escitalopram

escitalopram

(ess-sit-al-o-pram) ,

Cipralex

(trade name),

Lexapro

(trade name) Pregnancy Category: C

Indications

Action

Pharmacokinetics

Time/action profile (antidepressant effect)

ROUTE	ONSET	PEAK	DURATION
PO	within 1–4 wk	unknown	unknown

Contraindications/Precautions

Adverse Reactions/Side Effects

Central nervous system

• neuroleptic malignant syndrome (life-threatening)
• suicidal thoughts (life-threatening)
• insomnia (most frequent)
• dizziness
• drowsiness
• fatigue

Gastrointestinal

• diarrhea (most frequent)
• nausea (most frequent)
• abdominal pain
• constipation
• dry mouth
• indigestion

Genitourinary

• anorgasmia
• ↓ libido
• ejaculatory delay
• erectile dysfunction

Dermatologic

• sweating

Endocrinologic

• syndrome on inappropriate secretion of antidiuretic hormone (SIADH)

Fluid and Electrolyte

• hyponatremia

Metabolic

• serotonin syndrome (life-threatening)
• ↑ appetite

Interactions

Drug-Drug interaction

May cause serious, potentially fatal reactions when used with MAO inhibitors ; allow at least 14 days between escitalopram and MAO inhibitors.Concurrent use with MAO-inhibitor-like drugs, such as linezolid or methylene blue may ↑ risk of serotonin syndrome; concurrent use contraindicated; do not start therapy in patients receiving linezolid or methylene blue ; if linezolid or methylene blue need to be started in a patient receiving escitalopram, immediately discontinue escitalopram and monitor for signs/symptoms of serotonin syndrome for 2 wk or until 24 hr after last dose of linezolid or methylene blue, whichever comes first (may resume escitalopram therapy 24 hr after last dose of linezolid or methylene blue)Concurrent use with pimozide may result in prolongation of the QTc interval and is contraindicated.Use cautiously with other centrally acting drugs (including alcohol, antihistamines, opioid analgesics, and sedative/hypnotics ; concurrent use with alcohol is not recommended).Drugs that affect serotonergic neurotransmitter systems, including tricyclic antidepressants, SNRIs, fentanyl, buspirone, tramadol, and triptans ↑ risk of serotonin syndromeCimetidine may ↑ levels.Serotonergic effects may be ↑ by lithium (concurrent use should be carefully monitored).Carbamazepine may ↓ levels.May ↑ levels of metoprolol.Use cautiously with tricyclic antidepressants due to unpredictable effects on serotonin and norepinephrine reuptake.↑ risk of bleeding with aspirin, NSAIDs, clopidogrel, or warfarin.↑ risk of serotonin syndrome with St. John's wort and SAMe.

Route/Dosage

Availability (generic available)

Nursing implications

Nursing assessment

• Monitor mood changes and level of anxiety during therapy.
• Assess for suicidal tendencies, especially during early therapy. Restrict amount of drug available to patient. Risk may be increased in children, adolescents, and adults ≤24 yr. After starting therapy, children, adolescents, and young adults should be seen by health care professional at least weekly for 4 wk, every 3 wk for next 4 wk, and on advice of health care professional thereafter.
• Assess for sexual dysfunction (erectile dysfunction; decreased libido).
• Assess for serotonin syndrome (mental changes [agitation, hallucinations, coma], autonomic instability [tachycardia, labile BP, hyperthermia], neuromuscular aberrations [hyperreflexia, incoordination], and/or GI symptoms [nausea, vomiting, diarrhea]), especially in patients taking other serotonergic drugs (SSRIs, SNRIs, triptans).

Potential Nursing Diagnoses

Ineffective coping (Indications)
Risk for injury (Side Effects)
Sexual dysfunction (Side Effects)

Implementation

• Do not confuse Lexapro with Loxitane (loxapine).
• Do not administer escitalopram and citalopram concomitantly. Taper to avoid potential withdrawal reactions. Reduce dose by 50% for 3 days, then again by 50% for 3 days, then discontinue.
• Oral: Administer as a single dose in the morning or evening without regard to meals.

Patient/Family Teaching

• Instruct patient to take escitalopram as directed. Take missed doses on the same day as soon as remembered and consult health care professional. Resume regular dosing schedule next day. Do not double doses. Do not stop abruptly; should be discontinued gradually. Instruct patient to read Medication Guide before starting and with each Rx refill in case of changes.
• May cause dizziness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
• Advise patient, family, and caregivers to look for suicidality, especially during early therapy or dose changes. Notify health care professional immediately if thoughts about suicide or dying, attempts to commit suicide, new or worse depression or anxiety, agitation or restlessness, panic attacks, insomnia, new or worse irritability, aggressiveness, acting on dangerous impulses, mania, or other changes in mood or behavior or if rash or symptoms of serotonin syndrome occur.
• Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking any other Rx, OTC, or herbal products, especially alcohol or other CNS depressants.
• Instruct female patients to notify health care professional if pregnancy is planned or suspected or if they plan to breast feed. If used during pregnancy, should be tapered during 3rd trimester to avoid neonatal serotonin syndrome.
• Emphasize importance of follow-up exams to monitor progress.

Evaluation/Desired Outcomes

• Increased sense of well-being.
  • Renewed interest in surroundings. May require 1–4 wk of therapy to obtain antidepressant effects. Full antidepressant effects occur in 4–6 wk.
• Decrease in anxiety.