Escitalopram is a medication developed by the Danish pharmaceutical company Lundbeck, and is a selective serotonin reuptake inhibitor (SSRI). The drug is marketed under the name Lexapro in the US by Forest Laboratories, Inc.
Escitalopram was released two years prior to the patent expiration for Citalopram. The expiration of a patent means other companies are able to legally make cheaper generic versions. The FDA approved a generic version of escitalopram in May 2006, however, the US District Court of Delaware decided in July 2006 in favor of Lundbeck regarding a patent infringement dispute and rules escitalopram’s patent as being valid.
In clinical studies, Lexapro has shown to be more effective in depressed patients and especially shows higher efficacy vs. citalopram and other SSRIs in the severely depressed.
Treatment and usage:
Escitalopram is commonly prescribed for major depression – a persistently low mood that can interfere with daily functioning. To be considered major, depression must occur nearly every day for at least two weeks, and must include at least five of the symptoms of loss of interest in normal activities, low mood, significant change in weight or appetite, change in sleep patterns, agitation or lethargy, fatigue, feelings of worthlessness or guilt, slowed thinking or inability to concentrate, and thoughts of suicide.
Method of action:
Escitalopram works by boosting serotonin levels. Serotonin is one of the main chemical messengers in the brain. Like other SSRIs, Lexapro is a potent and highly selective reuptake inhibitor of serotonin. The drug’s precise mechanism of action is not fully understood; however, it is believed that escitalopram and related agents inhibit reuptake of serotonin at the neuronal membrane.
Warnings or dangers:
Patients with major depressive disorder (MDD), both adult and pediatric, may experience worsening of their depressive symptoms and/or the emergence of suicidal ideation and behavior (suicidality) or abnormal changes in behavior, whether or not they are taking antidepressants. In short-term studies of children and adolescents with MDD and other psychiatric disorders, antidepressants increased the risk of suicidality.
Adults with MDD or co-morbid depression with other psychiatric disorders being treated withantidepressants such as escitalopram should be closely observed for worsening and suicidality, especially during the initial treatment stage and any time the dosage is altered.
Lexapro should not be taken by patients using monoamine oxidase inhibitors (MAOIs). Concomitant use in patients taking pimozide is contraindicated. Lexapro should not be taken by patients with a hypersensitivity to escitalopram or citalopram or any of the inactive ingredients in Lexapro.
Lexapro side effects:
The most common side effects when taking Lexapro include dizziness, constipation, decreased appetite, premature ejaculation in men, decreased sex drive, diarrhea, flu-like symptoms, insomnia, sweating, fatigue, impotence, runny nose and sinusitis.
Less common side effects that may be experienced can include abnormal dreams, allergic reactions, abdominal pain, hot flashes, joint pain, inability to reach orgasm, light-headedness, blurred vision, bronchitis, chest pains, coughing, earache, rash, ringing in the ears, sinus congestion, sinus headache, stomachache, increased appetite, heartburn, hypertension, toothache, changes in weight, yawn, vomiting, vertigo, tremor and problems with urination.
Overdose and withdrawal:
In escitalopram trials, there were some reports of overdose, including overdoses of up to 600mg, with no associated fatalities. During post-marketing evaluation, Lexapro overdoses involving overdoses of over 1000mg have been reported. As with other SSRIs, fatality is rare.
Symptoms often accompanying overdose by escitalopram, alone or in combination with other drugs/alcohol, may include dizziness, convulsions, coma, hypotension (low blood pressure), insomnia, vomiting, nausea, sinus tachycardia, somnolence, and ECG changes.
Discontinuing antidepressants, especially suddenly, has been known to cause certain withdrawal symptoms. One possible symptom is a type of spontaneous nerve pulse, described by some patients as a feeling of small electric shocks, which may be accompanied by dizziness. These pulses may be short in duration, may affect any region of the body, and recur up to several times a minute in waking hours.
Other symptoms of discontinuation include extreme sensitivity to loud noises and brilliant light, chills, hot flushes, cold sweats, reddening of the face, abdominal pain, weight gain and extreme mental fatigue.
Overall, escitalopram is rated as being “very well tolerated.”
Precautions in children and the elderly:
The safety and efficacy of Lexapro in children and adolescents has not been properly established, and as such, escitalopram should not be given to people in this age group. There have been some studies that have shown Lexapro to be well-tolerated in both children and adolescents with no significant difference in withdrawal rates compared to placebo, but caution should be advised if administering Lexapro to young people.
However, other studies have shown occurrences of children having suicidal thoughts or exhibiting suicidal behavior. More research is necessary to be sure escitalopram is safe and effective in the pediatric population.
In the elderly, Lexapro has been tested and has not been shown to cause different side effects or problems than it does in younger adults. However, escitalopram is removed from the body more slowly in older people and thus, an elderly patient may require a lower dose than a younger adult. Some elderly people may experience greater sensitivity to the effects of Lexapro.
Generic Name: Escitalopram
Chemical Formula: C20H21N2FO
Routes of Administration: oral
Elimination Half Life: 27 – 32 hours
Legal Status: by prescription only