Esipram 5 mg

Description

Indications
Esipram is prescribed for the following conditions:

• Treatment of major depressive episodes.
• Treatment of panic disorder, with or without agoraphobia.
• Treatment of social anxiety disorder (social phobia).
• Treatment of generalized anxiety disorder.
• Treatment of obsessive-compulsive disorder.

Follow the advice of a registered healthcare provider when taking this medicine.

Pharmacology
Escitalopram is a selective serotonin reuptake inhibitor (SSRI) that is taken orally. It is the pure S-enantiomer of the racemic bicyclic phthalate derivative, citalopram. Escitalopram is at least 100 times more potent than the R-enantiomer in inhibiting the reuptake of serotonin (5-HT). Escitalopram has minimal or no affinity for other receptors, including alpha- and beta-adrenergic, dopamine, histamine, muscarinic, and benzodiazepine receptors.

Dosage
Escitalopram Oxalate is generally taken once a day, and can be taken with or without food. The safety of doses higher than 20 mg daily has not been established.

• Major depressive episodes: The usual starting dose is 10 mg daily. Depending on the patient’s response, the dose may be increased to a maximum of 20 mg daily. Typically, 2-4 weeks are needed to observe an antidepressant response. For maintaining results, treatment should continue for at least 6 months.
• Panic disorder with or without agoraphobia: Start with 5 mg daily for the first week, then increase to 10 mg daily. The dose may be raised up to 20 mg daily, depending on the individual response. Full effectiveness is usually seen within 3 months, and treatment may last several months.
• Social anxiety disorder: The usual dosage is 10 mg daily. Symptom relief is generally seen after 2-4 weeks, and the dose may be adjusted between 5 mg to 20 mg daily, based on individual response. A minimum of 12 weeks of treatment is recommended to consolidate the response. Long-term treatment (up to 6 months) can be considered to prevent relapse.
• Generalized anxiety disorder: The initial dose is 10 mg daily. Based on the patient’s response, the dose may be increased to 20 mg daily. Long-term treatment has been studied for at least 6 months in patients on 20 mg/day, with regular evaluation of treatment benefits.
• Obsessive-Compulsive Disorder (OCD): Start with 10 mg daily. The dose may be adjusted up to a maximum of 20 mg, depending on the patient’s response. Given that OCD is chronic, treatment should continue for an adequate period to ensure symptom relief. Regular evaluation of benefits and dosage is necessary.

Follow the advice of a registered healthcare provider when taking this medicine.

Administration
Escitalopram should be taken once daily, either in the morning or evening, with or without food.

Follow the advice of a registered healthcare provider when taking this medicine.

Interactions
SSRIs or similar antidepressants should not be started until at least 2 weeks after stopping a monoamine oxidase inhibitor (MAOI). Conversely, an MAOI should not be introduced until at least one week after discontinuing an SSRI or related antidepressant (2 weeks for paroxetine and sertraline, 5 weeks for fluoxetine).

Contraindications
Escitalopram is contraindicated in patients who are hypersensitive to Escitalopram, Citalopram, or any inactive ingredient of the drug. It should also not be used in combination with monoamine oxidase inhibitors (MAOIs) or pimozide.

Side Effects
Common side effects of SSRIs include gastrointestinal symptoms like nausea, vomiting, dyspepsia, abdominal pain, diarrhea, constipation, and anorexia (weight loss). Other possible reactions include rash, urticaria, angioedema, anaphylaxis, arthralgia, myalgia, and photosensitivity. Additional side effects may include dry mouth, anxiety, dizziness, insomnia, tremors, headaches, sexual dysfunction, and in rare cases, seizures, visual disturbances, and movement disorders. SSRIs are known for being less sedating and having fewer cardiotoxic and antimuscarinic effects compared to tricyclic antidepressants.

Pregnancy & Lactation
Escitalopram should be prescribed during pregnancy only after weighing the potential risks and benefits, particularly in the third trimester. It is excreted in breast milk, so the decision to continue nursing or medication should consider the risks for the infant and benefits for the mother.

Precautions & Warnings
Escitalopram should be used cautiously in patients with a history of epilepsy (avoid if poorly controlled), mania, cardiovascular disease, diabetes, angle-closure glaucoma, or bleeding disorders (especially gastrointestinal bleeding). It should also be used with caution in patients with liver or kidney impairment or those undergoing electroconvulsive therapy.

Use in Special Populations

• Elderly (>65 years): Start with 5 mg daily and adjust as needed based on the response.
• Children and adolescents (<18 years): Not recommended for use in children or adolescents.
• Renal impairment: No adjustment is needed for mild to moderate impairment, but caution is required in severe cases.
• Hepatic impairment: For mild to moderate liver issues, start with 5 mg daily, and adjust based on individual response. Caution is necessary in severe cases.
• Poor metabolizers of CYP2C19: Start with 5 mg daily for the first two weeks, then adjust to 10 mg based on the response.

Gradual reduction is recommended when discontinuing Escitalopram to minimize withdrawal symptoms. If discontinuation symptoms become intolerable, restarting the previous dose may be considered.

Overdose Effects
Symptoms of an overdose may include central nervous system effects (dizziness, tremors, agitation, and, in rare cases, serotonin syndrome, seizures, and coma), gastrointestinal symptoms (nausea, vomiting), and cardiovascular effects (hypotension, tachycardia, arrhythmias). Management involves general supportive measures, including airway management, gastric lavage, and activated charcoal. ECG monitoring is advised, especially in patients with a history of heart disease or those taking medications that prolong the QT interval.

Therapeutic Class
Selective serotonin reuptake inhibitors (SSRIs) and related antidepressant medications.

Storage Conditions
Store below 30°C, protected from light and moisture. Keep out of reach of children.

Pack Image
Esipram 5 mg Tablets.