Escitalopram (Oral route)
Antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults with major depressive disorder (MDD) and other psychiatric disorders in short-term studies. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared with placebo in adults beyond age 24, and there was a reduction in risk with antidepressants compared with placebo in adults aged 65 or older. This risk must be balanced with the clinical need. Monitor patients closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Not approved for use in pediatric patients less than 12 years of age .
Serotonin Reuptake Inhibitor
Uses of This Medicine:
Escitalopram is used to treat depression and generalized anxiety disorder (GAD). It is an antidepressant that belongs to a group of medicines known as selective serotonin reuptake inhibitors (SSRIs). These medicines work by increasing the activity of the chemical serotonin in the brain.
This medicine is available only with your doctor's prescription.
Before Using This Medicine:
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:
Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of escitalopram in children 12 years of age and older with depression. However, safety and efficacy have not been established in children less than 12 years of age. Escitalopram may cause weight loss or a decrease in appetite. Teenagers who will be taking it for a long time should have their weight and growth measured on a regular basis.
Appropriate studies have not been performed on the relationship of age to the effects of escitalopram in children with generalized anxiety disorder. Safety and efficacy have not been established.
Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of escitalopram in the elderly. However, elderly patients are more likely to have hyponatremia (low sodium in the blood) and age-related liver problems, which may require caution and an adjustment in the dose for patients receiving escitalopram.
Studies in women breastfeeding have demonstrated harmful infant effects. An alternative to this medication should be prescribed or you should stop breastfeeding while using this medicine.
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Methylene Blue
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Amtolmetin Guacil
- Antithrombin III Human
- Aripiprazole Lauroxil
- Arsenic Trioxide
- Choline Salicylate
- Dabigatran Etexilate
- Dermatan Sulfate
- Drotrecogin Alfa
- Eslicarbazepine Acetate
- Flufenamic Acid
- Inotuzumab Ozogamicin
- Iobenguane I 123
- Iobenguane I 131
- Mefenamic Acid
- Morphine Sulfate Liposome
- Niflumic Acid
- Nimesulide Beta Cyclodextrin
- Opium Alkaloids
- Pentosan Polysulfate Sodium
- Protein C
- Salicylic Acid
- Sodium Phosphate
- Sodium Phosphate, Dibasic
- Sodium Phosphate, Monobasic
- Sodium Salicylate
- St John's Wort
- Tiaprofenic Acid
- Tolfenamic Acid
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Other medical problems—
The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:
- Bipolar disorder (mood disorder with mania and depression), or risk of or
- Bleeding problems or
- Glaucoma, angle-closure or
- Hyponatremia (low sodium in the blood) or
- Mania, history of or
- Seizures, history of—Use with caution. May make these conditions worse.
- Kidney disease, severe or
- Liver disease—Use with caution. The effects may be increased because of slower removal of the medicine from the body.
Proper Use of This Medicine:
Take this medicine only as directed by your doctor to benefit your condition as much as possible. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.
This medicine should come with a Medication Guide. Read and follow these instructions carefully. Ask your doctor or pharmacist if you have any questions.
Escitalopram may be taken with or without food. If your doctor tells you to take it at a specific time, follow your doctor's instructions.
If you are using the oral liquid, shake the bottle well before measuring each dose. Use a marked measuring spoon, oral syringe, or medicine cup to measure each dose. The average household teaspoon may not hold the right amount of liquid.
You may have to take escitalopram for a month or longer before you begin to feel better.
The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
- For oral dosage forms (solution or tablets):
- For depression:
- Adults and children 12 years of age and older—10 milligrams (mg) once a day, taken either in the morning or evening. Your doctor may adjust your dose as needed. However, the dose is usually not more than 20 mg per day.
- Older adults—10 mg once a day, taken either in the morning or evening.
- Children younger than 12 years of age—Use and dose must be determined by your doctor.
- For generalized anxiety disorder:
- Adults—At first, 10 milligrams (mg) once a day, taken either in the morning or evening. Your doctor may adjust your dose as needed. However, the dose is usually not more than 20 mg per day.
- Older adults—10 mg once a day, taken either in the morning or evening.
- Children—Use and dose must be determined by your doctor.
- For depression:
If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.
Keep out of the reach of children.
Do not keep outdated medicine or medicine no longer needed.
