Escitalopram

CLINICAL USE

SSRI antidepressant:Depressive illness Panic and social anxiety disorder

DOSE IN NORMAL RENAL FUNCTION

Antidepressant:

  • 10 to 20     : mg dailyPanic and social anxiety disorder: 5–20 mg

    PHARMACOKINETICS

  • Molecular weight                           :414.4 (as Oxalate)
  • %Protein binding                           :<80
  • %Excreted unchanged in urine     : 8
  • Volume of distribution (L/kg)       :12–26
  • half-life – normal/ESRD (hrs)      :22–32/slightly increased

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

    30–50 Dose as in normal renal function10–30 Dose as in normal renal function. Start with a low dose and titrate slowly

  • <10           : Dose as in normal renal function. Start with a low dose and titrate slowly

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD                :Unlikely to be dialysed. Dose as in GFR <10 mL/min
  • HD                     :Not dialysed. Dose as in GFR <10 mL/min
  • HDF/high flux   :Not dialysed. Dose as in GFR <10 mL/min
  • CAV/VVHD      :Unlikely to be dialysed. Dose as in GFR=10–30 mL/min

    IMPORTANT DRUG INTERACTIONS

    Potentially hazardous interactions with other drugs

  • Analgesics: increased risk of bleeding with aspirin and NSAIDs; risk of CNS toxicity increased with tramadol
  • Anticoagulants: effect of coumarins possibly enhanced
  • Antidepressants: avoid concomitant use with MAOI, increased risk of toxicity; increased risk of CNS toxicity with moclobemide – avoid concomitant use; avoid concomitant use with St John’s wort; possibly enhanced serotonergic effects with duloxetine; can increase concentration of tricyclics; increased agitation and nausea with tryptophan
  • Anti-epileptics: convulsive threshold lowered
  • Antimalarials: avoid concomitant use with artemether/lumefantrine
  • Antivirals: plasma concentration possibly increased by ritonavir
  • Dopaminergics: use selegiline with caution; increased risk of CNS toxicity with rasagiline5HT 1 agonist: increased risk of CNS toxicity with sumatriptan; possibly increased risk of serotonergic effects with frovatriptanLinezolid: use with care, possibly increased risk of side effects
  • Lithium: increased risk of CNS effects
  • Sibutramine: increased risk of CNS toxicity – avoid concomitant use

    ADMINISTRATION

    Reconstition

    –

    Route

    Oral

    Rate of Administration

    –

    Comments

    Oral drops: 20 drops = 10 mg

    OTHER INFORMATION

    Escitalopram is an isomer of citalopram

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