- Last edited on April 30, 2020
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Escitalopram (Cipralex)
Primer
Escitalopram (Tradename: Cipralex/Lexapro) is a medication in the Selective Serotonin Reuptake Inhibitors (SSRI) class.
Metabolism
Metabolized by CYP2C19, 3A4
Dosing
- Start at 10mg
- Maximum dose is 20mg per day, due to QTc concerns[1]
Adult Dosing
- Max dose is 20mg
Geriatric Dosing
- Start at 5mg and increase to 10mg, max dose is 10mg in geriatric population
Pearls
- eScitalopram is the S-enantiomer of the racemic SSRI citalopram
- Compared to citalopram, escitalopram is thought to be a more potent and selective serotonin reuptake inhibitor (though the clinical significance is unclear)[2]
- A good first line choice for medically complex patients due to fewer drug-drug interactions
- May be sedating for some patients, and activating for others
Special Populations
Dose should be reduced in patients with hepatic impairment and/or age > 65.
QT prolongation
See main article: QT (QTc) Prolongation and Monitoring
Citalopram and escitalopram both have a dose-dependent QTc prolongation. This effect is greater in citalopram than 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.[3][4]
References
1)
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.
2)
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.