In the U.S.—

• Antianxiety agent
• Antidepressant

Escitalopram (ess-sit-AL-oh-pram ) is used to treat mental depression.

Escitalopram belongs to a group of medicines known as selective serotonin reuptake inhibitors (SSRIs). These medicines are thought to work by increasing the activity of the chemical serotonin in the brain.

This medicine is available only with your doctor's prescription, in the following dosage forms:

Oral
• Oral Solution (U.S.)
• Tablets (U.S.)

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 escitalopram, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to escitalopram or citalopram (e.g. Celexa). Also tell your doctor and pharmacist if you are allergic to any other substances, such as foods, preservatives (e.g. parabens), or dyes.

Pregnancy—Studies have not been done in pregnant women. However, studies in animals in medicines similar to this one have shown that it may cause decreased survival rates and slowed growth in offspring when given to the mother in doses many times higher than the usual human dose. Before taking this medicine, make sure your doctor knows if you are pregnant or if you may become pregnant.

Breast-feeding—It is not known whether escitalopram passes into breast milk. A similar drug has been found to pass into breast milk and it may cause unwanted effects, such as drowsiness, decreased feeding, and weight loss in the breast-fed baby. It may be necessary for you to take another medicine or to stop breast-feeding during treatment. Be sure you have discussed the risks and benefits of the medicine with your doctor.

Children—Studies on this medicine have been done only in adult patients, and there is no specific information comparing use of escitalopram in children with use in other age groups.

Older adults—This medicine has been tested in elderly patients and has not been shown to cause different side effects or problems in older people than it does in younger adults. However, escitalopram is removed from the body more slowly in older people and an older person may need a lower dose than a younger adult.

Other medicines—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 escitalopram, it is especially important that your doctor and pharmacist know if you are taking any of the following:

• Alcohol—It is not recommended that alcohol be consumed while taking escitalopram.

• Citalopram (e.g., Celexa)—This medicine is very similar to escitalopram and should not be given at the same time

• Linezolid (e.g., Zyvox) or
• Monoamine oxidase (MAO) inhibitor activity (isocarboxazid [e.g., Marplan], phenelzine [e.g., Nardil], procarbazine [e.g., Matulane], selegiline [e.g., Eldepryl], tranylcypromine [e.g., Parnate])— Do not take escitalopram while you are taking or within 2 weeks of taking an MAO inhibitor. If you do, you may develop confusion, agitation, restlessness, stomach or intestinal symptoms, sudden high body temperature, extremely high blood pressure, severe convulsions, or the serotonin syndrome. At least 14 days should pass between stopping treatment with one medicine (escitalopram or the MAO inhibitor) and starting treatment with the other

• Sumatriptan (e.g., Imitrex)—Use with escitalopram may cause certain unwanted side effects and you should be watched by your doctor.

• Diseases affecting metabolism or diseases involving blood circulation —caution should be used in patients with these medical problems

• Drug Abuse, history of—potential for increased dependence on medicine

• Heart disease (unstable) or
• Myocardial infarction (heart attack) recent history of—The effects of escitalopram in patients with these conditions are not known.

• Kidney disease, severe— Until enough patients have been evaluated, caution is recommended for patients with severe kidney disease.

• Liver disease—Higher blood levels of escitalopram may occur, increasing the chance of having unwanted effects. You may need to take a lower dose than a person without liver disease.

• Mania or hypomania (history of)—Use of escitalopram may activate these conditions.

• Seizure disorders (history of)—The risk of having seizures may be increased.

Take this medicine only as directed by your doctor to help 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.

Escitalopram may be taken with or without food on a full or empty stomach. If your doctor tells you to take it a certain way, follow your doctor's instructions.

You may have to take escitalopram for 1 to 4 weeks before you begin to feel better.

Do not stop taking this medication without checking first with your doctor

Dosing—

The dose of escitalopram 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 escitalopram. If your dose is different, do not change it unless your doctor tells you to do so.

The number of tablets that you take depends on the strength of the medicine.

