Escitalopram is an oral drug that is used for treating depression and generalized anxiety disorder. Chemically, escitalopram is similar to citalopram (Celexa). Both are in the class of drugs called selective serotonin reuptake inhibitors (SSRIs). SSRIs work by affecting neurotransmitters in the brain, the chemical messengers that nerves use to communicate with one another.
Escitalopram is primarily used for the treatment of major depressive disorder and general anxiety disorder in adults.There is some evidence favouring escitalopram over the antidepressants citalopram and fluoxetine in the first two weeks of major depression. Concerns of sponsorship bias with the studies are however noted.
Abstract
Escitalopram is an oral drug that is used for treating depression and generalized anxiety disorder. Chemically, escitalopram is similar to citalopram (Celexa). Both are in the class of drugs called selective serotonin reuptake inhibitors (SSRIs). SSRIs work by affecting neurotransmitters in the brain, the chemical messengers that nerves use to communicate with one another.
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Brand Names
Lexapro,
Cipralex,
Seroplex,
Lexamil,
Lexam,
Entact
Manufacturers
TEVA USA
MYLAN
FOREST PHARMA
STAT RX USA
INNOVIANT PHARMA
BIOGEN PHARMA
QUALITY CARE
SOUTHWOOD PHARMA
ALTURA PHARMA
[1]
History
Escitalopram was developed in close cooperation between Lundbeck and Forest Laboratories. Its development was initiated in the summer of 1997, and the resulting new drug application was submitted to the U.S. FDA in March 2001. The short time (3.5 years) it took to develop escitalopram can be attributed to the previous extensive experience of Lundbeck and Forest with citalopram, which has similar pharmacology.
In 2006 Forest Laboratories was granted an 828 day extension on its US patent for escitalopram. This pushed the patent expiration date from December 7, 2009 to September 14, 2011. Together with the 6-month pediatric exclusivity, the final expiration date is March 14, 2012.
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Uses
Escitalopram is primarily used for the treatment of major depressive disorder and general anxiety disorder in adults.There is some evidence favouring escitalopram over the antidepressants citalopram and fluoxetine in the first two weeks of major depression. Concerns of sponsorship bias with the studies are however noted.
[2]
Pharmacology
Escitalopram has no significant affinity for adrenergic (alpha1, alpha2, beta), cholinergic, GABA, dopaminergic, histaminergic, serotonergic (5HT1A, 5HT1B, 5HT2), or benzodiazepine receptors; antagonism of such receptors has been hypothesized to be associated with various anticholinergic, sedative, and cardiovascular effects for other psychotropic drugs. The chronic administration of escitalopram was found to downregulate brain norepinephrine receptors, as has been observed with other drugs effective in the treatment of major depressive disorder.
The antidepressant, antiobsessive-compulsive, and antibulimic actions of escitalopram are presumed to be linked to its inhibition of CNS neuronal uptake of serotonin. Escitalopram blocks the reuptake of serotonin at the serotonin reuptake pump of the neuronal membrane, enhancing the actions of serotonin on 5HT1A autoreceptors. SSRIs bind with significantly less affinity to histamine, acetylcholine, and norepinephrine receptors than tricyclic antidepressant drugs.
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Schedule
It is not a controlled substance in the US.
Dosage
In the age group of 12 to 18: 10 mg PO qDay; may increase dose, not to exceed 20 mg/day
Adult dosage: 10 mg PO qDay; may increase to 20 mg/day after 1 week
The elderly are more prone to SSRI/SNRI-induced hyponatremia
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Drug Interactions
The following drugs have contraindicatory interactions with Escitalopram:
furazolidone
isocarboxazid
moclobemide
pargyline
phenelzine
procarbazine
tranylcypromine
Among severe drugs that would have serious interactions with Escitalopram are:
amitriptyline
amoxapine
bupropion
buspirone
citalopram
clomipramine
desipramine
dextromethorphan
dosulepin
doxepin
duloxetine
fluoxetine
fluvoxamine
And the drugs that would have significant interactions with Escitalopram are:
aceclofenac
aspirin
butabarbital
clozapine
cocaine
fentanyl
hydroxyurea
lithium
salsalate
tenoxicam
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Adverse Effects
Headache (24% )
Nausea (18%)
Ejaculation disorder (14%)
Somnolence (13%)
Insomnia (12%)Diarrhea (8%)
Fatigue (8%)
Libido decrease (7%)
Anorgasmia (6%)
Weight gain (1%)
Additional adverse effects could be:
Lethargy
Vomiting
Yawning
Contraindications
Hypersensitivity:
MAOIs' & other serotonergic drugs bring about the risk of serotonin syndrome.
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Cautions
Pregnancy: Conflicting evidence regarding use of SSRIs during pregnancy and increased risk of persistent pulmonary hypertension of the newborn.
SSRIs/SNRIs increase risk of abnormal bleeding (further increased if concomitant aspirin, NSAIDs or anticoagulants, or hemorrhagic diathesis)
Interferes with serotonin release from platelets and may disrupt hemostasis; caution with platelet inhibitors (eg, aspirin, NSAIDs)
Risk of impairment of cognitive & motor functions
Risk of neuroleptic malignant syndrome-like reaction
No additional benefits at 20 mg/day
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Pricing
The pricing varies depending on what form one would like to buy and the brand.
The 10mg tablet is priced in between $3.03 to $8.76. The prices for 20mg tablet vary from $0.52 to $57.55. The 5mg/5ml solution would cost $0.99 while the 5mg tablet is priced in between $3.25 to $40.48
[1]
Referenecs
[1] http://reference.medscape.com/drug/lexapro-escitalopram-342961#90
[2] http://www.medicinenet.com/escitalopram/article.htm
[3] http://www.e-pages.dk/lundbeck/82/fullpdf/full5022e59396a30.pdf
[4] http://www.drugbank.ca/drugs/DB01175#pharmacology
[5] http://reference.medscape.com/drug/lexapro-escitalopram-342961#0
[6] http://reference.medscape.com/drug/lexapro-escitalopram-342961#3
[7] http://reference.medscape.com/drug/lexapro-escitalopram-342961#5
