Lexapro contains an active substance called Escitalopram. It belongs to a family of medicines called selective serotonin reuptake inhibitors. It is used to treat the following conditions:
-Major depressive episodes
-Panic disorders, with or without agoraphobia
-Social phobia
-Generalized anxiety disorders
-Obsessive-compulsive disorders
The mechanism of action is based on the potentiation of serotonergic activity in the central nervous system, which occurs due to the inhibition of the absorption of serotonin in central nervous system neurons. In vitro and in vivo studies have demonstrated that Lexapro binds highly selectively to serotonin receptors, and exhibits a very low affinity for dopamine and adrenergic receptors.
The efficacy of Lexapro in the treatment of depression and generalized anxiety disorder was confirmed in three placebo-controlled clinical studies lasting 8 weeks. All three studies have shown that this drug leads to a significantly greater improvement in the symptoms of depression compared to placebo.
Pharmacokinetics
After oral administration, Lexapro is very well absorbed in the digestive tract, regardless of the food intake. The maximum blood concentration is reached 4 hours after administration. The absolute bioavailability of this drug is 80%.
Lexapro is metabolized in the liver via CYP2C19 enzyme into glucuronide metabolites, after which most of them are excreted through urine. The drug is metabolized significantly slower in patients over 65 years of age (mainly due to impaired renal function), which results in a 50% increase of Celexa blood levels.
Precautions
Patients with major depression may experience worsening of symptoms and the occurrence of suicidal behavior. Depression, by itself, may lead to suicidal behavior. However, some studies have demonstrated that antidepressants, including Lexapro, increase the risk of suicidal thoughts and behaviors. Therefore, it is very important that the doctor tells the patient, as well as his/her family to be aware of signs of suicidality, and call a physician at once if they appear. The risk of suicide is higher at the beginning of therapy (during the first month), as well as in cases when the dosage of the drug is increased or decreased.
Interactions
Since Lexapro increases serotonin levels in the blood, concomitant administration with certain drugs can lead to a very high serotonin levels in the blood, thus leading to serotonin syndrome.
Symptoms of serotonin syndrome:
Behavioral and cognitive symptoms: headache, confusion, anxiety, hallucination, delirium, slurred speech, coma.
Autonomic symptoms: fever,nausea, diarrhea, dilated pupils, rapid heart rate, excessive sweating, high blood pressure.
Somatic symptoms: Akathisia (physical discomfort),repetitive head turning, muscle fasciculation, horizontal ocular clonus, muscle stiffness, myoclonus, hyperreflexia.
If you notice any symptom of serotonin syndrome, contact your doctor immediately because serotonin syndrome may have a fatal outcome! Simultaneous administration with the following medicines increases the risk of serotonin syndrome and therefore must be avoided:
-MAO inhibitors, such as Isocarboxazid, Tranylcipromine, Selegiline, Rasagiline, and Methylene blue. You must wait at least 14 days after you stop taking MAO inhibitors in order to start the treatment with Lexapro. Likewise, after the discontinuation of Lexapro, you must wait at least 14 days in order to start treatment with an MAO inhibitor.
Dextromethorphan – a cough remedy.
-5-HTP (5-hydroxytryptophan) – a medicine used to treat depression.
Narcotic analgesics, such as Methadone, Codeine, Morphine, Apomorphine, Oxycodone, Fentanyl, Oxymorphone, Tramadol, and Alfentanil.
-Tricyclic antidepressants, such as Doxepin, Amitriptyline, Amoxapine, Maprotiline, Trimipramine, Imipramine, Chloropramine, Desipramine, Nortriptyline, and others.
-Cyclobenzaprine – a medicine used to treat muscle pain and muscle injuries.
-5-HT3 antagonists – medicines used to prevent nausea induced by chemotherapy, such as Ondansetron, Palonosetron, Dolasetron, Tropisetron, Granisetron, and Ramosetron.
-Lorcaserin – a medicine used for weight loss.
Simultaneous administration with the following drugs increases the risk of life-threatening arrhythmias:
-Amiodarone, Ibutilide and Adenosine – medicines used to treat arrhythmias.
-Clarithromycin – an antibiotic used to treat infections.
-Doxorubicin – a medicine used in the treatment of prostate, ovarian, stomach, lung, breast, thyroid and bone carcinoma.
-Anagrelid– a medicine used to treat essential thrombocytosis.
–Alfa-1 blockers– medicines used to treat high blood pressure and benign prostate enlargement.
-Promethazine – a medicine used to treat allergy and motion sickness.
-Abarelix– a medicine used to treat advanced forms of prostate cancer.
-Bedaquiline– a medicine used to treat tuberculosis.
-Vandetanib and Cabozantinib– a medicine used to treat medullary thyroid carcinoma.
-Chloroquine – a medicine used to treat malaria.
-Pimozide– a medicine used to treat mental illnesses.
More than 300 drugs enter into the major interactions with Lexapro, and it is very important to inform your doctor about all the medicines you are taking.
Dosage
Lexapro is administered as a single daily dose, with or without food.
Major depression
The recommended dosage is Meds4sure: Generic Prozac Lexapro 10MG Zoloft Cymbalta Celexa Paxil Dosage Tablets once daily. Depending on the individual response, the dose can be increased to 20mg daily. The effect is achieved after 2-4 weeks. When the symptoms of depression withdraw, it is necessary to continue the therapy for at least 6 months, in order to stabilize the condition.
Generalized anxiety disorder
The initial dose is 10mg once a day. The dose may, if necessary, be increased to 20mg per day. The duration of therapy is at least 6 months.
Panic disorders with or without agoraphobia
The initial dose is 5mg once daily for the first 7 days. After that the dose should be increased to 10mg daily. If no effect is achieved with 10mg/day, the dose may be increased to 20mg per day. The maximum effect is achieved after three months of therapy.
Obsessive-compulsive disorders
The usual dose is 10mg per day but can be increased to 20mg per day.
Social phobia
The usual dose is 10mg per day. Symptoms usually get better after 2-4 weeks, and then the dose can be reduced to 5mg daily. The therapy should last at least 3 months.
Abrupt discontinuation of therapy should be avoided because of the possible occurrence of abstinence syndrome. Your doctor will explain you how to gradually reduce the dosage of Lexapro before you completely discontinue taking it.
Side Effects
Lexapro can cause the following side effects:
-Abdominal discomfort
-Diarrhea
-Difficulty swallowing
-Abdominal cramps
-Gastroesophageal reflux
-Pain in the arms and legs
-Fever
-Chest pain
-Bruises
-Anemia
-Nosebleeds
-Weight gain
-Hyperglycemia
-Gout
-Increase in blood cholesterol levels
-Nervousness
-Depression
-Emotional lability
-Anxiety attacks
-Forgetfulness
-Sugar cravings
-Bronchitis
-Asthma
-Menstrual cramps
-Dry eyes
-Eye irritation
-Eye infection
-Jaw pain
-Stiffness of the muscles and joints
-Hallucinations
-Suicidal behavior
Call your doctor immediately if you notice any above-mentioned adverse effects.
