, 2C9, 2C19, 2E1, and 3A4, and a weak inhibitor of 2D6.
- Although escitalopram has a low potential for clinically significant drug interactions, caution is recommended, when escitalopram is co-administered with drugs that are mainly metabolized by CYP2D6, and that have a narrow therapeutic index.
Dosing
- Start at 5 mg po once daily and titrate up another 5 mg in a week
- Maximum dose: 30 mg once daily
Drug Interactions
- MAOi
- Pimozide
Adverse Effects
- The most frequent adverse events (10%): nausea, headache and insomnia.
- Akathisia, agitation, emotional lability, hostility, aggression, depersonalization. In some cases, the events occurred within several weeks of starting treatment.
- Abnormal Bleeding
- Sexual dysfunction
- Anaemia
- Lymphadenopathy
- chest discomfort, chest pain
- feeling jittery,
- Influenza like illness
- Malaise, oedema
- Pain
- Sluggishness
- Thirst
Contraindications
- Cipralex is contraindicated in patients with known hypersensitivity to escitalopram
- Cipralex is contraindicated in patients with known QT interval prolongation or congenital long QT syndrome.
- Monoamine Oxidase Inhibitors: Cipralex should not be used in combination with a MAOI or within 14 days of discontinuing treatment with a MAOI. Similarly, at least 14 days should elapse after discontinuing Cipralex treatment before starting a MAOI.
- Pimozide: Cipralex should not be used in combination with the antipsychotic drug pimozide, as the concomitant use is associated with an increased risk of QTc prolongation compared to pimozide alone.
Pregnancy and Breastfeeding
- Pregnant Women: Cipralex should not be used during pregnancy, unless the potential benefit to the patient outweighs the possible risk to the foetus.
- Nursing Women: Cipralex should not be administered to nursing mothers unless the expected benefits to the patient outweigh the possible risk to the child; in which case the infant should be closely monitored.
Precautions
- Pediatrics (<18 years of age):
- Cipralex is not indicated for use in patients below the age of 18.
- Geriatrics (≥65 years of age):
- Elderly patients should be administered lower doses and a lower maximum dose
- Discontinuation Symptoms
- Patients currently taking Cipralex should NOT be discontinued abruptly, due to risk of discontinuation symptoms. A gradual reduction in the dose over weeks rather than an abrupt cessation is recommended and patients should be monitored for symptoms such as dizziness, abnormal dreams, sensory disturbances [including paraesthesias and electric shock sensations], agitation, anxiety, emotional indifference, impaired concentration, headache, migraine, tremor, nausea, vomiting and sweating) or other symptoms that may be of clinical significance.
- If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, dose titration should be managed on the basis of the patient’s clinical response.
- Serotonin Syndrome/Neuroleptic Malignant Syndrome (NMS)-Like Events:
- particularly when given in combination with other serotonergic and/or neuroleptic drugs.
- Hyponatraemia:
- As with other antidepressants
- Glaucoma:
- As with other SSRIs/SNRIs, Cipralex can cause mydriasis and should be used with caution in patients with raised intraocular pressure or those with narrow-angle glaucoma.
- Diabetic Patients:
- Cipralex should be used with caution in diabetic patients on insulin or oral hypoglycaemic drugs.
- Abnormal Bleedings:
- Cipralex, may increase the risk of bleeding events by causing abnormal platelet aggregation.
- Seizures:
- Cipralex and other SSRIs should be used with caution in patients with a history of seizure disorder.
- Activation of mania/hypomania has also been reported in some patients
Warning
- Heart: QT Interval Prolongation: Escitalopram has been found to cause a dose-dependent prolongation of the QT interval.
- Liver failure: the half-life approximately doubles in individuals with normal liver function. Consequently, the use of Cipralex in hepatically impaired patients should be approached with caution and a lower dosage is recommended.
Section
This document is prepared by the “Mental Health for All” team. This document is provided for information purposes only and does not necessarily represent endorsement by or an official position of the Essentials of Medicine. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient’s medical history.