Escitalopram 5 mg, 10 mg, 20 mg Tablets

By | July 1, 2012

Escitalopram (ess-sital-o-pram) [Lexapro]

Escitalopram Classification

(The therapeutic classification, which categorizes drugs by the disease state they are used to treat, appears first, followed by the pharmacologic classification, which is based on the drug’s mechanism of action.)

Therapeutic class: antidepressants

Pharmacologic class of Escitalopram: selective serotonin reuptake inhibitors (selective serotonin reuptake inhibitors (SSRIs)

Pregnancy Category (pregnancy categories (A, B, C, D, and X) provide a basis for determining a drug’s potential for fetal harm): C

Escitalopram Indications

(Medications are approved by the FDA for specific disease states. This section identifies the diseases or conditions for which the drug is commonly used and includes significant unlabeled uses as well.)

Major depressive disorder.

Generalized anxiety disorder (GAD).

Unlabeled uses: Panic disorder. Obsessive-compulsive disorder (OCD (obsessive-compulsive disorder). Post-traumatic stress disorder (posttraumatic stress disorder). Social anxiety discorder (social phobia). Premenstrual dysphoric disorder (PMDD).

Escitalopram Action

(This section contains a concise description of how the Escitalopram produces the desired therapeutic effect.)

Selectively inhibits the reuptake of serotonin in the central nervous system (CNS).

Therapeutic Effects of Escitalopram: Antidepressant action.

Pharmacokinetics

(Pharmacokinetics refers to the way the body processes a medication by absorption, distribution, metabolism, and excretion. Also includes information on the drug’s half-life.)

Absorption: 80% absorbed following oral administration.

Distribution: Enters breast milk.

Metabolism and Excretion: Mostly metabolized by the liver (primarily CYP3A4 and CYP2C19 isoenzymes); 7% excreted unchanged by kidneys.

Half-life: Increased in geriatric patients and patients with hepatic impairment.

Time/Action Profile (the table provides the onset of Escitalopram action, its peak effect, and its duration of activity) (antidepressant effect)

Route Onset Peak Duration
PO within 1-4 wk Unknown Unknown

Contraindications/Precautions

(Situations in which Escitalopram use should be avoided or alternatives strongly considered are listed as contraindications. In general, most drugs are contraindicated in pregnancy or lactation. The precautions portion includes disease states or clinical situations in which drug use involves particular risks or in which dosage modification may be necessary.)

Contraindicated in: Hypersensitivity; Concurrent MAO inhibitors; Concurrent use of cital-opram.

Use Cautiously in: History of mania (may activate mania/hypomania); History of seizures; Patients at risk for suicide; Hepatic impairment (dose reduction recommended); Geriatric: Hepatic impairment or geriatric patients (Escitalopram reduces doses recommended) ; Severe renal impairment; Obstetric Neonates exposed to SSRI in 3rd trimester may develop drug discontinuation syndrome including respiratory distress, feeding difficulty, and irritability. Weigh risks and benefits; Lactation: May cause adverse effects in infant; risk’benefit should be considered; Pediatric: Escitalopram may increase risk of suicide attempt/ideation especially during early treatment or dose adjustment in children/adolescents (unlabeled for pediatric use).

Adverse Reactions/Side Effects of Escitalopram

(Although it is not possible to include all reported reactions, major side effects for all drugs are included.)

Central Nervous System (CNS): insomnia, dizziness, drowsiness, fatigue. Gastrointestinal (GI): diarrhea, nausea, abdominal pain, constipation, dry mouth, indigestion. Genitourinary: anorgasmia, decreased libido, ejaculatory delay, erectile dysfunction. Dermatologic: increased sweating. Endocrine: syndrome on inappropriate secretion of antidiuretic hormone (SIADH). Fluid and Electrolyte: hyponatremia. Metabolic: increased appetite.

Interactions

(Escitalopram interactions are a significant risk for patients. As the number of medications a patient receives increases, so does the likelihood of drug-drug interactions. This section provides the most important drug-drug interactions and their physiological effects.)

Escitalopram-Drugs: May cause serious, potentially fatal reactions when used with MAO inhibitors; allow at least 14 days between escitalopram and MAO inhibitors. Use cautiously with other centrally acting drugs (including alcohol, antihistamines, opioid analgesics, and sedative/hypnotics; concurrent use with alcohol is not recommended). Concurrent use with sumatriptan or other 5-HT3 agonist vascular headache suppressants may result in weakness, hyperreflexia, and incoordination. Cimetidine increase blood levels of escitalopram. Serotonergic effects may be inreased by lithium (concurrent use should be carefully monitored). Carbamazepine may reduce blood levels. Escitalopram may increase blood levels of metoprolol. Concurrent use with tricyclic antidepressants should be undertaken with caution because of altered pharmacokinetics. Escitalopram-Natural Products: Escitalopram increases risk of serotonin syndrome with St. John’s wort and SAMe.

