At the doctor’s appointment, complaints are often heard of loss of strength, apathy, excitement for no reason. On the face are all signs of depression. The reason may be the loss of a loved one, a series of setbacks, or simply a reaction to some external event. A large number of drugs and techniques exist to treat such conditions. Only a doctor can choose the right treatment. Consider one of the commonly used medications for the treatment of depression, “Escitalopram”. Instructions for use, reviews, analogues of the drug will be discussed in this article.
Composition and effect of the drug
The main active substance of “Escitalopram” is escitalopram oxalate. The content of the basic substance may be 5-20 mg. The tablets are biconvex, with a film coating on top.
"Escitalopram" is an antidepressant. In the synaptic cleft increases the concentration of the neurotransmitter. Ultimately, it does not bind to dopamine alpha-adrenergic, histamine-benzodiazepine serotonin m-cholinergic receptors and opiate receptors.
From the beginning of taking the drug, the antidepressant effect can be observed only after a couple of weeks. The maximum result in the treatment of depressive conditions is achieved in a few months.
“Escitalopram” is well absorbed in the digestive tract, this process is not affected by food intake. Bioavailability is 80%. The maximum concentration of the substance after a single application is reached after 5 hours. With regular use of the drug, the equilibrium concentration will be established after 7 days.
Cleavage occurs in the liver, with the participation of the isoenzyme CYP2C19, partially the isoenzyme CYP3A4 and CYP2D6. It is excreted by the kidneys, with urine and partly by the liver. In people with impaired renal function, elimination of “escitalopram” significantly slows down. Care should be taken in treating individuals with severe renal failure.
The final elimination half-life is 27-32 hours.
Who is prescribed Escitalopram?
The instruction indicates the conditions in which the drug “Escitalopram” is prescribed:
- Depressive disorders.
- Generalized Anxiety Disorder.
- Panic attacks.
Before you begin treatment, you must make sure that you do not have contraindications for use. The attending physician should know about them.
Contraindications
The drug "Escitalopram" instructions for use recommends not to take in the presence of the following diseases and conditions:
- High susceptibility to the components of the drug.
- With the joint use of monoamine oxidase inhibitors.
Also do not recommend the use of the medicine to the following persons:
- Pregnant
- During breastfeeding.
- Until the age of 18.
Constant control
“Escitalopram” instructions recommend taking under special control for the following pathologies:
- Diabetes.
- Chronic kidney disease.
- Manic disorders.
- Hypomania.
- Cirrhosis of the liver.
- Depression with suicidal attempts.
- Drug-uncontrolled epilepsy.
- Tendency to bleeding.
And you also need to be careful when sharing with medicines that:
- Used for convulsive syndrome.
- Metabolized with the participation of CYP2C19 enzymes.
- Provoke hyponatremia.
Instructions for use of the drug
The tool recommends taking Escitalopram tablets at any time once a day. Eating does not affect the absorption of the drug.
At the first stage of therapy, the dosage should be 0.5 tablets. As the body gets used to the drug, the dose is increased. The maximum amount per day is 20 mg.
For elderly patients who are over 65, 5 mg is initially prescribed. The maximum dosage of "Escitalopram" is 10 mg.
Instructions for use have instructions for adjusting the dose for patients with kidney disease, liver and other disorders.
In case of liver dysfunction, the drug is prescribed in a dosage of 5 mg and subsequently, after 10-14 days, the dose can be increased. The doctor increases the dosage based on the patient's condition.
In case of impaired renal function, dose adjustment is not required.
The duration of treatment is determined by the attending physician. Periodically, he must evaluate the effectiveness of “Escitalopram” for each patient individually.
After a sharp cessation of the use of the drug, there is a risk of developing such symptoms:
- Irritability.
- Dizziness.
- Confusion.
- Violation of sensitivity.
- Stupor.
- Hypomania.
If the drug must be discontinued, then the dosage is reduced gradually. It is important to monitor the patient's condition.
