- Last edited on April 30, 2020
Differences
This shows you the differences between two versions of the page.
meds:antidepressants:ssri:escitalopram [on April 21, 2020] |
meds:antidepressants:ssri:escitalopram [on February 20, 2021] (current) |
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- | ====== Escitalopram (Cipralex) ====== | + | ====== Escitalopram (Cipralex/Lexapro) ====== |
+ | {{INLINETOC}} | ||
===== Primer ===== | ===== Primer ===== | ||
- | **Escitalopram** (Tradename: //Cipralex/////Lexapro//) is a medication in the [[meds:antidepressants:ssri:home|]] class. | + | <WRAP group> |
+ | <WRAP half column> | ||
+ | **Escitalopram** (Trade name: //Cipralex/Lexapro//) is an [[meds:antidepressants:home|antidepressant]] in the [[meds:antidepressants:ssri:home|selective serotonin reuptake inhibitor (SSRI)]] class commonly used in the treatment of [[mood:1-depression:home|major depressive disorder]]. | ||
+ | </WRAP> | ||
+ | <WRAP half column> | ||
+ | <catlist meds:antidepressants:ssri -columns:1 -noAddPageButton -sortAscending -noNSInBold> | ||
+ | </WRAP> | ||
+ | </WRAP> | ||
- | ===== Metabolism ===== | + | ===== Pharmacokinetics ===== |
- | Metabolized by CYP2C19, 3A4 | + | <WRAP group> |
+ | <WRAP half column> | ||
+ | <alert icon="fa fa-arrow-circle-right fa-lg fa-fw" type="success"> | ||
+ | See also article: **[[meds:pharmacology:home|]]** | ||
+ | </alert> | ||
+ | <panel type="info" title="Pharmacokinetics of Escitalopram" subtitle="" no-body="true" footer=""> | ||
+ | ^ [[meds:pharmacology:home#absorption|Absorption]] | | | ||
+ | ^ [[meds:pharmacology:home#distribution|Distribution]] | | | ||
+ | ^ [[meds:pharmacology:home#metabolism|Metabolism]] | | | ||
+ | ^ [[meds:pharmacology:home#excretionelimination|Elimination]] | | | ||
+ | ^ [[meds:pharmacology:home#half-life|Half-life]] | | | ||
+ | </panel> | ||
+ | </WRAP> | ||
+ | <WRAP half column> | ||
+ | <alert icon="fa fa-arrow-circle-right fa-lg fa-fw" type="success"> | ||
+ | See also article: **[[meds:cytochrome-p450|]]** | ||
+ | </alert> | ||
+ | <panel title="Escitalopram: Cytochrome P450 Metabolism" no-body="true"> | ||
+ | ^ Substrate of (Metabolized by) | 2C19, 3A4 | | ||
+ | ^ Induces | | | ||
+ | ^ Inhibits | | | ||
+ | </panel> | ||
+ | </WRAP> | ||
+ | </WRAP> | ||
+ | |||
+ | ===== Pharmacodynamics ===== | ||
+ | ==== Mechanism of Action ==== | ||
+ | ==== Toxicity ==== | ||
+ | |||
+ | ===== Indications ===== | ||
+ | ===== Escitalopram vs. Citalopram ===== | ||
+ | <panel type="info" title="Recommended daily dose ranges for citalopram and escitalopram" subtitle="" no-body="true" footer="*Omeprazole increases plasma levels of citalopram and escitalopram, | ||
+ | increasing the risk of QT prolongation and hyponatraemia."> | ||
+ | ^ Population ^ [[meds:antidepressants:ssri:citalopram|Citalopram]] ^ [[meds:antidepressants:ssri:escitalopram|Escitalopram]] ^ | ||
+ | ^ Adult 18-65 years\\ without risk factors | • Starting: 20mg \\ • Maximum: 40mg | • Starting: 10mg \\ • Maximum: 20mg | | ||
+ | ^ Adult >65 years or\\ impaired hepatic\\ function | • Starting: 10mg \\ • Maximum: 20mg | • Starting: 5mg \\ • Maximum: 10mg | | ||
+ | ^ Taking omeprazole* | • Starting: 20mg \\ • Maximum: 20mg | • Starting: 5mg \\ • Maximum: 10mg | | ||
+ | </panel> | ||
===== Dosing ===== | ===== Dosing ===== | ||
- | * Start at 10mg | + | <panel type="info" title="Dosing for Escitalopram" no-body="true"> |
- | * Maximum dose is 20mg per day, due to QTc concerns[([[https://www.ncbi.nlm.nih.gov/pubmed/26633294|Do, A., Noohi, S., Elie, D., Mahdanian, A. A., Yu, C., Segal, M., ... & Rej, S. (2016). Health Canada warning on citalopram and escitalopram—its effects on prescribing in consultation-liaison psychiatry. Psychosomatics, 57(1), 57-63.]])] | + | ^ Starting | 10 mg PO daily | |
+ | ^ Titration | Increase by 5 to 10 mg every 1 to 2 weeks, depending on tolerability | | ||
+ | ^ Maximum | 20 mg per day (10 mg in adults >65), due to QTc concerns[([[https://www.ncbi.nlm.nih.gov/pubmed/26633294|Do, A., Noohi, S., Elie, D., Mahdanian, A. A., Yu, C., Segal, M., ... & Rej, S. (2016). Health Canada warning on citalopram and escitalopram—its effects on prescribing in consultation-liaison psychiatry. Psychosomatics, 57(1), 57-63.]])] | | ||
+ | ^ Taper | [[meds:antidepressants:tapering-switching|]] | | ||
+ | </panel> | ||
+ | |||
+ | |||
+ | |||
+ | ==== Formulations ==== | ||
+ | * Escitalopram comes in | ||
+ | |||
+ | ==== Monitoring ==== | ||
+ | |||
+ | ===== Contraindications ===== | ||
+ | ==== Absolute ==== | ||
