Escitalopram is a drug that belongs to the group of selective serotonin reuptake inhibitors (SSRIs). It is used primarily in the treatment of depression.
What is escitalopram?
Escitalopram is an antidepressant that belongs to the group of selective serotonin reuptake inhibitors (SSRIs). It is used in the treatment of depression, generalized anxiety disorder, social phobias, and panic and obsessive-compulsive disorders. It has a stimulant effect and is also administered for pain caused by diabetic polyneuropathy. Its bioavailability is 80 percent, and its plasma half-life is about 30 hours. The maximum active level is reached after about 4 hours. It is administered either in tablet or solution form.
Pharmacologic effects on the body and organs
Escitalopram is the chemically active S form (S-enantiomer from the racemate) of citalopram. It has the mode of action of the selective serotonin reuptake inhibitors. Escitalopram blocks the transport substances responsible for returning the neurotransmitter serotonin to its storage sites after signal transmission has occurred. As a result of this inhibition, more free serotonin is available in the brain for the transmission of nerve signals. This can also explain the mood-lifting and anti-anxiety effects of escitalopram. Its effect is comparable to that of citalopram, but occurs much more quickly. Initial improvements can be observed after just one to two weeks of regular use.
Medical use and use for treatment and prevention.
So-called endogenous depression (major depression), panic disorder (with or without agoraphobia), generalized anxiety disorder, obsessive-compulsive disorder, and social phobias are considered indicators for the use of escitalopram. It is also used for pain caused by diabetic polyneuropathy. Furthermore, there is evidence of efficacy for conditions such as migraine, menopausal symptoms, premenstrual dysphoric syndrome, and stroke to improve cognitive performance. Escitalopram is not indicated for the treatment of children and adolescents. The antidepressant should always be taken exactly as directed by the doctor. Unless otherwise prescribed by the treating physician, the usual dose for adults is 10 mg once a day. The maximum daily dose is 20 mg. Elderly patients take 5 mg of escitalopram once daily; an increase should be discussed with the physician. No dose adjustment is necessary in patients with mild to moderate renal dysfunction; in severe renal dysfunction, the drug should not be used or should be used only after consultation with the physician. If the patient suffers from mild to moderate hepatic dysfunction, the daily dose is 5 mg; after 2 weeks, the dose may be increased to 10 mg in consultation with the physician. The duration of treatment is determined by the physician. As with any drug, the duration of treatment with escitalopram varies. It is not unusual for treatment to be successful only after several weeks. However, taking the tablets should not be discontinued. In addition, treatment should be continued for at least 6 months after the signs of the disease have subsided.
Risks and side effects
Very common side effects of taking escitalopram include headache, insomnia, nausea, constipation, weakness, tremor, drowsiness, increased sweating, and dry mouth. Often there are also problems with sleep, concentration, memory, sensation, vision, taste, or anxiety, fatigue, nervousness, confusion, changes in appetite, weight changes, digestive problems, abdominal pain, vomiting, increased salivation, flatulence, hypersensitivity reactions of the skin (e.g., rash, itching), muscle pain, impotence, and rapid heartbeat or a decrease in blood pressure. Occasionally, seizures, a slowing of the heartbeat, aggressiveness, an increase in liver enzymes, euphoria, ringing in the ears, allergic reactions (e.g., cough, shortness of breath), fainting, or hypersensitivity to light may occur during treatment with escitalopram.A rare side effect is a decrease in the level of sodium in the blood; very rarely, inflammation of the pancreas and liver, skin bleeding, gastrointestinal bleeding, uterine bleeding or mucosal bleeding may also occur. Especially at the beginning of treatment, patients may be affected by akathisia (restlessness of the limbs) and agonizing restlessness. In addition, long-term use of escitalopram may adversely affect the work of the cells that build and break down bone. The consequences are increased bone fractures or the development of osteoporosis. Interactions occur with concomitant use of escitalopram and MAO inhibitors, tramadol (opioid), alcohol, thiazide diuretics (diuretic medications), fluvoxamine (SSRI), anticoagulants (anticoagulants), platelet aggregation inhibitors, cimetidine (inhibits gastric acid production in acid-related stomach disorders), and QT time-prolonging medications. The use of escitalopram is not indicated in patients who are hypersensitive to the active ingredient, in patients with severe hepatic or renal dysfunction, during pregnancy and lactation, in unstable epilepsy, in increased bleeding tendency, in concomitant use of MAO inhibitors, in a tendency to hypokalemia, in congenital long-QT syndrome (ion channel disease with pathologically prolonged QT interval in the cardiac current curve), and in decompensated heart failure.