Possible side effects
During treatment with the medicine “Escitalopram”, the instruction warns of the possible manifestation of the following side effects:
- The digestive organs are able to respond to nausea, diarrhea, vomiting, changes in appetite, flatulence, constipation, and a violation of taste sensations. Often there are abnormalities in the liver.
- From the genitourinary system of organs: impotence, decreased libido, menstrual irregularities, delayed ejaculation, urinary retention, galactorrhea.
- Nervous system: insomnia, anxiety, weakness, confusion, increased irritability, panic disorders, dizziness, tremor of the extremities, hallucinations, blurred vision, headaches.
- Respiratory organs can respond with pharyngitis, sinusitis, rhinitis, respiratory infections.
- Allergic manifestations: anaphylactic shock, swelling, itching, rash, sweating.
And also possible:
- Fast fatiguability.
- Myalgia, muscle pain.
- Slow heart rate.
- Yawn.
- Hyponatremia.
- Orthostatic hypotension.
- Withdrawal syndrome.
If there are suspicious symptoms, the drug should be discontinued and consult your doctor.
Features of use
When treating panic attacks at the beginning of taking Escitalopram tablets, anxiety may increase, therefore it is recommended to prescribe low doses of the drug for two weeks.
When taking antidepressants, treating mental disorders in the early stages of treatment, the risk of suicidal intent increases. This is especially noticeable in the age group of 18-24 years. In people older, this risk does not increase, after 65 years it significantly decreases.
During treatment with antidepressants, it is necessary to constantly monitor the behavior of patients, regardless of age. In case of unusual changes in behavior, deterioration of the clinical picture, it is urgent to inform the doctor. When treating such patients with relatives, close people, doctors should inform about the possibility of suicidal tendencies.
With great caution, the drug "Escitalopram" is prescribed to patients with a history of mania. In the event of a manic phase, treatment should be discontinued. It is necessary to constantly monitor patients.
No studies have been conducted in patients with heart disease.
The drug is prescribed with caution to elderly patients, since the safety of the drug for this category has not been fully studied.
With an increase in epileptic seizures, “Escitalopram” is canceled.
A drug is prescribed with caution in the presence of diabetes mellitus, since a drug can affect the concentration of glucose in the blood. You may need a dose adjustment.
During pregnancy, the drug can be prescribed if the effect of treatment exceeds the risks to the fetus. But studies on pregnant women have not been conducted. In the role of experimental rats. None of the doses tested showed malformations. Tests for newborns showed that complications developed sharply at the birth of a child if a woman took the drug in the last months of pregnancy. A drug withdrawal syndrome developed in a newborn.
Nursing women should take breastfeeding while taking the medicine.
Caution must be exercised when taking other drugs that affect the functioning of the nervous system with “Escitalopram”.
It is forbidden to drink alcohol in the treatment of "Escitalopram".
When using drugs that have a psychotropic effect on the human body, it is better to abandon driving vehicles and work that requires increased attention.
"Escitalopram" is available at the pharmacy only by prescription from a doctor.
Combination with other medicines
Simultaneous therapy with “escitalopram” with selective serotonin reuptake inhibitors can cause weakness, impaired coordination, and hyperreflexia.
Norepinephrine and tryptophan reuptake inhibitors are not recommended to be used together. If such therapy is justified by the therapeutic effect, it is important to constantly monitor the patient at the beginning of treatment and after increasing the dose.
Do not use Escitalopram with Linezolid. The interval between taking medications should be 14 days.
Observe caution when prescribing "Escitalopram", the instruction recommends when taking drugs that affect the blood coagulation process, as well as with non-steroidal anti-inflammatory drugs. There is a risk of bleeding. This may include the joint use of “Escitalopram” with “Dipyridamole”, “Ticlopidine”. If reception is nevertheless necessary, then it is necessary to control the indicators of blood coagulation.
"Escitalopram" and tricyclic antidepressants, "Mefloquine" with simultaneous use lower the threshold of convulsive readiness. There is a risk of disruption of the coagulation process.
