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Pregnancy Category C
Drug classes
Antidepressant
SSRI
Therapeutic actions
Potentiates serotonergic activitity in the CNS by inhibiting reuptake of serotonin resulting
in antidepressant effect with little effect on norepinephrine or dopamine; an isomer of
citalopram.
Indications
• Treatment of major depressive disorder
• Maintenance treatment for patients with major depressive disorder
• Treatment of generalized anxiety disorder
Available forms
Tablets—5, 10, 20 mg; oral solution—5 mg/5 mL
Dosages
ADULTS
• Major depressive disorder: Initially, 10 mg/day PO as a single daily dose; if
needed, may be increased to 20 mg/day after a minimum of 1-wk trial period. For
maintenance, 10–20 mg/day PO; reassess periodically.
• Generalized anxiety disorder: 10 mg/day PO; may be increased to 20 mg/day
after 1 wk if needed. Treatment beyond 8 wk not tested.
PEDIATRIC PATIENTS
Safety and efficacy not established.
GERIATRIC PATIENTS OR ADULTS WITH HEPATIC IMPAIRMENT
10 mg/day PO as a single dose, do not increase dose.
Pharmacokinetics
Route Onset Peak
Oral Slow 3.5–6.5 hr
Adverse effects
• CNS: Somnolence, dizziness, insomnia, fatigue
• Dermatologic: Sweating
• GI: Nausea, dry mouth, constipation, diarrhea, indigestion, abdominal pain,
decreased appetite
• GU: Ejaculatory disorders, impotence, anorgasmia in females, decreased libido
• Respiratory: Rhinitis, sinusitis, flulike symptoms
Interactions
Drug-drug
• Risk of serious toxic effects if combined with citalopram; do not use these drugs
concomitantly
• Increased escitalopram levels and toxicity if taken with MAOIs; ensure that
patient has been off the MAOI for at least 14 days before administering
escitalpram
• Possible severe adverse effects if combined with other centrally acting CNS
drugs, including alcohol; use caution
• Possible decreased effects of escitalopram if combined with carbamazepine,
lithium; monitor patient closely
Drug-alternative therapy
• Increased risk of severe reaction if combined with St. John's wort; avoid this
combination
Nursing considerations
CLINICAL ALERT!
There is potential for name confusion between escitalopram and citalopram;
use caution.
Assessment
• History: MAOI use; allergy to drug, citalopram, or any component of the drug;
renal or hepatic impairment; the elderly; pregnancy; lactation; suicidal tendencies;
metabolic illnesses or problems with hemodynamic response; alcoholism
• Physical: orientation, reflexes; P, BP, perfusion; R, bowel sounds, normal output;
urinary output; liver evaluation; liver and renal function tests
Interventions
• Administer once a day, in the morning or the evening; may be taken with food if
desired.
• Encourage patient to continue use for 4–6 weeks, as directed, to ensure adequate
levels to affect depression.
• Limit amount of drug given in prescription to potentially suicidal patients.
• Advise any depressed patients to avoid the use of alcohol while being treated with
antidepressive drugs.
• Establish appropriate safety precautions if patient experiences adverse CNS
effects.
• Institute appropriate therapy for patient suffering from depression.
Teaching points
• Take this drug exactly as directed, and as long as directed; it may take a few
weeks to realize the benefits of the drug. The drug may be taken with food if
desired.
• Avoid the use of alcohol while you are taking this drug.
• This drug should not be taken during pregnancy or when nursing a baby; use of
barrier contraceptives is suggested.
• These side effects may occur: Drowsiness, dizziness, tremor (use caution and
avoid driving a car or performing other tasks that require alertness if you
experience daytime drowsiness); GI upset (eat frequent small meals; use frequent
mouth care); alterations in sexual function (this is a drug effect and will pass
when drug therapy is ended).
• Report severe nausea, vomiting; blurred vision; excessive sweating, suicidal
ideation, sexual dysfunction, insomnia.
Adverse effects in Italic are most common; those in Bold are life-threatening.