Esitanaaf 5 mg (Tablet)
Medicine Details
| Category | Details |
|---|---|
| Generic | Escitalopram oxalate |
| Company | Naafco pharma ltd |
| Also available as |
Indications
- Treatment of major depressive episodes
- Treatment of panic disorder with or without agoraphobia
- Treatment of social anxiety disorder (social phobia)
- Treatment of generalised anxiety disorder
- Treatment of obsessive-compulsive disorder
Pharmacology
Escitalopram is an orally administered selective serotonin reuptake inhibitor (SSRI) and the pure S-enantiomer of the racemic bicyclic phthalate derivative citalopram. It is at least 100 fold more potent than the R-enantiomer with respect to inhibition of 5-HT reuptake. Escitalopram has no or very low affinity for serotonergic or other receptors including alpha- and beta-adrenergic, dopamine, histamine, muscarinic, and benzodiazepine receptors.
Dosage
- Usual dosage is 10 mg once daily for major depressive episodes
- Initial dose of 5 mg recommended for panic disorder with or without agoraphobia
- Usual dosage is 10 mg once daily for social anxiety disorder
- Initial dosage is 10 mg once daily for generalised anxiety disorder
- Initial dosage is 10 mg once daily for obsessive-compulsive disorder
Administration
Escitalopram should generally be administered once daily, morning or evening with or without food.
Interactions
SSRI or related antidepressants should not be started until 2 weeks after stopping an MAOI. Conversely, an MAOI should not be started until at least a week after an SSRI or related antidepressant has been stopped.
Contraindications
Escitalopram is contraindicated in patients with known hypersensitivity to Escitalopram or Citalopram or any of the inactive ingredients of the drug product. Concomitant use of escitalopram in patients taking monoamine oxidase/pimozide is contraindicated.
Side effects
Side-effects of SSRIs include gastrointestinal effects, anorexia, weight loss or gain, hypersensitivity reactions, dry mouth, nervousness, anxiety, headache, insomnia, tremor, dizziness, asthenia, hallucinations, sexual dysfunction, urinary retention, sweating, movement disorders, and visual disturbances.
Pregnancy and lactation
When treating a pregnant woman with Escitalopram during the third trimester, the physician should carefully consider the potential risks and benefits of treatment. It is excreted in human breast milk. The decision whether to continue or discontinue either nursing or Escitalopram therapy should take into account the risk of citalopram exposure for the infant and the benefits of Escitalopram treatment for the mother.
Precautions and warnings
SSRIs should be used with caution in patients with epilepsy, history of mania, cardiac disease, diabetes mellitus, angle-closure glaucoma, concomitant use of drugs that increase risk of bleeding, hepatic and renal impairment.
Special populations
- Elderly patients: Initial dosage is 5 mg once daily and the efficacy in social anxiety disorder has not been studied.
- Children and adolescents: Not recommended in the treatment of children and adolescents under the age of 18 years
- Reduced renal function: Dosage adjustment is not necessary in patients with mild or moderate renal impairment. Caution is advised in patients with severely reduced renal function (CLCR less than 30 ml/min).
- Reduced hepatic function: An initial dose of 5 mg daily for the first two weeks of treatment is recommended in patients with mild or moderate hepatic impairment. Depending on individual patient response, the dose may be increased to 10 mg daily. Caution and extra careful dose titration is advised in patients with severely reduced hepatic function.
- Poor metabolizers of CYP2C19: For patients who are known to be poor metabolisers with respect to CYP2C19, an initial dose of 5 mg daily during the first two weeks of treatment is recommended. Depending on individual patient response, the dose may be increased to 10 mg daily. Discontinuation symptoms seen when stopping treatment. Abrupt discontinuation should be avoided.
- Discontinuation symptoms: When stopping treatment with escitalopram, the dose should be gradually reduced over a period of at least one to two weeks in order to reduce the risk of discontinuation symptoms. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered.
Overdose effects
- Symptoms: Symptoms seen in a reported overdose of escitalopram include CNS symptoms, gastrointestinal symptoms, cardiovascular symptoms, and electrolyte/fluid balance conditions.
- Management: There is no specific antidote. Establish and maintain an airway, ensure adequate oxygenation and respiratory function. Gastric lavage and the use of activated charcoal should be considered. Gastric lavage should be carried out as soon as possible after oral ingestion. Cardiac and vital signs monitoring are recommended along with general symptomatic supportive measures. ECG monitoring is advised in case of overdose, in patients with congestive heart failure/bradyarrhythmias, in patients using concomitant medications that prolong the QT-interval, or in patients with altered metabolism, e.g. liver impairment.
Therapeutic class
Selective serotonin reuptake inhibitor (SSRI) and related antidepressant drugs
Storage conditions
Store below 30°C temperature and protect from light & moisture. Keep the medicine out of the reach of children.