Class: SSRI Antidepressant
Dosage Forms. Tablet: 5 mg, 10 mg, 20 mg; Solution: 5 mg/5 mL
Common FDA Label Indication, Dosing, and Titration.
1. Depression: Children 12 y and older and Adults, 10 mg po daily, may titrate to 20 mg po daily
2. Generalized anxiety disorder: 10 mg po daily, may titrate to 20 mg po daily
1. OCD: 20-60 mg po daily
2. Panic disorder: 20-30 mg po daily, may titrate to 60 mg po daily
MOA. Escitalopram is the S-enantiomer of racemic citalopram and is an antidepressant that is a selective and potent inhibitor of presynaptic reuptake of serotonin (an SSRI). It does not affect reuptake of norepinephrine or dopamine and has a relative lack of affinity for muscarinic, histamine, α1- and α2-adrenergic, and serotonin receptors.
Drug Characteristics: Escitalopram
Medication Safety Issues: Escitalopram
Drug Interactions: Escitalopram
Adverse Reactions: Escitalopram
Efficacy Monitoring Parameters. Improvement in symptoms of depression, panic disorder (dyspnea, palpitations, trembling, experiencing an uncontrolled feeling, etc); OCD (recurrent and persistent impulses that are intrusive and senseless, or repetitive and intentional behaviors performed in response to obsessive thoughts); or generalized anxiety.
Toxicity Monitoring Parameters. Worsening of depression, suicidality, or unusual changes in behavior, especially at the initiation of therapy or with dosage increases or decreases; signs/symptoms of abnormal bleeding.
Key Patient Counseling Points. Avoid activities requiring mental alertness or coordination until drug effects are realized. Symptomatic improvement may not be seen for several weeks. Report worsening depression, suicidal ideation, unusual changes in behavior, or unusual bleeding. Avoid abrupt discontinuation, may precipitate withdrawal symptoms. Do not drink alcohol or use NSAIDs or aspirin while taking this drug.
Clinical Pearls. If intolerable withdrawal symptoms occur following a decrease in dose or therapy discontinuation, may need to resume the previous dose and taper at a more gradual rate.