Escitalopram Oxalate

Escitalopram Oxalate is approved by the FDA to treat major depressive disorder (MDD). It is also prescribed off-label for various conditions like generalized anxiety disorder, social anxiety disorder, posttraumatic stress disorder, and premenstrual dysphoric disorder. Escitalopram is an SSRI antidepressant (selective serotonin reuptake inhibitor) that works by increasing serotonin levels in the brain to improve mood and emotional stability. The recommended dosage varies based on the condition and patient age, with adults typically starting at 10 to 20 mg daily. It’s important to follow your healthcare provider’s instructions and be aware of potential side effects, including gastrointestinal issues, sexual problems, and the risk of serotonin syndrome.

Escitalopram is an effective SSRI antidepressant that helps regulate serotonin levels in the brain, enhancing mood and emotional stability. It is approved for treating major depressive disorder in adults and adolescents aged 12 and older, as well as generalized anxiety disorder in adults. Both of these conditions are prevalent mental health issues. Additionally, it is often prescribed off-label for various other mental health conditions, including social anxiety disorder, posttraumatic stress disorder, and premenstrual dysphoric disorder.

The medication comes in oral tablet forms with strengths of 5 mg, 10 mg, and 20 mg, as well as a liquid oral solution. For major depressive disorder, the typical dosage for adults is 10 to 20 mg once daily, while for generalized anxiety disorder, it is also 10 to 20 mg once daily. Dosages may be adjusted based on age, liver function, and the presence of other medical conditions.

When taking Escitalopram, it is essential to follow your doctor’s instructions and take the medication consistently at the same time each day, with or without food. If you experience an upset stomach, taking it with food may help alleviate this issue.

Regular check-ups with your doctor are essential to monitor your progress and adjust the dosage as needed. Be aware of possible side effects, which can range from mild, such as nausea and sweating, to more severe, like low sodium levels and suicidal thoughts. It is crucial not to stop taking Escitalopram abruptly, as this can lead to withdrawal symptoms. Always consult your doctor before making any changes to your medication regimen.

Targeted Treatment

It is approved to treat major depressive disorder (in adults & adolescents at least 12 years old)

Benefits

It may also be prescribed by your doctor off-label to treat conditions mentioned below:

• Generalized Anxiety disorders (in adults)
• Social anxiety disorder (SAD)
• Vasomotor symptoms during menopause
• Posttraumatic stress disorder (PTSD)
• Panic disorder
• Obsessive-compulsive disorder (OCD)
• Premenstrual dysphoric disorder (PMDD)

[Note: Do not take Escitalopram without consulting your doctor. They will determine whether you need this medication based on your conditions.]

Forms & Strengths

Escitalopram comes in these forms and strengths mentioned below:

From: Oral Tablet

Strengths: 5 mg, 10 mg, 20 mg 

Form: Liquid oral solution

Strength: 5 mg/5mL

Recommended Dosages

Dosage for Major Depressive Disorder

• Adults (18 to 64 years): Recommended dose is 10 to 20 mg, taken once daily.
• Children (12 to 17 years): 10 to 20 mg, taken once daily.
• Children (0 to 11 years): It is unknown whether this drug is safe and effective.
• Seniors (65 or more): Recommended dose is 10 mg, taken once daily.
  • As people age, their liver function may decline, leading to slower processing of medications. Consequently, a higher concentration of a drug may remain in the body for an extended period, increasing the risk of side effects.
  • To mitigate this, your doctor might initiate treatment with a reduced dosage or adjust the medication schedule, aiming to prevent excessive accumulation of the drug in your system.
• People with Liver problems: Recommended dose is 10 mg, once daily.

Dosage for Generalized Anxiety Disorder

• Adults (18 to 64 years): Recommended dose is 10 to 20 mg, taken once daily.
• Children (0 to 17 years): It is not known if this drug is safe to treat anxiety disorders in this age group.
• Seniors (65 or more): Recommended dose is 10 mg, taken once daily.
  • As people age, their liver function may decline, leading to slower processing of medications. Consequently, a higher concentration of a drug may remain in the body for an extended period, increasing the risk of side effects.
  • To mitigate this, your doctor might initiate treatment with a reduced dosage or adjust the medication schedule, aiming to prevent excessive accumulation of the drug in your system.
• People with Liver problems: Recommended dose is 10 mg, once daily.

[Note: Remember, these recommendations may vary from person to person. Discuss it with your doctor, and they’ll customize your dosage accordingly.]

