Cipralex

Action

Prevents serotonin reuptake by CNS neurons, making more serotonin available in brain and thereby relieving depression

Availability

Oral solution: 5 mg/5 ml

Tablets: 5 mg, 10 mg, 20 mg

Indications and dosages

➣ Major depression

Adults: Initially, 10 mg P.O. daily as a single dose. After at least 1 week, may increase to 20 mg P.O. daily, as needed.

Adolescents ages 12 to 17: Initially, 10 mg P.O. daily. After at least 3 weeks, may increase to 20 mg P.O. daily as needed.

Elderly adults and patients with hepatic impairment: Maximum dosage of 10 mg P.O. daily as a single dose

➣ Generalized anxiety disorder

Adults: Initially, 10 mg P.O. daily as a single dose. After at least 1 week, may increase to 20 mg P.O. daily as needed.

Dosage adjustment

• Hepatic impairment

• Elderly patients

Contraindications

• Hypersensitivity to drug

• Concurrent use of pimozide

• MAO inhibitor use within past 14 days

Precautions

Use cautiously in:

• renal or hepatic impairment, other conditions that cause altered metabolism or hemodynamic responses, history of mania or seizures, suicidal tendency

• concomitant use of nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, warfarin, or other drugs that affect coagulation

• elderly patients

• pregnant or breastfeeding patients

• children younger than age 12 with major depression and younger than age 18 with generalized anxiety disorder (safety and efficacy not established).

Administration

• Give with or without food in the morning or evening.

See Don't give within 14 days of MAO inhibitor.

Adverse reactions

CNS: drowsiness, dizziness, insomnia, fatigue, neuroleptic malignant syndrome-like reactions, increased risk of suicide or suicidal ideation (especially in child or adolescent)

EENT: rhinitis, sinusitis

GI: nausea, vomiting, diarrhea, constipation, dyspepsia, abdominal pain, dry mouth

GU: ejaculatory disorders, erectile dysfunction, anorgasmia (in females), decreased libido

Metabolic: hyponatremia (in association with syndrome of inappropriate antidiuretic hormone secretion)

Other: increased appetite, flulike symptoms, serotonin syndrome

Interactions

Drug-drug. Aspirin, NSAIDs, warfarin: increased risk of bleeding

Carbamazepine, lithium: decreased effects of escitalopram

Citalopram: increased risk of serious toxic effects

MAO inhibitors: increased escitalopram blood level and risk of toxicity

Pimozide: prolonged QT interval

Triptans: weakness, hyperreflexia, incoordination

Drug-diagnostic tests. Sodium: decreased level

Drug-herbs. Ginkgo, St. John's wort: increased risk of adverse effects

Drug-behaviors. Alcohol use: increased motor impairment

Patient monitoring

See Assess patient's mood closely. Watch for signs and symptoms of increased depression or suicidal ideation (especially in child or adolescent).

See Monitor patient closely for serotonin syndrome or neuroleptic malignant syndrome-like reactions; immediately discontinue drug if these occur.

• Be aware that gradual dosage reduction rather than abrupt cessation is recommended. When drug is discontinued, monitor for dysphoric mood, irritability, agitation, dizziness, sensory disturbances, anxiety, confusion, headache, lethargy, emotional lability, and insomnia.

Patient teaching

• Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids.

• Inform patient that full drug effect may take up to 4 weeks. Caution him not to overuse drug or stop drug abruptly.

See Tell patient (and parent or significant other as appropriate) to contact prescriber immediately if depression worsens or suicidal thoughts develop (especially in child or adolescent).

See Instruct patient to immediately discontinue drug and notify prescriber if the following symptoms occur: overheating, muscle rigidity, altered mental status, irregular pulse or blood pressure, rapid or irregular heart beat, excessive sweating, involuntary muscle movements, fever, or seizures.

• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.