Disclaimer: This article is for informational purposes only and does not constitute medical advice. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition.
Overview
Escitalopram is a prescription antidepressant from the selective serotonin reuptake inhibitor (SSRI) group. In Canada it is authorized for adults with major depressive disorder, generalized anxiety disorder (GAD) and obsessive-compulsive disorder (OCD). Cipralex is the original brand, and generic escitalopram tablets are sold in 5, 10, 15 and 20 mg strengths. Lexapro is the name used in the United States.
Escitalopram is usually one part of a treatment plan that may also include talk therapy and regular follow-up. It is not authorized for children and teens under 18 in Canada. Benefits build up over several weeks, and the prescriber regularly reviews whether it is still needed.
If you are struggling with low mood, anxiety or intrusive thoughts, BC residents can speak with a BC-licensed doctor by phone through Avee Health about their symptoms and treatment options. If you are thinking about harming yourself, call or text 9-8-8 or go to the nearest emergency department.
In Canada, escitalopram is authorized for adults for the relief of symptoms of:
- Major depressive disorder (depression)
- Generalized anxiety disorder (GAD), where anxiety causes significant distress
- Obsessive-compulsive disorder (OCD)
Health Canada has not authorized escitalopram for anyone under 18. For long-term use, the prescriber should regularly review whether it is still helping.
Escitalopram
Antidepressant (selective serotonin reuptake inhibitor, SSRI)
mental health
Prescription required
Available
How Escitalopram Works
Escitalopram belongs to the selective serotonin reuptake inhibitor (SSRI) group of antidepressants. It is the active half of an older medicine called citalopram. It blocks nerve cells from taking back serotonin, a chemical messenger in the brain, which raises the amount available. This is thought to relieve the symptoms of depression, anxiety and OCD.
It has very little effect on other brain messengers. Peak levels are reached about 4 hours after a dose, and food does not change how much is absorbed. Its half-life is about 27 to 32 hours, so it is taken once a day, and steady levels are reached after about a week.
Dosage Instructions of Escitalopram
Take escitalopram exactly as your prescriber directs. The Canadian Cipralex product monograph gives these usual doses:
- Adults under 65 (depression, generalized anxiety disorder and OCD): 10 mg once a day. If side effects are a concern, a prescriber may start at 5 mg and increase as tolerated.
- Maximum dose: 20 mg a day, if needed and tolerated. The prescriber aims for the lowest effective dose and reviews it regularly.
- Lower doses (start at 5 mg, usual maximum 10 mg a day) are recommended for adults 65 and older, people with mild to moderate liver problems, people known to be CYP2C19 poor metabolizers, and people taking cimetidine, omeprazole or similar medicines.
Take it once a day, in the morning or evening, with or without food. Swallow the tablet with some water and do not chew it, as it tastes bitter. The 10, 15 and 20 mg tablets are scored and can be split.
Do not stop suddenly. Stopping abruptly can cause dizziness, electric-shock sensations, anxiety, nausea, headache and other symptoms. Your prescriber will lower the dose gradually over several weeks.
Missed dose: skip the missed dose and take your next dose at the usual time. Do not take a double dose.
Storage Instructions
Store in a dry place at room temperature, 15°C to 30°C. Keep out of the reach and sight of children.
Side Effects of Escitalopram
Side effects are most common in the first one or two weeks and usually ease with continued treatment. In placebo-controlled depression trials in adults, compared with placebo:
- Nausea: 15.2%, compared with 8.1% (19.4% compared with 9.0% in anxiety trials)
- Diarrhea: 8.4%, compared with 5.2%
- Trouble sleeping: 8.2%, compared with 3.6%
- Dry mouth: 6.6%, compared with 4.6%
- Dizziness: 6.3%, compared with 3.6%
- Fatigue: 4.9%, compared with 2.7%
- Sleepiness: 4.1%, compared with 1.2%
- Increased sweating: 3.4%, compared with 1.4%
- Sexual side effects in men: delayed ejaculation 3.6%, ejaculation failure 2.7% and erectile dysfunction 2.7%, compared with none on placebo. Lower sex drive (2.1%) and difficulty reaching orgasm (1.8%) also occurred.
Constipation and indigestion can also occur. Headache is common in people who take escitalopram, but it was just as common or more common with placebo, so it is thought to be related to the condition rather than the medicine.
