Overview
Overdose treatment: no specific antidote. Symptomatic and supportive treatment: gastric lavage (as soon as possible after taking the drug inside), ensure airway patency, adequate oxygenation and ventilation. ECG monitoring of the function of the cardiovascular system is recommended (possible arrhythmias, including fatal ones) and monitoring of the respiratory system
Use during pregnancy and lactation:
Escitalopram should not be prescribed to pregnant and breast-feeding women, if the potential clinical benefit does not prevail over the theoretical risk, because the safety of the drug during pregnancy and lactation in women is not established.
Embryofetotoxicity was observed in rats during studies of the reproductive toxicity of escitalopram in rats, but an increase in the number of congenital malformations was not found. If escitalopram continued in the late stages of pregnancy, especially in the third trimester, then the newborn should be monitored.
If the administration of escitalopram continued allow the birth or was stopped shortly before the birth, the newborn may develop a "withdrawal" syndrome. If the mother uses selective serotonin reuptake inhibitors or selective serotonin and norepinephrine reuptake inhibitors (SSRIs), the following side effects may develop in the newborn: persistent pulmonary hypertension, respiratory failure, cyanosis, apnea, convulsive disordersfeeding difficulties, vomiting, hypoglycemia, hypertension, muscle hypotension, hyperreflexia, tremor, increased neuro-reflex irritability, irritate flaccidity, lethargic sleep, constant crying, drowsiness, or insomnia. These symptoms may occur due to the development of the "withdrawal" syndrome or serotonergic action. In most cases, such complications occur within 24 hours after birth.
Epidemiological data suggest that the use of SSRIs / SSRIs during pregnancy, especially in the later stages, may increase the risk of developing stable pulmonary hypertension in newborns with a frequency of up to 5 cases per 1000 with a frequency in the general population of 1-2 per 1000.
The drug is excreted in small amounts in breast milk, therefore, when taking the drug during lactation, it is recommended to resolve the issue of stopping breastfeeding.
Animal studies have shown that escitalopram can affect sperm quality. Cases from medical practice, including the use of Mylan-Escitalopram, have shown that the effect on sperm quality is reversible. So far, no effects on human fertility have been detected.
Interaction with other drugs:
Combined use is contraindicated
With irreversible non-selective MAO inhibitors
Cases of serious adverse reactions have been reported in patients receiving combination therapy with SSRIs and irreversible non-selective MAO inhibitors, as well as in patients who recently discontinued SSRI therapy and started therapy with such MAO medical. In some cases, patients developed serotonin syndrome. Escitalopram may be prescribed 14 days after discontinuation of treatment irreversible non-selective MAO inhibitors. At least 7 days must elapse after escitalopram is taken before treatment can be prescribed. irreversible non-selective MAO inhibitors.
With reversible selective MAO type A inhibitors (moclobemide)
Due to the risk of developing serotonin syndrome, the combined use of escitalopram with reversible selective MAO inhibitors, such as moclobemide, contraindicated. If there is a reasonable need for the use of such a combination, treatment should begin with the minimum recommended dose under enhanced clinical supervision.
With reversible non-selective MAO inhibitors (linezolid)
Antibiotic linezolid is an reversible non-selective MAO inhibitor and should not be used in patients receiving escitalopram therapy. If there is a reasonable need for the use of such a combination, treatment best begin with the lowest doses under close clinical supervision.
With irreversible selective MAO inhibitors of type B (selegiline)
Caution is necessary in case of combined use of escitalopram and irreversible selective MAO Mylan-Escitalopram type B selegiline due to the risk of developing serotonin syndrome. Selegiline in doses up to best way mg per day was successfully used in conjunction with racemic citalopram.
With QT interval extenders
It is unacceptable to use with drugs that extend the QT interval, such as antiarrhythmics (procainamide, amiodarone, etc.), antipsychotics medicine antipsychotics (for example, pimozide, phenothiazine derivatives (chlorpromazine, trifluoperazine, thioridazine, etc.), butyrirophenone derivatives ( etc.), tricyclic and tetracyclic antidepressants (amitriptyline, imipramine, maprotiline, etc.), SSRIs and similar antidepressants (e.g. fluoxetine, venlafaxine, etc.), antimicrobials (macrolide antibiotics tics and their analogues, for example, erythromycin, clarithromycin; quinolone and fluoroquinolone derivatives: sparfloxacin, moxifloxacin; pentamidine), azole-type antifungals (ketoconazole, fluconazole), domperidone, ondansetron, because it can cause more than twenty-five hours, abnormal changes in the electrical activity of the heart (prolongation of the QT interval on the ECG) and lead to a violation of the heart rhythm (including the development of arrhythmias of the “pirouette” type), which can be fatal.
The combined use of escitalopram should be performed with caution when using
Drugs that lower the seizure threshold
Escitalopram may lower the threshold for convulsive readiness. Caution is required while taking other drugs that lower the threshold of convulsive readiness (tricyclic antidepressants, SSRIs, antipsychotics - derivatives of phenothiazine, thioxanthene and butyrophenone; mefloquine and tramadol).
Serotonergic Drugs
capsule is advisable not to combine the intake of escitalopram with serotonergic drugs such as sumatriptan or other triptans, as well as tramadol, as this can lead to the development of serotonin syndrome.