Escitalopram Dosage / Route

(Routes of administration are grouped together and include recommended doses for adults, children, and other. Dosage units are expressed in the terms in which they are usually prescribed. Dosing intervals also are provided in the manner in which they are frequently ordered.)

PO (by mouth, orally) (Adults): 10 mg of Escitalopram once daily, may be increased to 20 mg of Escitalopram once daily after one week. Hepatic Impairment PO (Adults): 10 mg of Escitalopram once daily.

PO (by mouth, orally) (Geriatric Patients): 10 mg of Escitalopram once daily.

Package & Price of Escitalopram in Pharmacies of the US

(This lists the strengths and concentrations of available dose forms. Such information is useful in planning more convenient regimens (fewer tablets / capsules, less injection volume). General availability and average wholesale prices of commonly prescribed drugs have also been added as an aid to nurses with prescriptive authority.)

Escitalopram Tablets: 5 mg, 10 mg, 20 mg. Escitalopram Cost: 5 mg of Escitalopram cost $214.97/90, 10 mg of Escitalopram cost $228.97/90, 20 mg of Escitalopram cost $239 97/90. Oral solution (peppermint): 1 mg/ml in 240-ml bottles. Escitalopram Cost: of Escitalopram cost $131.64/240 ml.

Nursing Implications for Escitalopram

(This section helps the nurse apply the nursing process to pharmacotherapeutics. The subsections provide a step-by-step guide to clinical assessment, implementation (Escitalopram administration), and evaluation of the outcomes of pharmacologic therapy.)

Assessment

(This section includes guidelines for assessing patient history and physical data before and during drug therapy. Assessments specific to the drug’s various indications are also included.)

• Monitor mood changes and level of anxiety during therapy.

• Assess for suicidal tendencies, especially during early therapy. Restrict amount of drug available to patient. Risk may be increased for children or adolescents. After starting therapy, children and adolescents should be seen by health care professional at least weekly for 4 weeks, every 2 weeks for next 4 weeks, and on advice of health care professional thereafter.

• Assess for sexual dysfunction (erectile dysfunction; decreased libido).

Potential Nursing Diagnoses

(The two or three most pertinent NANDA diagnoses that potentially apply to a patient receiving the Escitalopram are listed. Each diagnosis includes the pharmacologic effect from which the diagnosis has been derived.)

Ineffective coping (Indications) Post-trauma syndrome (Indications) Risk for injury (Side Effects)

Sexual dysfunction (Side Effects)

Escitalopram Implementation

(Guidelines specific for Escitalopram administration)

• Do not administer escitalopram and citalopram concomitantly. Taper to avoid potential withdrawal reactions. Reduce dose by 50% for 3 days, then again by 50% for 3 days, then discontinue.

Per Os/By Mouth: Administer as a single dose in the morning or evening without regard to meals.

Escitalopram: Patient/Family Teaching

(This section includes information that should be taught to patients. Side effects that should be reported, information on minimizing and managing side effects of Escitalopram, details on administration, and follow-up requirements are presented. Home Care Issues discusses aspects to be considered for medications taken in the home setting.)

• Instruct patient to take escitalopram as directed. Take missed doses on the same day as soon as remembered and consult health care professional. Resume regular dosing schedule next day. Do not double doses. Do not stop abruptly, should be discontinued gradually.

• May cause dizziness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.

• Advise patient to avoid alcohol and other CNS-depressant drugs during therapy and to consult a health care professional before taking other Rx (prescription) or OTC medications or herbal products.

• Instruct female patients to notify health care professional if pregnancy is planned or suspected or if they plan to breastfeed an infant.

• Caution patients that escitalopram should not be used for at least 14 days after discontinuing MAO inhibitors, and at least 14 days should be allowed after stopping escitalopram before starting an MAO inhibitor.

• Emphasize importance of follow-up exams to monitor progress.

• Encourage patient participation in psychotherapy to improve coping skills.

• Refer patient/family to local support groups.

Escitalopram: Evaluation / Desired Outcomes

(Outcome criteria for determination of the effectiveness of Escitalopram are provided.)

• Increased sense of well-being.

• Renewed interest in surroundings. May require 1-4 week of therapy to obtain antidepressant effects. Full antidepressant effects occur in 4-6 weeks.

• Decrease in anxiety.