+ | ==== Relative ==== | ||
+ | |||
+ | ===== Drug-Drug Interactions ===== | ||
+ | |||
+ | ===== Side Effects ===== | ||
+ | |||
+ | ===== Adverse Events ===== | ||
+ | * [[meds:antidepressants:serotonin|Serotonin syndrome]] | ||
+ | |||
+ | ==== QTc prolongation ==== | ||
+ | <alert icon="fa fa-arrow-circle-right fa-lg fa-fw" type="success"> | ||
+ | See main article: **[[meds:qtc]]** | ||
+ | </alert> | ||
+ | |||
+ | Citalopram and escitalopram both have a dose-dependent QTc prolongation, but this effect is greater in [[meds:antidepressants:ssri:citalopram|citalopram]] than [[meds:antidepressants:ssri:escitalopram|escitalopram]] (due to escitalopram only having S-enantiomer).[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3581598/|Lam, R. W. (2013). Psychopharmacology for the Clinician. Journal of psychiatry & neuroscience: JPN, 38(2), E5.]])][([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3692726/|Hasnain, M., Howland, R. H., & Lam, R. W. (2013). Escitalopram and QTc prolongation/Author response. Journal of psychiatry & neuroscience: JPN, 38(4), E11.]])] | ||
- | == Adult Dosing == | ||
- | * Max dose is 20mg | ||
- | == Geriatric Dosing == | ||
- | * Start at 5mg and increase to 10mg, max dose is 10mg in geriatric population | ||
- | ===== Pearls ===== | + | ===== Clinical Pearls ===== |
* e__**S**__citalopram is the __**S**__-enantiomer of the racemic SSRI [[meds:antidepressants:ssri:citalopram|citalopram]] | * e__**S**__citalopram is the __**S**__-enantiomer of the racemic SSRI [[meds:antidepressants:ssri:citalopram|citalopram]] | ||
* Compared to citalopram, escitalopram is thought to be a more potent and selective serotonin reuptake inhibitor (though the clinical significance is unclear)[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC314378/|Burke, W. J., & Kratochvil, C. J. (2002). Stereoisomers in psychiatry: the case of escitalopram. Primary care companion to the Journal of clinical psychiatry, 4(1), 20.]])] | * Compared to citalopram, escitalopram is thought to be a more potent and selective serotonin reuptake inhibitor (though the clinical significance is unclear)[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC314378/|Burke, W. J., & Kratochvil, C. J. (2002). Stereoisomers in psychiatry: the case of escitalopram. Primary care companion to the Journal of clinical psychiatry, 4(1), 20.]])] | ||
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* May be sedating for some patients, and activating for others | * May be sedating for some patients, and activating for others | ||
+ | ===== Special Populations ===== | ||
+ | ==== Geriatric ==== | ||
+ | <alert icon="fa fa-arrow-circle-right fa-lg fa-fw" type="success"> | ||
+ | See main article: **[[meds:pharmacology:geri|]]** | ||
+ | </alert> | ||
- | ==== Special Populations ==== | + | ==== Pediatric ==== |
- | Dose should be reduced in patients with hepatic impairment and/or age > 65. | + | <alert icon="fa fa-arrow-circle-right fa-lg fa-fw" type="success"> |
+ | See main article: **[[meds:pharmacology:pediatric|]]** | ||
+ | </alert> | ||
- | ==== QT prolongation ==== | + | ==== Obstetric and Fetal ==== |
- | <callout type="success">{{fa>arrow-circle-right?color=green}} See main article: **[[meds:qtc]]**</callout> | + | <alert icon="fa fa-arrow-circle-right fa-lg fa-fw" type="success"> |
+ | See main article: **[[meds:pharmacology:obstetric-and-fetal|]]** | ||
+ | </alert> | ||
- | Citalopram and escitalopram both have a dose-dependent QTc prolongation. This effect is greater in [[meds:antidepressants:ssri:citalopram|citalopram]] than [[meds:antidepressants:ssri:escitalopram|escitalopram]] (due to escitalopram only having S-enantiomer). The threshold for clinical significance of the QTc interval is an absolute duration of 500 ms or longer or a change from baseline of 60 ms or more.[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3581598/|Lam, R. W. (2013). Psychopharmacology for the Clinician. Journal of psychiatry & neuroscience: JPN, 38(2), E5.]])][([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3692726/|Hasnain, M., Howland, R. H., & Lam, R. W. (2013). Escitalopram and QTc prolongation/Author response. Journal of psychiatry & neuroscience: JPN, 38(4), E11.]])] | + | ==== Medically Ill ==== |
+ | <alert icon="fa fa-arrow-circle-right fa-lg fa-fw" type="success"> | ||
+ | See main article: **[[meds:pharmacology:psychotropic-rx-medically-ill|]]** | ||
+ | </alert> | ||
+ | * Dose should be reduced in patients with hepatic impairment and/or age > 65. | ||
+ | ===== Resources ===== |