escitalopram LEXAPRO
Class: SSRIFDA Indications: MDD, GAD
Off-Label Use: Fibromyalgia, Agitation In Alzheimers Disease
Prescribing
Forms: 5, 10, 20mg tablet; 5mg/5mL po solnDose Range: 5-20 mg/day
Starting: Start at 5 mg QHS because initial sedation is common. Target dose of 10-20 mg for most patients.
Precautions
Contraindications: Concomitant use of MAOIsSerious Side Effects: Serotonin syndrome; ↑ risk of SI in children and young adults; may impair platelet aggregation; SIADH
Known Risk of TdP
Side Effects: nausea, fatigue, sexual dysfunction, insomnia
Pharmacodynamics
1° MOA: Selective serotonin reuptake inhibitorTarget: SERT
Pharmacokinetics
t½: 30 (27-33)° TMAX: 3-4°Substrate of: 3A4, 2C19
Inhibits: 2D6 (mild); Induces: ∅
Active Metabolites: ∅
DDIs
- - DO NOT CO-PRESCRIBE WITH MAOIs
- - lowest potential for drug interactions among the SSRIs
Misc
- - S-isomer of citalopram
- - most selective serotonin reuptake inhibitor
- -
2nd highest risk of QTc prolongation in its class; mean QTc prolongation at various doses
- 10mg: 4.5ms
- 20mg: 6.6ms
- 30mg: 10.7ms
- - has the fewest side effects of all the SSRIs
- - linear & dose-proportional pharmacokinetics
Special Populations
Category C—Human pregnancy experience is limited. Animal data suggest that risk to an embryo-fetus is low. Two large case-control studies did find ↑ risks for some birth defects, but the absolute risk appears to be low. A large prospective cohort that adjusted for many confounders did not find an ↑'d risk. However, SSRIs have been assoc w/ developmental toxicities, including SABs, ↓ birth weight, prematurity, neonatal serotonin syndrome, neonatal behavioral syndrome (withdrawal), respiratory distress, and PPHN
RID 3-8.3%; ∅AE's were reported in 2 case reports
Clearance values ~30% ↓ than younger controls; has been associated with cases of clinically significant hyponatremia in elderly patients
No dosing adjustment required in moderate renal impairment
10 mg is the recommended dose for most hepatically impaired patients