• Take Escitalopram at the same time every day to maintain consistent levels in your body.
• You can take this medication with or without food. If you experience an upset stomach, taking it with food may help with this issue.
• The 10 mg and 20 mg tablets can be cut or crushed if needed. However, do not cut or crush the 5 mg tablets.
• Always follow your doctor’s instructions and the directions on your prescription label. Read any medication guides or instruction sheets provided to you. Your doctor may adjust your dose as needed.
• If you are taking the liquid form of Escitalopram, measure your dose carefully. Use the dosing syringe that comes with the medication or a proper medicine dose-measuring device, not a regular kitchen spoon.
• It may take up to four weeks to notice an improvement in your symptoms. Continue taking the medication as directed and inform your doctor if there is no improvement.
• If you experience any changes in sexual function, such as reduced interest in sex, difficulty achieving orgasm, or issues with erections or ejaculation (in men), discuss these with your doctor. Some sexual problems may be treatable.
• Regular check-ups with your doctor are essential to monitor your progress. For children taking Escitalopram, their height and weight should be monitored to ensure healthy growth.
• Do not abruptly stop taking Escitalopram Oxalate, as this can lead to withdrawal symptoms. Follow your doctor’s guidance on gradually reducing your dose if needed.

[Note: Your doctor will decide the right amount for you based on your condition, following guidelines and studies on the drug. They’ll adjust it as needed over time.]

Escitalopram works by increasing the levels of a natural substance in your brain called serotonin, which is important for maintaining mental balance. Escitalopram Oxalate is part of a group known as selective serotonin reuptake inhibitors, also known as SSRIs. These medications work similarly and are often prescribed for similar health issues.

Side Effects

Common side effects of Escitalopram may include:

• Lack of hunger
• Sexual problems
• Sweating
• Weakness
• Dizziness
• Dry mouth
• Trouble sleeping
• Shaking
• Anxiety
• Constipation
• Infection
• Sleepiness
• Yawning
• Nausea

Mild side effects in children may include:

• Trouble sleeping
• Heavy menstrual periods
• Lack of hunger
• Increased thirst
• Weakness
• Sweating
• Nausea
• Dizziness
• Sexual problems
• Unexpected nosebleeds
• Abnormal increase in muscle movement or agitation
• Anxiousness
• Sleepiness
• Constipation
• Difficult urination
• Shaking
• Dry mouth
• Possible slowed growth rate and weight change
• Yawning
• Infection

Serious Side Effects of Escitalopram may include:

• Low sodium levels in the blood
• Convulsions or Seizures
• Suicidal thoughts and behaviors
• serotonin syndrome, symptoms can include:
  • Coordination problems or muscle twitching (overactive reflexes)
  • Nausea, vomiting, or diarrhea
  • Racing heartbeat
  • Agitation, hallucinations, coma, or other changes in mental status
  • Muscle rigidity
  • Sweating or fever
  • High or low blood pressure
• Manic episodes, signs include:
  • Reckless behavior
  • Excessive talking or speech that is faster than usual
  • Severe trouble sleeping
  • Excessive happiness or irritability
  • Unusually grand ideas
• Visual problems (changes in vision, eye pain, redness or swelling in or around your eyes)
• Changes in weight or appetite
• Severe allergic reactions including:
  • Rash or blisters (alone or with fever or joint pain)
  • Trouble breathing
  • Hives (itchy welts)
  • Swelling of your tongue, face, mouth, or eyes

[Note: This list may not cover all possible side effects. Always consult with your healthcare giver for medical advice about side effects.]

• Serotonin Syndrome: This severe condition can happen when taking this medication. It’s caused by too much serotonin, a natural chemical in the brain. It’s more likely to occur if you’re also taking other medicines that increase serotonin levels. Symptoms include irritability, agitation, confusion, hallucinations, stiff muscles, shaking, and seizures. If you experience these symptoms, get emergency medical help immediately.
• Stopping the Medication Suddenly: If you stop taking this medication abruptly, you might experience withdrawal symptoms like irritability, agitation, anxiety, mood changes, restlessness, sleep changes, headache, sweating, nausea, dizziness, electric shock-like feelings, shaking, and confusion. Don’t stop taking this medication without consulting your doctor, who will gradually reduce your dose to prevent these withdrawal symptoms.
• Bleeding Risk: Taking this medication can increase your risk of bleeding, especially if you’re also using aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), warfarin, or other blood thinners. Talk to your doctor or pharmacist if you notice any bleeding or unusual bruising.