Caution is also required while taking with CYP2C19 isoenzyme inhibitors. With this connection, the concentration of “escitalopram” in the blood may increase. It is necessary to monitor the patient's condition, since the manifestation of adverse reactions is possible.
With the simultaneous use of “Escitalopram” with “Boceprevir”, the concentration of the former decreases. A dosage adjustment is needed.
The Escitalopram tablets are not recommended for joint use with herbal preparations, which include St. John's wort, because the risk of developing negative consequences significantly increases.
Read the instructions for use before taking the drug “Escitalopram”. Reviews on the effect of the drug help doctors in the appointment of treatment.
Signs of an overdose of the drug
Data on an overdose of “Escitalopram” to a greater extent note the absence of symptoms or mild symptoms.
An overdose is observed to a greater extent with the joint use of other medications. The use of the drug “Escitalopram” without other drugs at a dose of 400-800 mg did not cause severe symptoms of an overdose.
We list how the use of the drug in large quantities can manifest itself:
- Dizziness appears.
- Tremor.
- Cramps.
- Vomiting
- Nausea.
- Tachycardia.
- Arrhythmia.
- Hypokalemia hyponatremia.
- ECG change.
When assisting, the airway should be restored and adequate oxygenation should be carried out. They control the functions of the cardiovascular and respiratory system. The stomach is washed, therapy is required to eliminate the symptoms and to maintain the body.
The instructions for use attached to the drug " Escitalopram" were studied. Analogs will be discussed later.
Analogues of the drug
We list the name of the drug with the active substance escitalopram:
- Cipralex.
- "Selectra."
- "Excitalopram Sandoz."
- Eisipi.
- "Miracitol".
- "Lenuxin."
- "Escitalopram teva."
- " Escitalopram canon."
Instructions for use of these drugs has practically no differences, since they contain the same active substance. The difference lies in the company and the country of manufacture, which significantly affects the cost of the drug. As for the “Escitalopram Teva” remedy, the instructions indicate the country of origin of Israel. The price is higher than that of Russian drugs.
If the medicine prescribed for you is not available in the pharmacy, only the attending physician can choose the analogue.
Reviews about the drug
The instructions for the "Escitalopram" were considered above. Reviews are different.
The positive aspects of the drug were noted by many patients. After they started taking it, they gradually returned to normal life. The feeling of anxiety, nervousness disappears, sleep normalizes. A surge of strength appears, there are no attacks of aggression, tearfulness, a sense of fear. The depressive state is leaving, the mood is normal.
However, there are disadvantages to the drug. So, many note exacerbation of symptoms at the beginning of the dose. As the instructions for use attached to the Escitalopram tool indicate, at the initial stage it is important to constantly monitor the patient's condition. Suicidal tendencies, a sense of fear, panic disorders appear . And also some talk about jumps in blood pressure, the appearance of fear of death. There is tremor, dizziness, lack of air. Manifestations of such adverse reactions are noted by many patients in the first 10-14 days of treatment. After this comes a period of equilibrium. The condition is normal, depression goes away. You can observe the therapeutic effect of the drug.
Also, from the negative sides of the drug, I want to note the withdrawal syndrome. With a sharp cessation of medication, the appearance of side effects is noted. Dizziness, nausea, tremor. Some note the return of panic attacks.
A separate category of patients notes a weak effect of the drug in the first weeks of admission. This is possible, since the maximum effect is achieved two weeks after taking the medicine. It should be noted that only the attending physician can prescribe an increase in dose. In this case, it is necessary to monitor the patient's condition and his behavior. In case of development of undesirable manifestations, the help of a doctor will be needed.
There is a group of patients who do not have manifestations of adverse events, as indicated by the instructions for the drug “Escitalopram”. Reviews indicate good tolerability of the tablets. When combined with other antidepressant drugs, it has a good therapeutic effect. In this case, it is necessary to correctly adjust the dose.
Dose adjustment should not be carried out without consulting a doctor, although cases of overdose have not been established, there are no clear signs or they are poorly expressed. However, there is a danger of serious consequences if you take any other medications with Escitalopram. Be careful when using drugs that affect the activity of the nervous system.