Escitalopram: Difference between revisions

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| generic = Escitalopram

| brand = Lexapro

| classes = SSRI, Antidepressant

| structure =

| mechanism = Selective serotonin reuptake ~~inhibitor~~

| classes = [[:Category:SSRIs|Selective serotonin reuptake inhibitor (SSRI)]], [[:Category:Antidepressants|Antidepressant]], [[:Category:Anxiolytics|Anxiolytic]]

| uses = <vote slug="major-depressive-disorder-use">Major depressive disorder (FDA, ages 12+)</vote>, <vote slug="generalized-anxiety-disorder-use">Generalized anxiety disorder (FDA, adult)</vote>, <vote slug="panic-disorder-use">Panic disorder (off-label)</vote>, <vote slug="ocd-use">Obsessive-compulsive disorder (off-label)</vote>, <vote slug="ptsd-use">Posttraumatic stress disorder (off-label)</vote>, <vote slug="premenstrual-dysphoric-disorder-use">Premenstrual dysphoric disorder (off-label)</vote>, <vote slug="menopausal-vasomotor-use">Menopausal vasomotor symptoms (off-label)</vote>

| starting_dose = 10 mg PO once daily; titrate to 20 mg/day after 1-2 weeks if needed

| preparations = Tablets 5, 10, 20 mg; oral solution 1 mg/mL

| fda_max = 20 mg/day (adult); 10 mg/day in elderly and in hepatic impairment

| pill_id =

| routes = Oral

| onset = Antidepressant effect emerges over 1-2 weeks; full clinical effect 4-6 weeks

| duration = 24 hours (once-daily dosing)

| halflife = 27-32 hours<ref name="lexapro-label">FDA Prescribing Information, Lexapro (escitalopram oxalate), AbbVie/Allergan, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/021323s047lbl.pdf</ref>

| bioavailability = ~80% (oral)<ref name="lexapro-label" />

| pregnancy = Observational signal for persistent pulmonary hypertension of the newborn (small absolute risk) and neonatal adaptation syndrome with third-trimester exposure; weigh against the risks of untreated maternal depression.{{citation needed}}

| legal = [[USLegal:Prescription only|Rx-only]] in US. Carries the antidepressant '''Boxed Warning''' for suicidality in children, adolescents, and young adults<ref name="lexapro-label" />

| mechanism = <vote slug="escitalopram-mech-claim">Highly selective serotonin reuptake inhibitor. Escitalopram is the (S)-enantiomer of citalopram, which carries essentially all of the serotonin transporter (SERT) binding activity; the (R)-enantiomer contributes little SERT activity and may carry the QT-prolonging liability that prompted the FDA's 2011 citalopram dose ceiling, giving escitalopram a more favorable QT profile.</vote> CYP2C19 + CYP3A4 metabolism, with CPIC PGx guidance: poor CYP2C19 metabolizers have ~3-fold higher exposure and benefit from a lower starting dose; ultrarapid metabolizers may have inadequate response<ref name="cpic-ssri">CPIC Guideline for CYP2D6 and CYP2C19 Genotypes and Dosing of Selective Serotonin Reuptake Inhibitors, 2023. https://cpicpgx.org/guidelines/guideline-for-selective-serotonin-reuptake-inhibitors-and-cyp2d6-and-cyp2c19/</ref>.

}}

== References ==

[[Category:SSRIs]]

[[Category:Antidepressants]]

[[Category:Anxiolytics]]

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