Miraklide (Escitalopram)

Escitalopram is an SSRI that modulates serotonin pathways and is indicated for the following conditions:

• Major depressive disorder: alleviates depressive symptoms and improves mood.
• Generalized anxiety disorder: reduces excessive worry and physical tension.
• Panic disorder: decreases frequency and severity of panic attacks.
• Social anxiety disorder: lessens fear of social situations and improves functioning.

• Escitalopram selectively inhibits the serotonin transporter (SERT) on presynaptic neurons, preventing reuptake of serotonin from the synaptic cleft. This increases extracellular serotonin concentrations, enhancing serotonergic neurotransmission and contributing to mood stabilization and anxiolytic effects.

Escitalopram may cause a range of adverse reactions. Patients should be informed of both common and serious possibilities.

Common Side Effects

• Nausea: mild to moderate stomach upset.
• Headache: transient tension‑type headaches.
• Insomnia: difficulty falling or staying asleep.
• Dry mouth: reduced salivation.
• Sexual dysfunction: decreased libido or difficulty achieving orgasm.
• Dizziness: light‑headed sensation, especially on standing.

Serious or Rare Side Effects

• Serotonin syndrome: agitation, hyperthermia, muscle rigidity.
• Suicidal thoughts: emergence of suicidal ideation, particularly early in treatment.
• Severe allergic reaction: rash, swelling, or breathing difficulty.
• QT interval prolongation: cardiac rhythm disturbances.
• Hyponatremia: low blood sodium causing confusion or seizures.
• Abnormal bleeding: increased bruising or prolonged bleeding.

Before initiating therapy, clinicians should consider several safety aspects.

• Assess for suicidal ideation: monitor patients closely during the first weeks.
• Evaluate hepatic function: dose adjustment may be needed in severe impairment.
• Review concomitant serotonergic agents: avoid combinations that increase serotonin syndrome risk.
• Caution in elderly: higher incidence of hyponatremia and falls.
• Pregnancy and lactation: discuss potential risks with the prescriber.
• Store below 25°C: keep in the original pack, protect from moisture.

Escitalopram can interact with other medicines, requiring attention to avoid adverse outcomes.

Major Interactions (Avoid)

• Monoamine oxidase inhibitors (MAOIs): risk of serotonin syndrome.
• Pimozide or thioridazine: can cause QT prolongation.
• Linezolid: additive serotonergic effect.
• Other serotonergic agents (e.g., tramadol, triptans): increase serotonin syndrome risk.

Moderate Interactions (Monitor Closely)

• NSAIDs or anticoagulants: heightened bleeding tendency.
• CYP2C19 inhibitors (e.g., fluoxetine, omeprazole): may raise escitalopram levels.
• CYP3A4 inhibitors (e.g., ketoconazole): modest increase in exposure.
• Alcohol: may exacerbate CNS depression.
• Antihistamines: potential additive sedation.