Ask your healthcare professional how you should dispose of any medicine you do not use.
Precautions While Using This Medicine:
It is very important that your doctor check your progress at regular visits to allow for changes in your dose and to help reduce any side effects. Blood tests may be needed to check for any unwanted effects.
Do not take escitalopram with a monoamine oxidase (MAO) inhibitor (eg, isocarboxazid [Marplan®], linezolid (Zyvox®), methylene blue injection, phenelzine [Nardil®], selegiline [Eldepryl®], tranylcypromine [Parnate®]). Do not start taking escitalopram during the 2 weeks after you stop a MAO inhibitor and wait 2 weeks after stopping escitalopram before you start taking a MAO inhibitor. If you take them together or do not wait 2 weeks, you may develop confusion, agitation, restlessness, stomach or intestinal symptoms, a sudden high body temperature, an extremely high blood pressure, or severe convulsions.
Do not take escitalopram with pimozide (Orap®). Using these medicines together can cause very serious heart problems.
Escitalopram may cause some teenagers and young adults to be agitated, irritable, or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. Some people may have trouble sleeping, get upset easily, have a big increase in energy, or start to act reckless. If you or your caregiver notice any of these unwanted effects, tell your doctor right away. Let the doctor know if you or anyone in your family has bipolar disorder (manic-depressive) or has tried to commit suicide.
Escitalopram may cause a serious condition called serotonin syndrome if taken together with some medicines. Do not use escitalopram with buspirone (Buspar®), fentanyl (Abstral®, Duragesic®), lithium (Eskalith®, Lithobid®), tryptophan, St. John's wort, amphetamines, or some pain or migraine medicines (eg, rizatriptan, sumatriptan, tramadol, Frova®, Imitrex®, Maxalt®, Relpax®, Ultram®, Zomig®). Check with your doctor first before taking any other medicines with escitalopram.
Do not suddenly stop taking this medicine without checking first with your doctor. Your doctor may want you to gradually reduce the amount you are taking before stopping it completely. This will decrease the chance of having withdrawal symptoms such as increased anxiety, burning or tingling feelings, confusion, dizziness, headache, irritability, nausea, trouble sleeping, or unusual tiredness or weakness.
This medicine may increase your risk for bleeding problems. Make sure your doctor knows if you are also taking other medicines that thin the blood, such as aspirin, nonsteroidal antiinflammatory agents, also called NSAIDs (eg, diclofenac, ibuprofen, naproxen, Advil®, Aleve®, Celebrex®, Voltaren®), or warfarin (Coumadin®, Jantoven®).
This medicine may cause hyponatremia (low sodium in the blood). This is more common in elderly patients, those who are taking diuretic medicines for high blood pressure, or those who have decreased amounts of fluid in the body due to severe diarrhea or vomiting. Check with your doctor right away if you have confusion, headache, memory problems, trouble concentrating, weakness, or unsteadiness.
This medicine may cause some people to become drowsy, to have trouble with thinking or controlling body movements. Make sure you know how you react to escitalopram before you drive, use machines, or do anything else that could be dangerous if you are not alert or well-coordinated.
The use of alcohol is not recommended in patients who are taking escitalopram.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.
Side Effects of This Medicine:
- decreased urine output
- fast or irregular heartbeat
- increased thirst
- muscle pain or cramps
- nausea or vomiting
- shortness of breath
- swelling of the face, ankles, or hands
- unusual tiredness or weakness
- More common
- decreased interest in sexual intercourse
- dry mouth
- ejaculation delay
- gas in the stomach
- inability to have or keep an erection
- loss in sexual ability, desire, drive, or performance
- sleepiness or unusual drowsiness
- trouble sleeping
- Less common
- Bloated or full feeling
- burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
- decreased appetite
- excess air or gas in the stomach or intestines
- general feeling of discomfort or illness
- increased sweating
- joint pain
- muscle aches and pains
- not able to have an orgasm
- pain in the neck or shoulders
- pain or tenderness around the eyes and cheekbones
- passing gas
- runny nose
- sore throat
- stuffy nose
- tightness of the chest
- tooth problems
- trouble breathing
- unusual dreams
- unusual drowsiness, dullness, tiredness, weakness or feeling of sluggishness
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Last Updated: 9/5/2019