Boxed Warning

FDA Warning: Suicide Risk

• The FDA has issued a boxed warning for this medication, indicating that it is associated with serious risks. A boxed warning is the highest level of caution from the FDA, highlighting potential dangers related to the drug’s use.
• Escitalopram, like other antidepressants, may increase the risk of suicidal thoughts and behavior in individuals taking it for depression or other mental health conditions. This risk is particularly higher in children, teenagers, and young adults, especially during the initial months of treatment or when the dosage is adjusted. Patients, their families, caregivers, and healthcare providers must monitor for any unusual changes in mood, behavior, thoughts, or feelings.

Here are some precautions for people with certain health conditions including:

• For those with a history of suicidal thoughts or behaviors: This medication may increase the risk of such thoughts and behaviors, particularly in children, teenagers, and young adults. Inform your doctor if you have a history of these issues.
• For those with glaucoma: The drug may widen your pupils, potentially triggering a glaucoma attack. Make sure to let your doctor know if you have glaucoma before starting this medication.
• For those with bipolar disorder: If you have a history of bipolar disorder, inform your doctor, as this medication may trigger a mixed or manic episode if taken alone.
• For those with seizure disorders: This medication may cause seizures. If you have a history of seizures, notify your doctor before starting this medication, as it may increase the risk of further seizures.
• For those with heart problems: The medication may cause a prolonged QT interval, a heart rhythm issue that can lead to an abnormal heartbeat. If you have heart disease, discuss the risks with your doctor before taking this medication.

For other groups including:

• For Pregnant Women: If you’re pregnant or planning to become pregnant, discuss it with your doctor. Animal studies show potential harm to the fetus from this drug, but human studies are lacking. Use the drug only if the benefits outweigh the risks.
• For Breastfeeding Women: Escitalopram may enter the breast milk and affect the baby. Consult with your doctor if you’re breastfeeding. You may need to choose between stopping breastfeeding or discontinuing the medication.
• For Seniors: Older adults are more prone to low sodium levels. This drug can reduce sodium so that seniors may face a higher risk of low sodium levels.
• For Children: Children taking drugs like Escitalopram may experience reduced appetite and weight loss. For more information, consult with your healthcare provider.

• Take your missed dose when you remember (as soon as possible).
• Take only one dose when you remember a few hours before your next scheduled dose.
• Don’t/Never try to take two doses at once. This could result in side effects that are dangerous for your health.

[Note: If you have missed a dose of your medication and are unsure about when to take the next one, immediately consult your doctor or pharmacist.]

Do not take more Escitalopram Oxalate than recommended. If you think you’ve taken too much of this drug or notice these symptoms of an overdose, call your primary caregiver immediately:

• Fast heart rate
• Nausea, vomiting
• Seizures and coma
• Sleep problems
• High or low blood pressure
• Dizziness

[Note: If you consumed more than the recommended dose, get medical help right away or call the Poison Help line at 1-800-222-1222.]

• Keep the medication at a temperature between 59ºF and 86°F (15ºC and 30°C).
• Avoid storing it in hot environments.
• Ensure that it is not kept in moist or damp places, such as bathrooms.

[Note: Discuss with your healthcare professional about the proper disposal of any unused medicine and any questions you may have regarding its storage.]

Escitalopram oral tablets can interact with other medications, vitamins, or herbs you’re taking. An interaction occurs when something alters how a drug functions, which can be harmful or reduce the drug’s effectiveness.

To prevent interactions, your doctor should carefully manage all your medications. Make sure to inform your doctor about all the medicines, vitamins, or herbs you’re taking. To understand how Escitalopram might interact with other substances you’re taking, consult your doctor or pharmacist. There are several drugs that can interact with Escitalopram, and these are listed below:

Blood thinners: Escitalopram has a mild blood-thinning effect. When taken with blood thinners, the likelihood of bleeding increases. Some examples of blood-thinning medications include:

• Apixaban
• Dabigatran
• Edoxaban
• Rivaroxaban
• Warfarin
• Nonsteroidal anti-inflammatory drugs (Diclofenac, Ibuprofen, Ketorolac, etc)

Migraine drugs: Some migraine drugs, known as triptans, have a similar effect to Escitalopram. Taking these drugs with Escitalopram could maximize your risk of side effects. Examples of these drugs include:

• Naratriptan
• Rizatriptan
• Eletriptan
• Frovatriptan
• Sumatriptan
• Zolmitriptan
• Almotriptan

Psychiatric Drugs: Some of these medications work in a similar way to Escitalopram. If you take these medications together, you might have a higher chance of experiencing side effects. Here are some examples of these drugs:

• Monoamine oxidase inhibitors (MAOIs): These are a type of medication that you should not take with Escitalopram or within two weeks of stopping Escitalopram unless your doctor advises you to do so. Likewise, you should not start taking Escitalopram if you have stopped taking an MAOI in the last two weeks unless your doctor has specifically directed you to do so. Taking these medications too close together can increase your risk of serotonin syndrome, a potentially life-threatening condition. Here are some of the examples:
  • Tranylcypromine
  • Phenelzine
  • Isocarboxazid
• Pimozide (An Antipsychotic Drug): Don’t take this medication if you’re taking Escitalopram and vice versa.
• Antidepressant Drugs: These drugs may interact. Examples of these drugs include:
  • Sertraline
  • Fluoxetine
  • Paroxetine
  • Citalopram
  • Fluvoxamine
• Medications Affecting the Central Nervous System: Here are some of these drugs include:
  • Gabapentin
  • Sleeping pills, such as Temazepam, Triazolam, Estazolam, or Zolpidem
  • Benzodiazepines

Drugs to reduce stomach acid: Medications to reduce stomach acid: Taking these medications along with Escitalopram can raise the levels of Escitalopram in your body and increase the chances of experiencing side effects. An example of these medications includes:

• Cimetidine

Water pills: Certain diuretics, commonly known as water pills, can lower the sodium levels in your body. Escitalopram, an antidepressant, can also reduce sodium levels. Taking water pills alongside Escitalopram might further increase the risk of low sodium levels, a condition known as hyponatremia. Examples of these diuretics include:

• Torsemide
• Furosemide
• Spironolactone
• Hydrochlorothiazide

Serotonergic drugs: Taking certain medications alongside Escitalopram, known as serotonergic drugs, can raise your risk of a serious condition called serotonin syndrome. This condition can be life-threatening. If you’re prescribed any of these medications, your doctor will likely start you on a lower dose of Escitalopram and keep an eye out for symptoms of serotonin syndrome. These symptoms can include feeling agitated, sweating, muscle twitching, and confusion. Some examples of serotonergic drugs are: 

• Tricyclic antidepressants (TCAs) such as clomipramine and amitriptyline
• Tryptophan
• The anxiolytic buspirone
• SSRIs such as sertraline and fluoxetine
• The opioids fentanyl and tramadol
• Lithium
• Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine and duloxetine
• Amphetamines
• St. John’s wort
• Triptans

[Note: This isn’t a complete list, and there could be other drugs that interact with Escitalopram. Make sure to tell your doctor about any prescription, over-the-counter medicines, and herbal products you’re taking.]

• Wellbutrin XL (bupropion extended-release)
• Lexapro (Escitalopram)
• Amitriptyline HCl
• Celexa (citalopram)
• Zoloft (sertraline)
• Paxil (paroxetine)
• Prozac (fluoxetine)
• Eldepryl (selegiline)
• Cymbalta (duloxetine) SNRI
• Viibryd (vilazodone)
• Effexor XR (venlafaxine extended-release)
• Pristiq (desvenlafaxine)
• Cymbalta (duloxetine)
• Fetzima (levomilnacipran)
• Trazodone
• Remeron (mirtazapine)
• Abilify (aripiprazole)
• Trintellix (vortioxetine)
• Amitriptyline
• Surmontil (trimipramine)
• Zyprexa (olanzapine)
• Buspirone
• Anafranil (clomipramine)
• Nefazodone
• Norpramin (desipramine)
• Imipramine
• Doxepin
• Pamelor (nortriptyline)
• Trimipramine
• Protriptyline
• Amoxapine
• Nardil (phenelzine)
• Marplan (isocarboxazid)
• Paxil CR (paroxetine extended-release)
• Parnate (tranylcypromine)
• Tofranil (imipramine)
• Xanax (alprazolam)
• Klonopin (clonazepam)
• Wellbutrin SR (bupropion extended-release)
• Ativan (lorazepam)
• Valium (diazepam)

[Note: Your doctor will choose what’s best for you. Don’t use any of these alternative medications without consulting your healthcare provider. Taking them by yourself may cause serious side effects.]

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