Lexapro

Lexapro Information

Lexapro (escitalopram oxalate) is an orally administered selective serotonin reuptake inhibitor (SSRI), and is used for the treatment of major depressive disorder.

How Does Lexapro Work?

The mechanism of antidepressant action of escitalopram, the S-enantiomer of racemic citalopram, is presumed to be linked to potentiation of serotonergic activity in the central nervous system resulting from its inhibition of CNS neuronal reuptake of serotonin (5-HT). In vitro and in vivo studies in animals suggest that escitalopram is a highly selective serotonin reuptake inhibitor (SSRI) with minimal effects on norepinephrine and dopamine neuronal reuptake. Escitalopram is at least 100 fold more potent than the R-enantiomer with respect to inhibition of 5-HT reuptake and inhibition of 5-HT neuronal firing rate.

Lexapro Ingredients and Composition

How To Take Lexapro and Lexapro Dosage and Administration

Initial treatment

The recommended dose of Lexapro is 10 mg once daily. Afixed dose trial of Lexapro demonstrated the effectiveness of both 10 mg and 20 mg of Lexapro, but failed to demonstrate a greater benefit of 20 mg over 10 mg (see Clinical Efficacy Trials under Clinical Pharmacology). If the dose is increased to 20 mg, this should occur after a minimum of one week.

Lexapro should be administered once daily, in the morning or evening, with or without food.

Maintenance Treatment

It is generally agreed that acute episodes of depression require several months or longer of sustained pharmacological therapy beyond response to the acute episode. Lexapro has not been evaluated in controlled, longer-term trials. However, systematic evaluation of racemic citalopram in two studies has demonstrated a benefit of maintaining treatment following response occurring during 6 to 8 weeks of initial treatment. In both studies, patients were observed for relapse during an observation period of up to 24 weeks. In one study, patients were assigned randomly to placebo or to the same dose of racemic citalopram (20-60 mg/day) during maintenance treatment as they had received during the acute stabilization phase, while in the other study, patients were assigned randomly to continuation of racemic citalopram 20 or 40 mg/day, or placebo, for maintenance treatment. In the latter study, the rates of relapse to depression were similar for the two dose groups. A third longer-term study has demonstrated the efficacy of racemic citalopram in maintaining an antidepressant response in patients with recurrent depression who had responded and continued to be improved during an initial 22-25 weeks of treatment and were then observed for relapse for a period of up to 72 weeks (see Clinical Efficacy Trials under Clinical Pharmacology). Patients should be periodically reassessed to determine the need for maintenance treatment and the appropriate dose for such treatment.

If you suspect a Lexapro Overdose

There have been three reports of Lexapro overdose involving doses of up to 600 mg. All three patients recovered and no symptoms associated with the overdoses were reported. In clinical trials of racemic citalopram, there were no reports of fatal citalopram overdose involving overdoses of up to 2000 mg. During the postmarketing evaluation of citalopram, like other SSRIs, a fatal outcome in a patient who has taken an overdose of citalopram has been rarely reported. Postmarketing reports of drug overdoses involving citalopram have included 12 fatalities, 10 in combination with other drugs and/or alcohol and 2 with citalopram alone (3920 mg and 2800 mg), as well as non-fatal overdoses of up to 6000 mg. Symptoms most often accompanying citalopram overdose, alone or in combination with other drugs and/or alcohol, included dizziness, sweating, nausea, vomiting, tremor, somnolence, sinus tachycardia, and convulsions. In more rare cases, observed symptoms included amnesia, confusion, coma, hyperventilation, cyanosis, rhabdomyolysis, and ECG changes (including QTc prolongation, nodal rhythm, ventricular arrhythmia, and one possible case of Torsades de pointes).

Overdose Management

Establish and maintain an airway to ensure adequate ventilation and oxygenation. Gastric evacuation by lavage and use of activated charcoal should be considered. Careful observation and cardiac and vital sign monitoring are recommended, along with general symptomatic and supportive care. Due to the large volume of distribution of escitalopram, forced diuresis, dialysis, hemoperfusion, and exchange transfusion are unlikely to be of benefit. There are no specific antidotes for Lexapro.

In managing overdosage, consider the possibility of multiple drug involvement. The physician should consider contacting a poison control center for additional information on the treatment of any overdose.

Lexapro Side Effects

Lexapro Precautions and Contraindications

Concomitant use in patients taking monoamine oxidase inhibitors (MAOI's) is contraindicated.

Lexapro is contraindicated in patients with a hypersensitivity to escitalopram or citalopram or any of the inactive ingredients in Lexapro.

Because psychoactive drugs may impair judgment, thinking or motor skills, patients should be cautioned about operating hazardous machinery, including automobiles, until they are reasonably certain that Lexapro therapy does not affect their ability to engage in such activities.

Patients should be told that, although citalopram has not been shown in experiments with normal subjects to increase the mental and motor skill impairments caused by alcohol, the concomitant use of Lexapro and alcohol in depressed patients is not advised.

Lexapro Experiences and Results

The efficacy of Lexapro in the treatment of major depressive disorder was established, in part, on the basis of extrapolation from the established effectiveness of racemic citalopram, of which escitalopram is the active isomer. In addition, the efficacy of escitalopram was shown in an 8-week controlled trial of outpatients whose diagnoses corresponded most closely to the DSM-IV category of major depressive disorder.

The efficacy of Lexapro in hospitalized patients with major depressive disorders has not been adequately studied. While the longer-term efficacy of Lexapro has not been systematically evaluated, the efficacy of racemic citalopram, of which escitalopram is the active isomer, in maintaining a response following 6 to 8 weeks of acute treatment in patients with major depressive disorder was demonstrated in two placebo-controlled trials, in which patients were observed for relapse for up to 24 weeks. The efficacy of racemic citalopram in maintaining a response in patients with recurrent major depressive disorder who had responded and continued to be improved during an initial 22-25 weeks of treatment and were then followed for a period of up to 72 weeks was demonstrated in a third placebo-controlled trial (see Clinical Pharmacology). Nevertheless, the physician who elects to use Lexapro for extended periods should periodically reevaluate the long-term usefulness of the drug for the individual patient.

Taking Lexapro during Pregnancy or Breast-feeding

There are no adequate and well-controlled studies in pregnant women; therefore, escitalopram should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Lexapro, like many other drugs, is excreted in human breast milk. There have been two reports of infants experiencing excessive somnolence, decreased feeding, and weight loss in association with breast feeding from a Lexapro-treated mother; in one case, the infant was reported to recover completely upon discontinuation of citalopram by its mother and, in the second case, no follow up information was available. The decision whether to continue or discontinue either nursing or Lexapro therapy should take into account the risks of citalopram exposure for the infant and the benefits of Lexapro treatment for the mother.