escitalopram oxalate: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
escitalopram oxalate: clinical details
Prescribing considerations
- Assess suicide risk and monitor closely during early treatment and after treatment changes, particularly in younger adults or those with previous suicidal behaviour.
- Review cardiac, bleeding, seizure, manic, diabetic, renal, hepatic and glaucoma history before prescribing.
- Use caution in severe renal impairment, hepatic impairment, controlled epilepsy, previous mania or hypomania, diabetes, bleeding disorders and angle-closure glaucoma.
- Review all medicines for serotonergic, QT-prolonging, bleeding and metabolic interactions.
Contraindications and cautions
- Hypersensitivity to escitalopram or formulation excipients
- Concurrent non-selective irreversible MAO inhibitors
- Concurrent moclobemide or linezolid
- Known QT prolongation or congenital long-QT syndrome
- Concurrent medicines known to prolong the QT interval
Monitoring
- Clinical response, adverse effects, restlessness, mania and suicidal thinking
- ECG where cardiac disease or arrhythmia risk warrants it; investigate palpitations, syncope, vertigo or seizures
- Correct low potassium or magnesium before treatment and consider electrolyte monitoring in at-risk patients
- Serum sodium if hyponatraemia is suspected or risk is increased
- Bleeding and coagulation control where clinically relevant, especially with oral anticoagulants
- Glycaemic control in people with diabetes
Clinical pharmacology
Escitalopram selectively inhibits serotonin reuptake. It is metabolised mainly through CYP2C19, with smaller contributions from CYP3A4 and CYP2D6, and inhibits CYP2D6.
Formulation and product differences
- Selected film-coated tablets may be swallowed with water; some are scored and divisible.
- The selected orodispersible tablet dissolves on the tongue, may be swallowed with or without water, is not divisible and contains lactose.
- The oral drops can be mixed with water, orange juice or apple juice, contain ethanol and should be used within eight weeks of opening and stored below the stated post-opening temperature.
escitalopram oxalate preparations and strengths
Dispersible tablet
Route: Oral
Strengths: 5 mg, 10 mg, 15 mg, 20 mg
Oral drops
Route: Oral
Strengths: 20 mg/mL
escitalopram oxalate interactions
Check prescribed, over-the-counter and herbal products before combining them with escitalopram.
Monoamine oxidase inhibitors, including moclobemide, and linezolid
These combinations are contraindicated because they can cause serotonin syndrome.
Medicines that prolong the QT interval
Combined use is contraindicated because effects on cardiac repolarisation may add together and cause dangerous arrhythmias.
Tramadol, other serotonergic opioids and triptans
The combination increases the risk of serotonin syndrome.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.