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Lexapro (Escitalopram)
- Generic name: escitalopram oxalate
- Brand/Trade names: Lexapro
- Pharmacologic category: Selective serotonin
reuptake inhibitor, Antidepressant
- FDA approved: August 14, 2002
- Manufacturer: Forest Pharmaceuticals, Inc.
- Habit forming? No
- Pregnancy risk factor: C
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Medical Uses
Lexapro (Escitalopram Oxalate), the S-enantiomer of RS-citalopram
and a highly selective SSRI, is an effective antidepressant in
the treatment of Major depressive disorder. It has a favourable
tolerability profile, and appears to have a rapid onset of therapeutic
effect. Modelled pharmacoeconomic analyses suggest that it may
be a cost-effective alternative to citalopram,
fluoxetine, and sertraline. Overall, clinical and pharmacoeconomic
data support the use of escitalopram as first-line therapy for depression [1].
The most common side effects with Lexapro are nausea, insomnia,
ejaculation disorder, somnolence, increased sweating, fatigue,
decreased libido, and anorgasmia. |
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Pharmacological characteristics
- Absorption: Absorption is expected to be almost complete
and independent of food intake.
- Metabolism: Hepatic via CYP2C19 and 3A4 to an active
metabolite, S-desmethylcitalopram (S-DCT; 1/7 the activity);
S-DCT is metabolized to S-didesmethylcitalopram (S-DDCT; active;
1/27 the activity) via CYP2D6
- Excretion: Urine (Escitalopram: 8%; S-DCT: 10%)
- Elimination half-life: Escitalopram: 27-32 hours; S-desmethylcitalopram:
59 hours
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Advantages
- most selective of all SSRIs
- favorable side-effect profile
- more effective than citalopram and some other SSRIs in the
treatment of major depression
- works quickly - more rapid onset of effect than other SSRIs,
improvements are noted at week 1 or 2 [2]
- fewer problems with discontinuation than either paroxetine
and venlafaxine [3]
- superior efficacy in comparison with conventional SSRIs,
particularly in the treatment of more severe depression
- relatively low incidence of sexual side effects and weight
gain
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Concerns
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Unlabeled Uses
- panic disorder [4]
- social anxiety disorder [5]
- posttraumatic stress disorder
- premenstrual dysphoric disorder [6]
- bipolar disorder
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Mechanism of Action
Escitalopram is the S-enantiomer of the racemic derivative citalopram,
which selectively inhibits the reuptake of serotonin with little
to no effect on norepinephrine or dopamine reuptake. It has no
or very low affinity for 5-HT1-7, alpha- and beta-adrenergic,
D1-5, H1-3, M1-5, and benzodiazepine receptors. It does
not bind or has low affinity for Na+, K+, Cl-, and Ca++ ion channels. |
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Discussions Boards & Forums
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References
- Lexapro official website
- Escitalopram on MedlinePlus
- 1. Croom KF, Plosker GL. Escitalopram: a pharmacoeconomic
review of its use in depression. Pharmacoeconomics. 2003;21(16):1185-209.
- 2. Wade A, Friis Andersen H. The onset of effect for escitalopram
and its relevance for the clinical management of depression.
Curr Med Res Opin. 2006 Nov;22(11):2101-10. PubMed
- 3. Baldwin DS, Montgomery SA, Nil R, Lader M. Discontinuation
symptoms in depression and anxiety disorders. Int J Neuropsychopharmacol.
2007 Feb;10(1):73-84. PubMed
- 4. 13. Stahl SM, Gergel I, Li D. Escitalopram in the treatment
of panic disorder: a randomized, double-blind, placebo-controlled
trial. J Clin Psychiatry. 2003 Nov;64(11):1322-7. PubMed
- 5. Stein DJ, Kasper S, Andersen EW, Nil R, Lader M. Escitalopram
in the treatment of social anxiety disorder: analysis of efficacy
for different clinical subgroups and symptom dimensions. Depress
Anxiety. 2004;20(4):175-81.
- 6. 15. Freeman EW, Sondheimer SJ, Sammel MD, Ferdousi T, Lin
H. A preliminary study of luteal phase versus symptom-onset
dosing with escitalopram for premenstrual dysphoric disorder.
J Clin Psychiatry. 2005 Jun;66(6):769-73. PubMed
Last modified: August, 2010 |
Interesting facts
- Lexapro is the newest and most selective of the
selective serotonin reuptake inhibitors approved by the FDA for
the treatment of depression.
- It is a cleaner, improved version of Celexa.
- In fact, 47% of patients who did not respond to Celexa treatment
responded to treatment with Lexapro.
- This medication seems to offer a less complicated pharmacokinetic profile
and better tolerability.
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