ESCITALOPRAM OXALATE

ESCITALOPRAM OXALATE
(es-ci-tal'o-pram)
Lexapro
Classifications: psychotherapeutic agent; antidepressant; selective serotonin reuptake inhibitor (ssri);
Therapeutic:antidepressant
; ssri
Prototype: Fluoxetine
Pregnancy Category: C

Availability

5 mg, 10 mg, 20 mg tablets; 5 mg/5 mL liquid

Action

Selective serotonin reuptake inhibitor (SSRI) in the CNS. Antidepressant effect is presumed to be linked to its inhibition of CNS presynaptic neuronal uptake of serotonin.

Therapeutic Effect

Selective serotonin reuptake inhibition mechanism results in the antidepressant activity with or without anxiety symptoms.

Uses

Depression, generalized anxiety disorder.

Unlabeled Uses

Treatment of panic disorders.

Contraindications

Hypersensitivity to citalopram; concurrent use of MAOIS or use within 14 d of discontinuing MAOIS; pregnancy (category C); volume depleted; suicidal ideation.

Cautious Use

Hypersensitivity to other SSRIs; suicidal ideations, depression, mania, hyponatremia, ethanol intoxication, ECT, dehydration, renal or hepatic insufficiency; older adults; concurrent use of diuretics, cardiovascular disease (e.g., dysrhythmias, conduction defects, myocardial ischemia); history of seizure disorders or suicidal tendencies; lactation. Safety and efficicacy in children <18 y are unknown.

Route & Dosage

Depression, Generalized Anxiety
Adult: PO 10 q.d., may increase to 20 mg q.d. if needed after 1 wk
Geriatric: PO 10 mg q.d.

Panic Disorder
Adult: PO 5 q.d., may increase to 20 mg q.d. if needed after 1 wk

Hepatic Impairment
Adult: PO 10 q.d.

Administration

Oral
  • Do not begin this drug within 14 d of stopping an MAOI.
  • Reduced doses are advised for the older adult and those with hepatic or renal impairment.
  • Dose increments should be separated by at least 1 wk.
  • Store at 15°–30° C (59°–86° F) in tightly closed container and protect from light.

Adverse Effects (≥1%)

Body as a Whole: Fatigue, fever, arthralgia, myalgia. CV: Palpitation, hypertension. GI: Nausea, diarrhea, dyspepsia, abdominal pain, dry mouth, vomiting, flatulence, reflux. CNS: Dizziness, insomnia, somnolence, paresthesia, migraine, tremor, vertigo. Metabolic: Increased or decreased weight. Respiratory: URI, rhinitis, sinusitis. Skin: Increased sweating. Urogenital: Dysmenorrhea, decreased libido, ejaculation disorder, impotence, menstrual cramps.

Interactions

Drug: Combination with maoi could result in hypertensive crisis, hyperthermia, rigidity, myoclonus, autonomic instability; cimetidine may increase escitalopram levels; linezolid may cause serotonin syndrome. Herbal: St. John's wort may cause serotonin syndrome.

Pharmacokinetics

Absorption: Rapidly absorbed from GI tract. Onset: Approximately 1 wk. Peak: 3 h. Distribution: 80% protein bound; crosses placenta; distributed into breast milk. Metabolism: In liver by CYP3A4, 2C19, and 2D6 enzymes. Elimination: 20% in urine, 80% in bile. Half-Life: 25 h.

Nursing Implications

Assessment & Drug Effects

  • Monitor for therapeutic effectiveness: Indicated by elevation of mood; 1–4 wk may be needed before improvement is noted.
  • Closely observe for worsening of depression or emergence of suicidality especially in adolescents or children.
  • Lab tests: Monitor periodically hepatic functions, CBC, serum sodium, and lithium levels when the two drugs are given concurrently.
  • Monitor periodically HR and BP, and carefully monitor complete cardiac status in person with known or suspected cardiac disease.
  • Monitor closely older adult patients for adverse effects, especially with doses >20 mg/d.

Patient & Family Education

  • Do not engage in hazardous activities until reaction to this drug is known.
  • Avoid using alcohol while taking escitalopram.
  • Inform physician of commonly used OTC drugs as there is potential for drug interactions.
  • Report distressing adverse effects including any changes in sexual functioning or response.
  • Periodic ophthalmology exams are advised with long-term treatment.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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