Itakem (Escitalopram)

Escitalopram is an SSRI indicated for several mood and anxiety disorders.

• Major depressive disorder: reduces depressive symptoms and improves overall mood.
• Generalized anxiety disorder: alleviates excessive worry and associated physical tension.
• Social anxiety disorder: lessens fear of social situations and improves social functioning.
• Panic disorder: decreases frequency and intensity of panic attacks.
• Obsessive‑compulsive disorder: diminishes intrusive thoughts and compulsive behaviors.

• Escitalopram selectively inhibits the serotonin transporter (SERT) on presynaptic neurons, preventing reuptake of serotonin from the synaptic cleft. This results in increased extracellular serotonin concentrations, enhancing serotonergic neurotransmission throughout central nervous system pathways that regulate mood, anxiety, and cognition. The drug exhibits high affinity for SERT and minimal activity at other receptors, contributing to its favorable efficacy and tolerability profile.

Escitalopram may cause a range of adverse reactions, which are generally categorized by frequency and severity.

Common Side Effects

• Nausea: mild stomach upset often occurring early in treatment.
• Headache: transient tension‑type headaches.
• Insomnia: difficulty falling or staying asleep.
• Dry mouth: reduced salivation.
• Sexual dysfunction: decreased libido or delayed orgasm.
• Dizziness: light‑headed sensation upon standing.

Serious or Rare Side Effects

• Serotonin syndrome: potentially life‑threatening condition with agitation, hyperthermia, and muscle rigidity.
• Suicidal thoughts: emergence of suicidal ideation, especially in young adults.
• Severe allergic reaction: rash, swelling, or difficulty breathing.
• QT interval prolongation: cardiac rhythm disturbance detectable on ECG.
• Mania or hypomania: sudden elevation of mood in susceptible individuals.
• Hyponatremia: low blood sodium causing confusion or seizures.

When prescribing escitalopram, clinicians should observe several safety considerations to minimize risk.

• Assess for suicidal ideation: monitor patients, especially during initial weeks and dose changes.
• Monitor for serotonin syndrome: watch for agitation, hyperthermia, and neuromuscular abnormalities.
• Use caution in hepatic impairment: dose adjustment may be required in patients with liver dysfunction.
• Avoid abrupt discontinuation: taper gradually to reduce withdrawal symptoms.
• Consider dose adjustment in elderly: start with lower dose and titrate cautiously.
• Store at room temperature: keep in original container, protect from moisture and direct sunlight.

Escitalopram can interact with other medicines, altering its effectiveness or increasing adverse effects.

Major Interactions (Avoid)

• MAO inhibitors: concurrent use can precipitate serotonin syndrome.
• Pimozide: increased risk of QT prolongation and cardiac arrhythmias.
• Linezolid or other reversible MAO‑A inhibitors: may cause severe serotonergic toxicity.

Moderate Interactions (Monitor Closely)

• NSAIDs and anticoagulants: heightened risk of gastrointestinal bleeding.
• CYP2C19 inhibitors (e.g., fluconazole): may raise escitalopram plasma levels.
• Alcohol: can enhance central nervous system depression and dizziness.