Get medical help right away if you have:
- Thoughts of harming yourself or others, or new or worse agitation, restlessness, hostility or impulsivity
- A fast, pounding or irregular heartbeat, fainting or a seizure
- Fever, sweating, shivering, muscle twitching or stiffness, a fast heartbeat and confusion, which can be serotonin toxicity
- Unusual bleeding or bruising, or black or bloody stools
- Sudden eye pain, changes in vision, or swelling or redness in or around the eye
- Headache, confusion, weakness and unsteadiness, which can be signs of low blood sodium, especially in older adults
- Very high energy, racing thoughts and little need for sleep (mania)
- Swelling of the face or mouth, hives, trouble breathing, or a severe rash with blisters or peeling skin
Important Safety Information About Escitalopram
- Mood and behaviour: antidepressants can increase the risk of suicidal thoughts and actions, and of agitation-type changes, especially in the first weeks or after a dose change and in young adults. Family and friends can help by watching for changes.
- Heart rhythm: escitalopram can lengthen the QT interval in a dose-related way. Do not take it if you have a known long QT interval or congenital long QT syndrome. Tell your prescriber about heart disease, a slow heartbeat, or low potassium or magnesium.
- Bleeding: SSRIs can raise the risk of bleeding, including stomach bleeding, especially with NSAIDs, ASA or blood thinners.
- Older adults: use lower doses. Escitalopram can cause dizziness and falls, and low blood sodium is more likely, especially in older women.
- Other conditions: tell your prescriber about seizures, bipolar disorder or past mania, liver or severe kidney disease, diabetes (blood sugar may change), glaucoma, osteoporosis or a bleeding disorder.
- Pregnancy: it should be used during pregnancy only if the benefit outweighs the risk. Use late in pregnancy can cause breathing, feeding and other problems in newborns, may raise the risk of a serious lung condition in newborns (PPHN), and may raise the risk of heavy bleeding after birth. Tell your prescriber right away if you become pregnant.
- Breastfeeding: escitalopram is expected to pass into breast milk. Talk to your prescriber before breastfeeding.
- Sexual function: SSRIs may cause sexual problems, and in rare cases these have continued after stopping the medicine.
- Driving: see how the medicine affects you before driving or using machinery.
Drug Interactions
Tell your prescriber and pharmacist about everything you take, including vitamins, natural products and street drugs. Important interactions include:
- MAO inhibitors (including linezolid and methylene blue): must not be taken with escitalopram or within 14 days of each other
- Pimozide and citalopram (Celexa): must not be taken with escitalopram
- Medicines that affect heart rhythm, such as some antiarrhythmics, antipsychotics, tricyclic antidepressants, methadone and moxifloxacin: higher risk of a dangerous heart rhythm, and generally discouraged
- Medicines that lower blood salt levels, such as diuretics, laxatives and high-dose corticosteroids: combining them is discouraged
- Other medicines that raise serotonin, such as triptans, lithium, tryptophan, dextromethorphan, opioids and St. John's wort: higher risk of serotonin toxicity
- ASA, ibuprofen, naproxen and other NSAIDs, warfarin and other blood thinners: higher risk of bleeding
- Cimetidine, omeprazole, esomeprazole, lansoprazole and fluvoxamine: can raise escitalopram levels, so the dose should not go above 10 mg a day
- Antifungals such as fluconazole, ketoconazole and itraconazole, and the antibiotic erythromycin: can slow how fast the body clears escitalopram
- Metoprolol and desipramine or imipramine: escitalopram can raise their levels, so they are combined with caution
Brands & DIN Number of Escitalopram
Brand Names
Cipralex
Key Takeaways
- 1Escitalopram (Cipralex) is a prescription SSRI antidepressant for depression, generalized anxiety disorder (GAD) and obsessive-compulsive disorder (OCD) in adults.
- 2The usual dose is 10 mg once a day, with or without food. The maximum is 20 mg a day, and lower doses are used for people 65 and older.
- 3Common side effects include nausea, diarrhea, trouble sleeping, dry mouth, dizziness, sleepiness and sexual side effects. Nausea usually eases after the first week or two.
- 4It can affect heart rhythm. It must not be used by people with a known long QT interval or taken with pimozide, MAO inhibitors or citalopram.
- 5In the first weeks or after a dose change, some people feel more agitated or have thoughts of self-harm. Tell your prescriber right away.
- 6Do not stop it suddenly. Your prescriber will taper the dose over several weeks.
Frequently Asked Questions
Do I need a prescription for escitalopram in Canada, and how do I get it in BC?
Is Lexapro available in Canada?
How long does escitalopram take to work?
Does escitalopram cause sexual side effects?
Can I drink alcohol while taking escitalopram?
What is the difference between escitalopram and sertraline?
How much does escitalopram cost in Canada?
When should I talk to a doctor about depression or anxiety?
Avee Editorial
Avee Editorial Team