Lexapro comes in a generic form called escitalopram, an antidepressant that belongs to a group of drugs named SSRI or selective serotonin reuptake inhibitors.
Escitalopram works by creating a reaction in the chemicals in the brain for people experiencing anxiety or depression.
The use of Lexapro involves some side effects which can be common or severe.
Typical Lexapro side effects
- Weight changes
- Taste alterations
- Blurred vision
- Frequent urination
- Difficulty sleeping
- Change in appetite
- Sexual difficulties
- Increased sweating
Potential serious side effects
- Low sodium
- Serotonin syndrome
- Angle-closure glaucoma
- Muscle rigidity
- Suicidal thinking and behavior
- Manic episodes
- High fever
- Slurred speech
Indication and dosage
Lexapro must be taken with much care such that it cannot be taken more than the dosage that you are only required to have, or more often than just what you should. Lexapro may not be used for a prolonged period.
Before starting with this treatment, always read theLexapro medication guide and follow precisely what the doctor tells you. If advised to take it at a specific time, follow the instructions, and if you have questions, do not hesitate to ask either the doctor or the pharmacist.
This can be taken with food or on an empty stomach. Results will start to show after a month or so from the start of treatment.
For oral liquid, make sure to shake the bottle well first before using, and use the measuring cup provided to have the exact and proper dosage.
Lexapro is used in different dosages and varies depending on the patient’s condition, which is why it is essential always to follow your doctor’s orders and instructions when taking Lexapro.
How you will take your Lexapro, like the amount that you should take, the number of times it should be made, and the gaps of time in between intakes should be based according to your doctor’s instructions.
Here though are the average dosages:
- For oral dosage forms (solution or tablets):
- For depression:
- Children 12 years old and up and adults- 10 mg once daily and can be taken either in the morning or night. The dosage may change as per the doctor’s instructions, but it would not exceed 20mg each day.
- Older adults- 10mg once daily, and can be taken either in the morning or evening
- Children 12 years old and below- dosage and usage must be upon doctor’s advice.
- For generalized anxiety disorder:
- Adults- 10mg once daily and can be taken either day or night. Dosage may change as per doctor’s instructions, but would not be more than 20mg per day.
- Older adults- 10mg once daily and taken day or night.
- Children- usage and dosage must be upon the doctor’s advice.
In case you missed a dose, never double the intake of Lexapro. Simply take it the moment you remember, then follow your regular medication for anxiety schedule.
Lexapro may interfere with other drugs, so before starting with Lexapro, you must tell your doctor about all your other medications for insomnia, whether it is an over- the- counter medicine, herbs, supplements, and even illegal drugs.
Alcohol is also not advised to go with this treatment as it may have further adverse effects on your motor and mental skills.
Lexapro may make you feel tired and has the possibility of affecting your thinking, motor, and mental skills. Until you know how Lexapro responds or affects your body, avoid driving a vehicle or operating machinery.
Some drugs that may interact with Lexapro are:
- Monoamine oxidase inhibitors (MAOIs)
- Other SSRIs like Celexa
- St. John’s Wort
- Blood thinners like Coumadin
- Some pain medicines like ConZip, Ryzolt, and Ultram
- NSAIDs like Alleve, Naprosyn, Motrin, and Advil
- Heartburn drugs like Tagamet
- Drugs for mental treatment like Lithotabs, Eskalith, and Lithobid
- Anti-seizure medicines like Tegretol
- Medications for the heart like Lanoxin and Digoxin
- Cure for migraines like Axert, Relpax, and Frova
- Antidepressant drugs like Norpramin
- Sedatives like Halcion
- Medications for HIV like Norvir
- Antibiotic like Zyvox
- Antifungal drugs like Extina, Nizoral, and Xolegel
Warnings and Precautions
Lexapro must be taken with great care because there is a risk of suicidal tendencies. There is a higher risk for this kind of side effect among teens, adolescents, and individuals who are less than 24 years old and are being treated for major depressive disorder or other types of mental illness.
Adults who are above 24 years old also have the potential for their mental health to change while taking Lexapro.
Younger individuals who are undergoing this treatment need to have close monitoring.
It is essential to note that at the onset of this treatment or when your dosage is adjusted, suicidal thoughts may occur.
If you are having this kind of symptom or if there is a sudden change in your behavior, mood, feeling, and thinking, inform your doctor right away.
According to research that was published in 2014, it revealed that prenatal exposure to SSRIs and autism spectrum nerve disorders or developmental delays are correlated. This study also revealed that risk is higher for newborns whose mothers had SSRI in the early part of their pregnancy.
However, researchers say that the results from some other studies of SSRIs were not reliable as they were inconsistent and that further and more significant studies should be made.
Before starting on the Lexapro treatment, you need to discuss with your doctor about your medical condition, most especially if you recently had a heart attack or if you currently have heart disease.
Tell your doctor if you have the following conditions or medical concerns:
- Thyroid condition
- Liver disease
- Kidney problems
If you are also going to have surgery soon, and this includes the dental procedure, it is best to let your doctor know about them as well.
Escitalopram’s antidepressant action, the S- enantiomer of racemic citalopram, is believed to be associated with the potentiation of serotogenic activity in the CNS (Central Nervous System) which results to the inhibition of (5- HT) CNS neuronal reuptake of serotonin.
Studies on animals, both in vitro and in vivo reveals that escitalopram is a highly selective serotonin reuptake inhibitor that has minimal effects on dopamine and norepinephrine neuronal uptake.
The study also suggests that escitalopram’s potency is 100- fold more than the R- enantiomer in respect to the inhibitions of 5- HT reuptake and 5- HT neuronal firing.
The experiment on the antidepressant effect on rats using the escitalopram treatment was not done on a long term period, so the result has very low to no affinity to serotogenic (5- HT1- 7) or other receptors that includes alpha- and beta-adrenergic, dopamine (D1- 5), histamine (H1- 3), muscarinic (M1- 5), and benzodiazepine receptors.
Escitalopram does not also exhibit or has a low affinity for specific ion channels like Na+, K+, Cl- and Ca++. The strain of muscarinic, histaminergic, and adrenergic receptors is assumed to be related to a different sedative, anticholinergic, and cardiovascular side effects of other psychotropic drugs.
Both the multiple and single-dose pharmacokinetics of escitalopram are dose-proportional and linear for the dosage ranging from 10 to 30mg per day. Escitalopram’s biotransformation is hepatic and has about 27 to 32 hours of mean terminal half-life.
The steady-state plasma concentrations for the once a day dosage was achieved in one week, and the extent of the escitalopram accumulation in the plasma among young and healthy subjects was 2.2 to 2.5 times the plasma concentration observed using a single dosage.
The dosage forms of escitalopram oxalate in the oral solution and the tablet are bioequivalent.
Absorption and Distribution
After a Lexapro single oral dose of either a 20mg solution or tablet of escitalopram, peak blood levels take effect around after 5 hours. Food does not affect its absorption.
Citalopram’s bioavailability is around 80% relative to an intravenous dose, and its volume of distribution is around 12L per kg. There is no specific data available on escitalopram, and its binding to human plasma proteins is about 56%.
Metabolism and Elimination
After implementing oral administrations of escitalopram, the percentage of drug recovered in the urine is 8% escitalopram, and 10% S- demethylcitalopram, while the oral clearance is 600ml per min. With about 7% of it because of renal clearance.
Escitalopram is digested into S- DCT, and S- DDCT (S- didemethylcitalopram), but its consistent form in humans is the predominant compound in plasma.
The concentration of the escitalopram metabolite S- DCT in plasma is about 1/3 of the escitalopram in a steady state. In many subjects, the levels of S- DDCT was not very evident.
The in vitro studies reveal that escitalopram is 7 to 27 times more potent than S- DDCT and S- DCT in the inhibition of serotonin reuptake, which can assume that the metabolites of escitalopram do not have a significant contribution to the antidepressant effects of the escitalopram.
S- DCT and S- DDCT have very low to 0 affinities for serotogenic 5- HT1- 7 or other receptors such as alpha- and beta-adrenergic, dopamine (D1- 5), histamine, muscarinic and benzodiazepine. They also do not bind to ion channels such as Na+, K+, and Ca++.
In vitro studies that used human liver microsomes showed that CYP3A4 and CYP2C19 are the primary isozymes present in the N- demethylation of escitalopram.