Escitalopram

CLINICAL USE

SSRI antidepressant:Depressive illness Panic and social anxiety disorder

DOSE IN NORMAL RENAL FUNCTION

Antidepressant:

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

PHARMACOKINETICS

Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :414.4 (as Oxalate)

%Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :<80

%Excreted unchanged in urine &nbsp &nbsp : 8

Volume of distribution (L/kg) &nbsp &nbsp &nbsp :12–26

half-life – normal/ESRD (hrs)&nbsp &nbsp &nbsp :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 &nbsp &nbsp &nbsp &nbsp &nbsp : Dose as in normal renal function. Start with a low dose and titrate slowly

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp:Unlikely to be dialysed. Dose as in GFR <10 mL/min

HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Not dialysed. Dose as in GFR <10 mL/min

HDF/high flux &nbsp :Not dialysed. Dose as in GFR <10 mL/min

CAV/VVHD &nbsp &nbsp &nbsp: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

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Route

Oral

Rate of Administration

–

Comments

Oral drops: 20 drops = 10 mg

OTHER INFORMATION

Escitalopram is an isomer of citalopram

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