Escitalopram

ATC code

N06AB10

Therapeutic class

Selective serotonin reuptake inhibitor (SSRI) · Antidepressant

Forms

oral tablet, oral solution

Brand names

Lexapro (US) · Cipralex (EU) · Escitalopram Cinfa (ES) · Escitalopram Zentiva (FR) · Escitalopram Oral Solution (US)

Overall confidence

high

Regulatory sources consulted

openfda-label-2f987c95-695b-d900-e063-6294a90a0cf8
aemps-ft-71430
ansm-rcp-69451151
PubMed PMID:36350591 ↗
PubMed PMID:37183813 ↗
PubMed PMID:36828150 ↗
PubMed PMID:36749328 ↗
PubMed PMID:36853245 ↗
crediblemeds.org
OpenFDA · N06AB10
RxNorm rxcui 321988 ↗

Approved indications

Treatment of major depressive disorder (MDD) in adults and pediatric patients 12 years of age and older.
Treatment of generalized anxiety disorder (GAD) in adults.
Management of vasomotor symptoms (hot flashes) associated with menopause. · off-label
Treatment of panic disorder with or without agoraphobia.

Contraindications

Absolute

Concomitant use of monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing them.
Concomitant use with pimozide.
Known hypersensitivity to escitalopram or citalopram.
Patients with known congenital or acquired QT interval prolongation.
Concomitant use with other drugs that prolong the QT interval.

Clinical warnings

Boxed warning · Increased risk of suicidal thoughts and behaviors in pediatric and young adult patients. Monitor for clinical worsening and emergence of suicidal thoughts. — FDA
Major warning · Serotonin Syndrome: Can occur with SSRIs, especially with concomitant use of other serotonergic agents. Symptoms include mental status changes, autonomic instability, and neuromuscular symptoms. — FDA
Major warning · Risk of QT prolongation and Torsades de Pointes, especially at doses above 20 mg/day, in the elderly, women, and with hypokalemia or drug interactions. — EMA SPC

Drug interactions

HighMAO Inhibitors (e.g., phenelzine, linezolid)N06AF
Mechanism: Massive increase in serotonin levels, with risk of life-threatening serotonin syndrome.
Recommendation: Contraindicated. Allow a 14-day interval between discontinuing the MAOI and starting escitalopram, and 7-14 days in reverse.
FDA labelEMA SPC
HighPimozideN05AG02
Mechanism: Additive risk of QT interval prolongation, increasing the risk of serious ventricular arrhythmias such as Torsades de Pointes.
Recommendation: Concomitant use is contraindicated.
FDA label
HighQT-prolonging drugs (e.g., antiarrhythmics, some antipsychotics)C01B
Mechanism: Additive effect on QT interval prolongation, increasing the risk of ventricular arrhythmias.
Recommendation: Association is contraindicated according to the European SPC.
ANSM RCP
ModerateNSAIDs, aspirin, anticoagulants (e.g., warfarin)B01AC06
Mechanism: SSRIs can affect platelet aggregation, increasing the risk of bleeding when combined with other drugs that affect hemostasis.
Recommendation: Use with caution. Monitor for signs of bleeding. In patients on warfarin, monitor INR when starting or stopping escitalopram.
FDA label

Adverse events

Common (≥1%)

nausea · insomnia · ejaculation disorder · somnolence · increased sweating · fatigue · decreased libido · anorgasmia · headache

Rare but serious

serotonin syndrome · QT prolongation · Torsades de Pointes · hyponatremia · seizures · abnormal bleeding · angle-closure glaucoma

Pregnancy and lactation

FDA category: Not applicable (narrative summary required)

Use in the third trimester may increase the risk of persistent pulmonary hypertension of the newborn (PPHN) and poor neonatal adaptation syndrome. Has been associated with an increased risk of postpartum hemorrhage. Use only if the potential benefit justifies the risk to the fetus.

Recent literature (PubMed)

Mindfulness-Based Stress Reduction vs Escitalopram for the Treatment of Adults With Anxiety Disorders: A Randomized Clinical Trial.
Hoge EA, et al. · JAMA Psychiatry · 2023 · Relevance 5/5
Ensayo clínico aleatorizado que comparó la reducción del estrés basada en mindfulness (MBSR) con escitalopram para trastornos de ansiedad. Se demostró que MBSR no fue inferior a escitalopram en la reducción de la ansiedad, ofreciendo una alternativa terapéutica no farmacológica con eficacia similar.
Pharmacological Treatment of Generalised Anxiety Disorder: Current Practice and Future Directions.
Fagan HA, et al. · Expert Rev Neurother · 2023 · Relevance 4/5
Revisión sobre el tratamiento del Trastorno de Ansiedad Generalizada (TAG) que posiciona a escitalopram como uno de los tratamientos farmacológicos de primera línea, junto con duloxetina, pregabalina, quetiapina y venlafaxina, destacando su eficacia.
Antidepressants or running therapy: Comparing effects on mental and physical health in patients with depression and anxiety disorders.
Verhoeven JE, et al. · J Affect Disord · 2023 · Relevance 4/5
Estudio que comparó antidepresivos (escitalopram o sertralina) con terapia de carrera. Ambas intervenciones mostraron tasas de remisión similares para la salud mental, pero la terapia de carrera fue superior en la mejora de la salud física (peso, presión arterial, etc.).
Management of Menopausal Symptoms: A Review.
Crandall CJ, et al. · JAMA · 2023 · Relevance 3/5
Revisión sobre el manejo de los síntomas menopáusicos que menciona a escitalopram como una opción no hormonal eficaz para reducir los síntomas vasomotores (sofocos), con una reducción de frecuencia del 40% al 65%.
Borderline Personality Disorder: A Review.
Leichsenring F, et al. · JAMA · 2023 · Relevance 3/5
Revisión sobre el Trastorno Límite de la Personalidad (TLP) que indica que, aunque no hay medicación para los síntomas nucleares del TLP, se pueden prescribir ISRS como escitalopram para tratar trastornos comórbidos graves como la depresión mayor.