Names and pronunciation
(es-sit-tal′oh-pram) Cipralex , Lexapro
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Drug reference
(es-sit-tal′oh-pram) Cipralex , Lexapro
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Func. class.: Antidepressant, SSRI (selective serotonin reuptake inhibitor)
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Do not confuse: Lexapro/Loxitane
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ACTION: Inhibits CNS neuron uptake of serotonin but not of norepinephrine
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USES: General anxiety disorder; major depressive disorder in adults/adolescents Unlabeled uses: Panic disorder, social phobia, hot flashes related to menopause
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CONTRAINDICATIONS: Hyper- sensitivity to this product, citalopram, MAOIs Precautions: Pregnancy, breastfeeding, geriatric patients, renal/hepatic disease, history of seizures, abrupt discontinua- tion, bleeding, anticoagulants
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Black Box Warning: Children/adoles- cents ≤12 yr, suicidal ideation Black Box Warning: Mental status: mood, sensorium, affect, suicidal tendencies, increase in psychiatric symptoms, depres- sion, panic; not approved for use in chil- dren <12 yr, provide a limited amount of E product, continuing follow-ups should be weekly × 4 wk, q3wk × next 4 wk • Appetite with bulimia nervosa, weight daily; increase nutritious foods in diet, watch for bingeing and vomiting • Allergic reactions: itching, rash, urti- caria; product should be discontinued, may need to give antihistamine • B/P (lying/standing), pulse q4hr; if systolic B/P drops 20 mm Hg, hold prod- uct, notify prescriber • Serotonin syndrome: nausea, vomit- ing, sedation, dizziness, sweating, facial flushing, mental changes, shivering, in- creased B/P; discontinue product, notify prescriber • Weight weekly; appetite may decrease with product • Alcohol consumption; if alcohol is consumed, hold dose until AM • Sexual dysfunction: ejaculation dys- function, erectile dysfunction, decreased libido, orgasm dysfunction, priapism • Assistance with ambulation during therapy, since drowsiness, dizziness occur; safety measures primarily for geriatric patients • Pregnancy/breastfeeding: use only if benefit outweighs risk to fetus; if used during pregnancy, taper in third trimes- ter; use cautiously in breastfeeding, ex- creted in breast milk Black Box Warning: That clinical worsening of depression and suicide risk may occur, especially in adolescents and young adults, increased depression, thoughts of dying • To use medication guide provided • To notify prescriber if pregnant or plan- ning to become pregnant or if breastfeed- ing, discuss sexual dysfunction
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SIDE EFFECTS CNS: Insomnia, ideation, suicidal drowsiness, anxiety, tremor, dizziness, fatigue, sedation, abnormal dreams, neuroleptic malignant–like syndrome CV: Postural hypotension GI: Nausea, diarrhea, dry mouth, anorexia, constipation, taste changes, hepatitis GU: Decreased libido, impotence, ejacu- lation disorder INTEG: Sweating, rash, pruritus SYST: Serotonin syndrome, Stevens- Johnson syndrome
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INTERACTIONS • Paradoxical worsening of OCD: busPI- Rone Increase: serotonin syndrome—trypto- phan, amphetamines, busPIRone, lith- ium, amantadine, bromocriptine, SSRIs, SNRIs, serotonin-receptor agonists, tra- MADol, trazodone, tricyclic antidepres- sants, linezolid, methylene blue • Do not use pimozide, MAOIs with or 14 days prior to escitalopram Increase: CNS depression—alcohol, antidepressants, opioids, sedatives Increase: side effects of escitalopram— highly protein-bound products Increase: levels or toxicity of carBAMaze- pine, lithium, warfarin, phenytoin, anti- psychotics, antidysrhythmics Increase: levels of tricyclics, phenothi- azines, haloperidol, diazePAM Increase: bleeding risk—NSAIDs, salicy- lates, anticoagulants, SSRIs, platelet inhibitors Drug/Herb • SAMe, St. John’s wort: do not use together; serotonin syndrome may occur Increase: CNS effect—kava, valerian Drug/Food • Grapefruit juice—increased escitalo- pram effect Drug/Lab Test Increase: serum bilirubin, blood glu- cose, alkaline phosphatase Decrease: VMA, 5-HIAA, sodium False increase: urinary catecholamines NURSING CONSIDERATIONS
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DOSAGE AND ROUTES • Adult/adolescent: PO 10 mg/day; after 1 wk, dose may be increased to 20 mg/day PM Hepatic dose/geriatric • Adult/child ≤12 yr: PO 10 mg/day Hot flashes related to menopause (unlabeled) • Adult: PO 10-20 mg/day × 8 wk
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Available forms: Tablets 5, 10, 20 mg; oral solution 5 mg (as base)/5 mL (contains sorbitol)
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Administer: • With food or milk for GI symptoms, give with full glass of water once a day in the AM • Crushed if patient is unable to swallow medication whole; scored tablets can be cut • Dosage at bedtime if oversedation oc- curs during the day • Gum, hard candy, frequent sips of water for dry mouth • Oral solution: measure with calibrated device • Store at room temperature; do not freeze
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Assess:
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Evaluate: • Therapeutic response: decreased de- pression
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Patient and caregiver information: • That therapeutic effect may take 1-4 wk, may have increased anxiety for first 5-7 days, do not abruptly discontinue • Serotonin syndrome: to report im- mediately nausea, vomiting, sedation, diz- ziness, sweating, facial flushing, mental changes, shivering • To use caution when driving, perform- ing other activities requiring alertness because drowsiness, dizziness, blurred vision may occur • To avoid alcohol, other CNS depres- sants; to avoid all OTC, herbals, supple- ment products unless approved by pre- scriber, to take without regard to meals • To change positions slowly; ortho- static hypotension may occur
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PHARMACOKINETICS PO: Metabolized in liver; excreted in urine; 56% protein binding; metabo- lized by CYP2C19, CYP 3A4, half-life 27-32 hr; half-life increased by 50% in geriatric patients
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• Adult/adolescent: PO 10 mg/day; after 1 wk, dose may be increased to 20 mg/day PM Hepatic dose/geriatric
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• Adult/child ≤12 yr: PO 10 mg/day Hot flashes related to menopause (unlabeled)
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• Adult: PO 10-20 mg/day × 8 wk
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