• For oral dosage form (oral solution):
  • For depression:
    • Adults—To start, usually 10 milligrams (mg) once a day, taken either in the morning or evening. Your doctor may increase your dose gradually if needed. However, the dose usually is not more than 20 mg a day.
    • Older adults and patients with liver problems—Usually 10 milligrams (mg) once a day, taken either in the morning or evening.
    • Children—Use and dose must be determined by your doctor.
  • For anxiety:
    • Adults—To start, usually 10 milligrams (mg) once a day, taken either in the morning or evening. Your doctor may increase your dose gradually if needed. However, the dose usually is not more than 20 mg a day.
    • Older adults and patients with liver problems—Usually 10 milligrams (mg) once a day, taken either in the morning or evening.
    • Children—Use and dose must be determined by your doctor.
• For oral dosage form (tablets):
  • For depression:
    • Adults—To start, usually 10 milligrams (mg) once a day, taken either in the morning or evening. Your doctor may increase your dose gradually if needed. However, the dose usually is not more than 20 mg a day.
    • Older adults and patients with liver problems—Usually 10 milligrams (mg) once a day, taken either in the morning or evening.
    • Children—Use and dose must be determined by your doctor.
  • For anxiety:
    • Adults—To start, usually 10 milligrams (mg) once a day, taken either in the morning or evening. Your doctor may increase your dose gradually if needed. However, the dose usually is not more than 20 mg a day.
    • Older adults and patients with liver problems—Usually 10 milligrams (mg) once a day, taken either in the morning or evening.
    • Children—Use and dose must be determined by your doctor.

Missed dose—

Because escitalopram may be taken by different patients at different times of the day, you and your doctor should discuss what to do if you miss any doses.

Storage—

To store this medicine:

• Keep out of the reach of children.
• Do not store in the bathroom, near the kitchen sink, or in other damp places. heat or moisture may cause the medicine to break down.

It is important that your doctor check your progress at regular visits, to allow for changes in your dose and to help reduce any side effects.

Do not take escitalopram with or within 14 days of taking a drug with Monoamine oxidase (MAO) inhibitor activity (isocarboxazid [e.g., Marplan], phenelzine [e.g., Nardil], procarbazine [e.g., Matulane], selegiline [e.g., Eldepryl], tranylcypromine [e.g., Parnate]). Do not take an MAO inhibitor within 14 days of taking escitalopram. If you do, you may develop extremely high blood pressure or convulsions (seizures).

Avoid drinking alcoholic beverages while you are taking escitalopram.

This medicine may cause some people to become drowsy, to have trouble thinking, or to have problems with movement. Make sure you know how you react to citalopram before you drive, use machines, or do anything else that could be dangerous if you are not alert or well-coordinated.

Contact your doctor right away if you are unusually agitated, irritable, or have thoughts about hurting or killing yourself.

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:

• Rare
  • Coma;  confusion;  convulsions;  decreased urine output;  dizziness;  fast or irregular heartbeat ;  headache;  increased thirst ;  muscle pain or cramps;  nausea or vomiting;  shortness of breath;  swelling of face, ankles, or hands;  unusual tiredness or weakness 
  
  

Other 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. However, check with your doctor if any of the following side effects continue or are bothersome.

• More common
  • Constipation;  decreased interest in sexual intercourse;  diarrhea;  dizziness;  dry mouth;  ejaculation delay;  gas in stomach;  heartburn;  inability to have or keep an erection ;  impotence;  increased sweating ;  loss in sexual ability desire, drive, or performance ;  nausea;  stomach pain ;  sleeplessness;  trouble sleeping;  unable to sleep;  sleepiness or unusual drowsiness 
  
  

• Less common
  • Abdominal pain;  chills;  cough;  decreased appetite;  diarrhea;  fever;  general feeling of discomfort or illness;  headache ;  joint pain;  loss of appetite ;  muscle aches and pains;  nausea;  not able to have an orgasm;  pain or tenderness around eyes and cheekbones;  runny nose;  shivering;  shortness of breath or troubled breathing;  sneezing ;  sore throat;  stuffy nose ;  sweating;  tightness of chest or wheezing;  trouble sleeping;  unusual tiredness or weakness;  vomiting  
  
  

Other side effects may occur after you stop taking the medicine. 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:

• Less common
  • Ejaculation delay;  nausea 
  
  

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.