Escitalopram (Lexapro®) for Hot Flashes
- 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
Lexapro (Escitalopram oxalate), the active S-enantiomer of racemic citalopram, is highly selective SSRI antidepressant indicated for the treatment of Major depressive disorder and and anxiety disorders. Escitalopram has a favourable tolerability profile, and seems to have a rapid onset of therapeutic effect. Research data suggests 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.
Efficacy for Hot flashes
About 70% of women experience hot flashes as they pass through memnopause. Hot flashes gradually lessen in frequency and intensity with advancing age. Hot flushes are characterized by the sudden increase in body temperature caused by declining estrogen levels. Frequent flashes at night (night sweats) may impair the quality of sleep.
Escitalopram (Lexapro) is used off-label to treat menopausal hot flashes. Several clinical trials demonstrated escitalopram efficacy for reducing menopausal hot flashes10-12. However, one study found only negligible benefits of escitalopram 8.
Dosage for hot flashes: 10-20 mg per day.
- Non-hormonal treatment, suitable for women who have contraindications for Hormone replacement therapy (HRT) or those who do not wish to take HRT.
- Alleviates the frequency, severity, and impact of hot flashes on quality of life 10, 11
- Reduces menopause-related pain 12
- Improves insomnia symptoms and sleep quality 7
- Well-tolerated with favorable side-effect profile. Relatively low incidence of sexual side effects, weight gain, and sedation.
- Not FDA approved for the treatment of menopausal hot flashes.
- Escitalopram does not eliminate hot flashes -- the symptoms return once you stop the treatment.
- Some clinical research does NOT support escitalopram efficacy 8
- High rate of headaches and nausea 9
- 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
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.
- Lexapro (escitalopram oxalate) Prescribing Information PDF
- 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. 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
- 7. Ensrud KE, Joffe H, Guthrie KA, et al. Effect of escitalopram on insomnia symptoms and subjective sleep quality in healthy perimenopausal and postmenopausal women with hot flashes: a randomized controlled trial. Menopause. 2012 Aug;19(8):848-55. PubMed
- 8. Freedman RR, Kruger ML, Tancer ME. Escitalopram treatment of menopausal hot flashes. Menopause. 2011 Aug;18(8):893-6. PubMed
- 9. Findling RL, Robb A, Bose A. Escitalopram in the treatment of adolescent depression: a randomized, double-blind, placebo-controlled extension trial. J Child Adolesc Psychopharmacol. 2013 Sep;23(7):468-80. PubMed
- 10. Freeman EW, Guthrie KA, Caan B. et al. Efficacy of escitalopram for hot flashes in healthy menopausal women: a randomized controlled trial. JAMA. 2011 Jan 19;305(3):267-74. PubMed
- 11. Carpenter JS, Guthrie KA, Larson JC, Freeman EW, Joffe H, Reed SD, Ensrud KE, LaCroix AZ. Effect of escitalopram on hot flash interference: a randomized, controlled trial. Fertil Steril. 2012 Jun;97(6):1399-404. PubMed
- 12. LaCroix AZ, Freeman EW, Larson J, et al. Effects of escitalopram on menopause-specific quality of life and pain in healthy menopausal women with hot flashes: a randomized controlled trial. Maturitas. 2012 Dec;73(4):361-8 PubMed
- 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.
- Escitalopram was the last SSRI developed for the treatment of depression.