Escitalopram Oxalate is the S-enantiomer of the racemic compound citalopram, belonging to the Selective Serotonin Reuptake Inhibitor (SSRI) class of antidepressants. It is a highly selective and potent inhibitor of serotonin (5-HT) reuptake at the presynaptic neuronal membrane, with minimal affinity for other neurotransmitter receptors. It is a first-line agent for the treatment of Major Depressive Disorder (MDD) and various anxiety disorders in the Indian context, valued for its efficacy, tolerability, and relatively simple pharmacokinetic profile.
Adult: Major Depressive Disorder & Generalized Anxiety Disorder: Initial dose: 10 mg once daily. May be increased to a maximum of 20 mg once daily after 1-4 weeks if needed. Panic Disorder: Start at 5 mg once daily for first week to reduce initial side effect burden, then increase to 10 mg once daily. Maximum: 20 mg/day.
Note: Can be taken with or without food, preferably at the same time each day (morning or evening). Swallow the tablet whole with water. Do not crush or chew. If a dose is missed, take it as soon as remembered unless it is close to the next dose. Do not double the dose.
Escitalopram is a highly selective and potent inhibitor of the serotonin transporter (SERT) protein located on the presynaptic neuronal membrane. By blocking SERT, it prevents the reuptake of serotonin (5-hydroxytryptamine, 5-HT) from the synaptic cleft back into the presynaptic neuron. This leads to increased concentrations of serotonin in the synaptic cleft, enhancing serotonergic neurotransmission. This action is believed to be responsible for its antidepressant, anxiolytic, and anti-obsessional effects over time, mediated through adaptive changes in pre- and post-synaptic receptors (e.g., downregulation of 5-HT1A autoreceptors).
Pregnancy: Pregnancy Category C (US FDA). Epidemiological data suggest a possible increased risk of cardiovascular malformations (particularly septal defects) with first-trimester exposure. Risk of persistent pulmonary hypertension of the newborn (PPHN) and poor neonatal adaptation syndrome (PNAS) with third-trimester exposure. Use only if potential benefit justifies potential fetal risk. Tapering before delivery may be considered. Consultation with a psychiatrist and obstetrician is mandatory.
Driving: May cause dizziness, drowsiness, or blurred vision, especially during initial therapy or dose changes. Patients should be cautioned about operating hazardous machinery, including driving, until they are reasonably certain escitalopram does not affect them adversely.
| Monoamine Oxidase Inhibitors (MAOIs) - e.g., Phenelzine, Selegiline, Linezolid | Risk of severe, potentially fatal Serotonin Syndrome. | Contraindicated |
| Other Serotonergic Drugs - e.g., Tramadol, Triptans, TCAs, other SSRIs/SNRIs, Fentanyl, Lithium, St. John's Wort | Increased risk of Serotonin Syndrome. | Major |
| Drugs that Prolong QT Interval - e.g., Class IA/III antiarrhythmics, Pimozide, certain antipsychotics, certain antibiotics (macrolides, fluoroquinolones) | Additive risk of QT prolongation and cardiac arrhythmias. | Major |
| NSAIDs, Aspirin, Warfarin, Clopidogrel | Increased risk of bleeding due to impaired platelet aggregation from serotonin. | Moderate |
| CYP2C19 Inhibitors - e.g., Omeprazole, Esomeprazole, Fluconazole, Fluvoxamine | Increase escitalopram plasma levels, increasing risk of side effects/QT prolongation. | Moderate |
| CYP3A4 Inducers - e.g., Carbamazepine, Rifampicin, Phenytoin | Decrease escitalopram plasma levels, potentially reducing efficacy. | Moderate |
Same composition (Escitalopram Oxalate (10mg)), different brands: