Escitalopram (Lexapro) Drug Study

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Generic Name: escitalopram oxalate

Brand Name: Lexapro

Other Info: Pregnancy Category C

Drug classes: Antidepressant, SSRI

Therapeutic actions

Potentiates serotonergic activitity in the CNS by inhibiting reuptake of serotonin resulting in antidepressant effect with little effect on norepinephrine or dopamine; an isomer of citalopram.

Indications

• Treatment of major depressive disorder
• Maintenance treatment for patients with major depressive disorder
• Treatment of generalized anxiety disorder
• Unlabeled use: Panic disorder

Contraindications and cautions

• Contraindicated with MAOI use; with allergy to drug or to citalopram or any component of the drug.
• Use cautiously in the elderly, and with renal or hepatic impairment, illnesses of metabolism or hemodynamic response, pregnancy, lactation, suicidal patients, patients with mania or seizure disorders.

Available forms

Tablets—5, 10, 20 mg; oral solution—5 mg/5 mL

Dosages

ADULTS

• Major depressive disorder: Initially, 10 mg/day PO as a single daily dose; if needed, may be increased to 20 mg/day after a minimum of 1-wk trial period. For maintenance, 10–20 mg/day PO; reassess periodically.
• Generalized anxiety disorder: 10 mg/day PO; may be increased to 20 mg/day after 1 wk if needed. Treatment beyond 8 wk not tested.

PEDIATRIC PATIENTS

Safety and efficacy not established.

GERIATRIC PATIENTS OR ADULTS WITH HEPATIC IMPAIRMENT

10 mg/day PO as a single dose, do not increase dose.

Pharmacokinetics

Metabolism: Hepatic metabolism; T_1/2: 27–32 hour

Distribution: Crosses placenta; enters breast milk

Excretion: Urine

Adverse effects

• CNS: Somnolence, dizziness, insomnia, fatigue
• Dermatologic: Sweating
• GI: Nausea, dry mouth, constipation, diarrhea, indigestion, abdominal pain, decreased appetite
• GU: Ejaculatory disorders, impotence, anorgasmia in females, decreased libido
• Respiratory: Rhinitis, sinusitis, flulike symptoms

Interactions

Drug-drug

• Risk of serious toxic effects if combined with citalopram; do not use these drugs concomitantly
• Increased escitalopram levels and toxicity if taken with MAOIs; ensure that patient has been off the MAOI for at least 14 days before administeringescitalpram
• Risk of serotonin syndrome—a syndrome characterized by increased BP, T, severe anxiety, agitation, rigidity, and can occur when multiple serotonin elevating drugs are used. Monitor patient carefully
• Possible severe adverse effects if combined with other centrally acting CNS drugs including alcohol; use caution
• Possible decreased effects of escitalopram if combined with carbamazepine, lithium; monitor patient closely

Drug-alternative therapy

• Increased risk of severe reaction if combined with St. John’s wort; avoid this combination

Nursing considerations

CLINICAL ALERT!

There is potential for name confusion between escitalopram and citalopram and Lexapro (escitalopram) and Loxitane (loxapine); use caution.

Assessment

• History: MAOI use; allergy to drug, citalopram, or any component of the drug; renal or hepatic impairment; the elderly; pregnancy; lactation; suicidal tendencies; metabolic illnesses or problems with hemodynamic response; alcoholism
• Physical: Orientation, reflexes; P, BP, perfusion; R, bowel sounds, normal output; urinary output; liver evaluation; LFTs, renal function tests

Interventions

• BLACK BOX WARNING: Monitor patient for risk of suicidality, especially when starting or altering dosage; children and adolescents at increased risk.
• Administer once a day, in the morning or the evening; may be taken with food if desired.
• Encourage patient to continue use for 4–6 weeks, as directed, to ensure adequate levels to affect depression.
• WARNING: Limit amount of drug given in prescription to potentially suicidal patients.
• Advise any depressed patients to avoid the use of alcohol while being treated with antidepressive drugs.
• Establish appropriate safety precautions if patient experiences adverse CNS effects.
• Institute appropriate therapy for patient suffering from depression.

Teaching points

• Take this drug exactly as directed, and as long as directed; it may take several weeks to realize the benefits of the drug. The drug may be taken with food if desired.
• Avoid the use of alcohol while you are taking this drug.
• This drug should not be taken during pregnancy or when nursing a baby; using barrier contraceptive is suggested.
• You may experience these side effects: Drowsiness, dizziness, tremor (use caution and avoid driving a car or performing other tasks that require alertness if you experience daytime drowsiness); GI upset (frequent small meals, frequent mouth care may help); alterations in sexual function (this is a drug effect and will pass when drug therapy is ended).
• Report severe nausea, vomiting; blurred vision; excessive sweating, suicidal ideation, sexual dysfunction, insomnia.