What is this medication?
Selective Serotonin Reuptake Inhibitor; Antidepressant
Brand Name US: Lexapro
Canadian Equivalent: Cipralex
Escitalopram/Cipralex is officially indicated for major depressive disorder and generalized anxiety disorder. It is also prescribed off-label for use in binge-eating disorder, body dysmorphic disorder, bulimia nervosa, obsessive-compulsive disorder, panic disorder, posttraumatic stress disorder, premenstrual dysphoric disorder, vasomotor symptoms associated with menopause, and premature ejaculation.
Premature ejaculation (PE) is also known as rapid or early ejaculation and is characterized by the following features:
- Ejaculation that always or nearly always occurs prior to or within approximately one minute of vaginal penetration.
- The inability to delay ejaculation on all or nearly all vaginal penetrations.
- Personal feelings of distress, frustration, anxiety, and/or the avoidance of sexual intimacy.
“ALERT: US Boxed Warning
Suicidality and antidepressant drugs:
Antidepressants increased the risk compared with placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of escitalopram or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared with placebo in adults older than 24 years; there was a reduction in risk with antidepressants compared with placebo in adults 65 years and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Appropriately monitor patients of all ages who are started on antidepressant therapy and closely observe for clinical worsening, suicidality, or unusual changes in behavior. Advise families and caregivers of the need for close observation and communication with the health care provider. Escitalopram is not approved for use in pediatric patients younger than 12 years.”
How does this medication work?
Cipralex/Escitalopram selectively inhibits serotonin uptake. It exhibits only weak affinity for alpha, beta, histaminic, muscarinic and serotonin receptors as well as has weak anticholinergic effects.
How should I take this medication?
Premature ejaculation (off-label use)
Initial dose is 10mg daily, can increase the dose based on response and tolerability after 1 week (some experts suggest dose titration intervals of 3 to 4 weeks). Can increase to a maximum daily dose of 20mg once daily due to the risk of QT prolongation. In patients with anxiety, who are more sensitive to overstimulation (i.e. anxiety, insomnia) with antidepressants a lower starting dose of 5mg daily is recommended.
How to Take Escitalopram, Lexapro/Cipralex: Can be taken with or without food and taken regularly as prescribed.
What should I watch for while using this medication?
Do not use in patients receiving monoamine oxidase inhibitors currently or within 2 weeks because of the risk of serotonin syndrome.
Use with caution in patients with liver disease.
Use with caution in patients with a history of seizures.
Has been rarely associated with platelet dysfunction, use cautiously in patients with underlying coagulation (platelet) defects.
How to Manage Common Side Effects of Escitalopram, Lexapro/Cipralex: Majority of side effects are mild and transient and disappear over time. However, if you develop a rash, hives or experience undesirable weight loss contact your doctor.
You Need to Avoid Escitalopram, Lexapro/Cipralex: If you have hypersensitivity to escitalopram or any of its components in the formulation; use of MAO inhibitors, linezolid, or intravenous methylene blue, pimozide or thioridazine.
Contact Your Doctor if You Ever Experience: Stop taking this medication and contact your doctor if you experience a rash (particularly in combination with facial swelling, breathing difficulties or flu-like symptoms); severe agitation, anxiety or excitation, major sleep disturbance or unusual change mood, muscle twitching or convulsions.
What if I miss a dose?
If you miss a dose of medication, try to take it as soon as possible. However, if it is almost time for your next dose, take only that scheduled dose. Do not take double or extra doses.
How should I store this medication?
Keep out of the reach of children at all times. Store at room temperature, 59 to 86° F (15 to 30° C). Protect from light. Keep the container tightly closed. Properly dispose of any unused medication after the expiration date.
What are the possible side effects of using this medication?
Well tolerated, most side effects are transient and mild to moderate in nature. The most common side effects include:
Central nervous system: Headache (24%), insomnia (7% to 14%), drowsiness (4% to 13%)
Gastrointestinal: Nausea (15% to 18%), diarrhea (6% to 14%)
Genitourinary: Ejaculatory disorder (9% to 14%)
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