escitalopram: clinical use

Prescribing considerations

• Assess suicide and self-harm risk, particularly early in treatment and after treatment changes.
• Review for bipolar disorder or previous mania, epilepsy, diabetes, bleeding tendency, glaucoma, cardiac disease, hepatic or severe renal impairment and hyponatraemia risk.
• The selected product is not licensed for treating children or adolescents.
• Consider increased exposure in older people, hepatic impairment and CYP2C19 poor metabolisers or inhibitor co-administration.

Contraindications and cautions

• Hypersensitivity to escitalopram or product excipients
• Concurrent non-selective irreversible MAO inhibitors, reversible MAO-A inhibitors such as moclobemide, or linezolid
• Known QT-interval prolongation or congenital long-QT syndrome
• Concurrent medicines known to prolong the QT interval

Monitoring

• Clinical response, agitation, akathisia, worsening mood and suicidality
• ECG where cardiac disease or other QT-risk factors are present; investigate palpitations, syncope, vertigo or seizures
• Correct potassium or magnesium abnormalities before treatment when relevant
• Seizure frequency and signs of manic switching
• Bleeding, particularly with anticoagulants, antiplatelets or NSAIDs
• Serum sodium when symptoms or risk factors suggest hyponatraemia
• Glycaemic control in people with diabetes

Clinical pharmacology

Escitalopram is the S-enantiomer of citalopram and selectively inhibits serotonin reuptake. It is metabolised mainly through CYP2C19, with smaller contributions from CYP3A4 and CYP2D6; the parent medicine and metabolites are eliminated through hepatic and renal pathways.

Formulation and product differences

• The selected product is a film-coated tablet that may be taken with or without food.
• Other UK presentations include standard tablets, orodispersible tablets and liquid drops; administration instructions are formulation-specific.

Tablet

Route: Oral

Strengths: 5 mg, 10 mg, 20 mg