Overview
Concomitant administration of escitalopram and omeprazole 30 mg once a day (CYP2C19 inhibitor) led to a moderate (approximately 50%) increase in the concentration of escitalopram in blood plasma.
Concomitant administration of escitalopram and cimetidine 400 mg 2 times a day (a general inhibitor of medium-strength enzymes) led to a moderate (approximately 70%) increase in the concentration of escitalopram in blood plasma. Escitalopram should be combined with caution with cimetidine. Dose adjustment recommended.
Therefore, the drug should be gentle with caution with CYP2C19 inhibitors (such as omeprazole, esomeprazole, fluvoxamine, lansoprazole, ticlopidine) or cimetidine. After tracking side effects caused by the simultaneous use of other drugs, a dose reduction of escitalopram may be required.
The effect of escitalopram on the pharmacokinetics of other drugs
Escitalopram is an inhibitor of the enzyme CYP2D6. Caution should be exercised while using escitalopram and drugs with a narrow therapeutic range, which are mainly metabolized by this enzyme, for example flecainide, propafenone and metoprolol (for use in heart failure), or certain drugs that affect the central nervous system, which are mainly metabolized by CYP2D6, such as antidepressants, such as desipramine, clomipramine and nortriptyline or antipsychotics such as risperidone, thioridazine and haloperidol. Dose adjustment may be recommended.
Concomitant use of the drug with desipramine or metoprolol led to a twofold increase in the concentration of these CYP2D6 substrates in plasma.
Research in vitro showed that escitalopram may also be a weak inhibitor of CYP2C19. It is recommended to use the drug with caution along with drugs metabolized pill CYP2C19
Special instructions and precautions:
Children's age under 18 is a contraindication for the use of escitalopram, since the effectiveness and safety of its use at this age have not been established.
Due to the possibility of suicidal attempts, in patients with depression it is necessary to carefully monitor patients at the beginning of treatment and to prescribe the minimum effective doses to reduce the risk of overdose. This precaution should also be observed in the treatment of other mental disorders because of the possibility of a simultaneous illness with a depressive episode.
Severe depression is characterized by a risk of suicidal actions, which can persist until significant remission is achieved. In this regard, at the beginning of treatment, constant medical supervision, supervision of patient behavior and the organization of storage and distribution of medicines only by authorized persons are necessary. In the treatment of panic disorders with the appointment of antidepressants and / or benzodiazepines, in some patients, in demonstrate to the treatment started, anxiety or anxiety is significantly increased. This condition, called by specialists “pathological disinhibition” or simply “paradoxical anxiety”, is regarded as a rare phenomenon, although this pathological reaction has been repeatedly documented in the scientific literature. This “paradoxical anxiety” usually decreases within the first two weeks after starting treatment. It is recommended that you start with a low dose to reduce the risk of paradoxical anxiety. In this case, drug withdrawal is recommended if such a paradoxical reaction does not capsule for a long time, and if such complications of therapy exceed the benefit of the treatment.
In children, adolescents and young people (under 24 years old) with depression and other mental disorders, antidepressants, compared with placebo, increase the risk of suicidal thoughts and suicidal behavior. Therefore, when prescribing the drug Escitalopram or any other antidepressants in this category of patients, the risk of suicide and the benefits of their use should be correlated. In gentle studies in people over 24 years of age, the risk of suicide did not increase, while in people over 65 years of age it decreased slightly. During antidepressant treatment, all patients should be monitored for the early detection of behavioral disorders, as well as suicidal tendencies.
Escitalopram can cause a dose-dependent prolongation of the QT interval on the ECG, which can lead to heart rhythm disturbance.
Hyponatremia develops due to impaired secretion of antidiuretic hormone, especially a high level of risk in older women.
Against the background of taking escitalopram, actually hemorrhages (ecchymosis and purpura) may develop. It is necessary to use the drug with caution in patients at risk of bleeding, as well as taking oral anticoagulants and drugs that affect blood coagulation.
Escitalopram treatment may alter glycemic control in patients with diabetes mellitus. The dose of insulin and / or oral hypoglycemic agents should be adjusted.
It is rarely possible to develop akathisia, characterized by a constant or periodically arising feeling of internal motor anxiety and manifested in the inability to sit quietly in one position for a long time or to remain motionless for a long time. Passes during the first weeks of treatment.
Patients with bipolar disorder or with mania / hypomania have a history of mania. Then treatment with escitalopram should be discontinued.
It is necessary to use Escitalopram with caution in the presence of drug dependence (including a history) and a history of epileptic seizures. In the case of convulsive seizures, as well as in patients with epilepsy with an increase in the frequency of gentle seizures, the drug Escitalopram, as well as other drugs of the SSRI group, should be discontinued. Not recommended for use in patients with unstable epilepsy.
Escitalopram should not be used in combination with monoamine oxidase inhibitors (MAO).
For mild to moderate impaired renal function, dose adjustment is not required; for severe renal impairment, caution is required. In case of impaired liver function, the drug is limited to the minimum recommended doses. Elderly patients require escitalopram dose reduction.
