Escitalopram is approved for the treatment of Major depressive disorder and Generalized anxiety disorder; other indications include Social anxiety disorder, Panic disorder and Obsessive compulsive disorder.
Dosage & Administration
Escitalopram is administered as a single daily dose and may be taken with or without food.
Major depression: The recommended dose is 10 mg once daily. Depending on individual patient response, the dose may be increased to a maximum of 20 mg daily.
Generalised anxiety disorder: The recommended dose is 10 mg once daily. Depending on individual patient response, the dose may be increased to a maximum of 20 mg daily.
Social anxiety disorder & Obsessive-compulsive disorder: The recommended dose is 10 mg once daily. Depending on individual patient response, the dose may be increased to a maximum of 20 mg daily.
Elderly patients (>65 years of age): A longer half-life and a decreased clearance have been demonstrated in the elderly. 10 mg is the recommended maximum maintenance dose in the elderly.
Children and adolescents (<18 years of age): Safety and efficacy have not been established in this population. Escitalopram should not be used in children and adolescents under 18 years of age.
Patients with reduced hepatic function: An initial dose of 5 mg daily for the first two weeks of treatment is recommended. Depending on individual patient response, the dose may be increased to 10 mg.
Patients with reduced renal function: Dosage adjustment is not necessary in patients with mild or moderate renal impairment.
Escitalopram should be taken at the same time each day to maintain an even level of the drug in the blood. It may be taken with or without food, in the morning or evening. If escitalopram bothers stomach, try to take it with food. If escitalopram makes drowsy, try to take escitalopram before bedtime. If escitalopram causes insomnia, try to take it in the morning.
Patients and their families should be alerted about the need to monitor for the emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, impulsivity, akathisia, hypomania, mania, worsening of depression, and suicidal ideation, especially during antidepressant treatment.
Haemorrhage: Bleeding abnormalities of the skin and mucous membranes have been reported with the use of SSRIs (including purpura, haematoma, epistaxis, vaginal bleeding and gastrointestinal bleeding). This risk may be potentiated by concurrent use of non-steroidal anti-inflammatory drugs (NSAIDs), aspirin or other medicines that affect coagulation.
Hyponatraemia: hyponatraemia has been reported as a rare adverse reaction with the use of SSRIs. Especially elderly patients seem to be a risk group. Seizures: The drug should be discontinued in any patient who develops seizures.
Diabetes: In patients with diabetes, treatment with an SSRI may alter glycaemic control, possibly due to improvement of depressive symptoms. Insulin and/or oral hypoglycaemic dosage may need to be adjusted.
ECT (electroconvulsive therapy): There is limited published clinical experience of concurrent administration of SSRIs and ECT, therefore caution is advisable.
Discontinuation: After a course of treatment with SSRIs, abrupt cessation of therapy may produce discontinuation reactions in some patients.
Cardiac disease: Escitalopram has not been evaluated or used to any appreciable extent in patients with a recent history of myocardial infarction or unstable heart disease.
Use in Pregnancy & Lactation
Consider as an option during pregnancy. When treating pregnant women with Escitalopram during the third trimester, the physician should carefully consider the potential risks and benefits of treatment. The physician may consider tapering Escitalopram in the third trimester. Escitalopram is excreted in human milk. Escitalopram should not be given to nursing mothers unless, in the opinion of the physician, the expected benefits to the patient outweigh the possible hazards to the child.