Esopam

Major depressive episodes, generalized & social (social phobia) anxiety disorder; panic disorder w/ or w/o agoraphobia; obsessive-compulsive disorder (OCD).

Adult Major depressive episodes Initially 10 mg/day. May increase dose to 20 mg/day. Treatment duration: Usually 2-4 wk to obtain antidepressant response, then at least 6 mth for consolidation of response after symptoms resolve. Panic disorder w/ or w/o agoraphobia Initially 5 mg/day for the 1st wk, then increase dose to 10 mg/day & may further increase to 20 mg/day based on response & tolerability. Treatment duration: Several mth. Max effectiveness is reached after about 3 mth. Generalized & social (social phobia) anxiety disorder Initially 10 mg/day. May increase dose to 20 mg/day. Treatment duration: Usually 2-4 wk to obtain symptom relief in social phobia. 3 mth to consolidate response. Long term (6 mth) to prevent relapse depending on individual basis. OCD Initially 10 mg/day. May increase dose to 20 mg/day. Treatment duration: Several mth or longer. Hepatic impairment, patient who is poor CYP2C19 metaboliser Initially 5 mg/day for the 1st 2 wk. May increase dose to 10 mg/day. Elderly ≥65 yr Initially ½ of usual recommended dose & lower max dose.

May be taken with or without food.

Hypersensitivity to citaplopram or escitalopram. Concomitant use w/ MAOI including linezolid or IV methylene blue (or w/in 14 days of discontinuation of MAOI or escitalopram); pimozide.

Discontinue use if symptoms of hyponatremia develop; life-threatening serotonin syndrome is suspected. Consider discontinuation or changing therapy if suicidal thoughts & behavior occur. Avoid use in older adults w/ history of falls or fractures. Hyponatremia, usually result of SIADH, especially in vol-depleted & elderly patients or w/ concurrent diuretic therapy. Bleeding events (including life-threatening hemorrhages); convulsions. Worsening of angle-closure glaucoma in patients w/ anatomically narrow angle w/o patent iridectomy. Increased risk of suicidal thoughts & behaviors in young adults (18-24 yr) & ped, especially in those w/ major depressive disorder. May trigger mixed/manic episode in patients w/ underlying bipolar disorder. Serious w/drawal symptoms upon abrupt discontinuation. Avoid abrupt discontinuation; taper dose gradually over at least 1-2 wk period. Patients w/ conditions or diseases that alter hemodynamic response; history of seizure disorder. Monitor Na levels when starting or changing doses; suicidal thoughts & behaviors especially during initial few mth of therapy & dose changes. Perform screening of patients w/ underlying bipolar disorder. Avoid concomitant use of 3 or more CNS-active agents in any combination due to increased risk of falls. Possible increased risk of bleeding events w/ concomitant NSAIDs, aspirin, warfarin & other anticoagulants. Life-threatening serotonin syndrome during concurrent use w/ other serotonergic drugs (eg, triptans, TCAs, fentanyl, lithium, tramadol, buspirone, amphetamines, tryptophan, St. John's wort) or drugs than impair serotonin metabolism (eg, MAOIs, linezolid, methylene blue). Hepatic & severe renal (CrCl <30 mL/min) impairment. May result in increased risk for neonatal complications, including persistent pulmonary HTN of newborn when used later in pregnancy. Discontinue breastfeeding or consider drug alternative when used during lactation. Not be used in childn & adolescents <18 yr. Elderly ≥65 yr.

Diaphoresis; abdominal pain, constipation, diarrhea, indigestion, nausea, vomiting, xerostomia; dizziness, headache, insomnia, somnolence; ejaculation disorder, erectile dysfunction, orgasm incapacity, reduced libido; fatigue, w/drawal symptom. Abnormal hemorrhage; worsening depression, suicidal thoughts, suicide; serotonin syndrome.

May increase levels/effects of agents w/ antiplatelet properties, anticoagulants, antipsychotic agents, apixaban, aripiprazole, aspirin, bemiparin, blood glucose lowering agents, brexanolone, cephalothin, citalopram, systemic collagenase, dabigatran etexilate, deoxycholic acid, desmopressin, domperidone, doxepin-containing products, duloxetine, edoxaban, enoxaparin, gilteritinib, haloperidol, heparin, ibritumomab tiuxetan, lofexidine, methylene blue, MAOIs (antidepressant), COX-2 selective & non-selective NSAIDs, obinutuzumab, oxitriptan, perhexiline, QT-prolonging kinase inhibitors (moderate risk), QT-prolonging miscellaneous agents (moderate risk), QT-prolonging moderate CYP3A4 inhibitors (moderate risk), rasagiline, rivaroxaban, salicylates, SSRIs, selegiline, serotonergic non-opioids CNS depressants, SNRIs, thiazide & thiazide-like diuretics, thrombolytic agents, TCAs, urokinase, vit K antagonists. Increased levels/effects w/ acalabrutinib, ethyl alcohol, almotriptan, alosetron, amphetamines, antiemetics (5HT₃ antagonists), antipsychotic agents, bromopride, bupropion, buspirone, cimetidine, citalopram, CNS depressants, cyclobenzaprine, dapoxetine, dexmethylphenidate-methylphenidate, dextromethorphan, eletriptan, ergot derivatives, fat emulsion (fish oil based), fexinidazole, glucosamine, herbs (anticoagulant/antiplatelet properties), ibrutinib, inotersen, lasmiditan, limaprost, linezolid, lofexidine, lorcaserin, metaxalone, metoclopramide, metyrosine, multivit/fluoride (w/ ADE), multivit/minerals (w/ ADEK, folate, Fe), multivit/minerals (w/ AE, no Fe), nefazodone, topical NSAIDs, omega-3 fatty acids, omeprazole, ondansetron, opioid agonists, systemic pentamidine, pentosan polysulfate Na, pentoxifylline, pimozide, prostacyclin analogues, QT-prolonging agents (highest risk), QT-prolonging antipsychotics (moderate risk), QT-prolonging class IC antiarrhythmics (moderate risk), QT-prolonging quinolones antibiotics (moderate risk), QT-prolonging strong CYP3A4 inhibitors (moderate risk), ramosetron, safinamide, serotonergic agents (high risk miscellaneous), serotonergic opioids (high risk), serotonin 5-HT1D receptor agonists (triptans), St. John's wort, syrian rue, tipranavir, tramadol, TCAs, systemic vit E, vortioxetine, zanubrutinib. May decrease levels/effects of ioflupane I 123, simeprevir, thyroid products. Decreased levels/effects w/ bosentan, moderate CYP2C19 & CYP3A4 inducers, strong CYP2C19 & CYP3A4 inducers, cyproheptadine, dabrafenib, deferasirox, enzalutamide, erdafitinib, gilteritinib, lorlatinib, mitotane, COX-2 selective & non-selective NSAIDs, sarilumab, siltuximab, St. John's wort, tocilizumab. Avoid concomitant use w/ bromopride, citalopram, dapoxetine, fexinidazole, linezolid, methylene blue, MAOIs, pimozide, rasagiline, selegiline, urokinase.

Antidepressants

N06AB10 - escitalopram ; Belongs to the class of selective serotonin reuptake inhibitors. Used in the management of depression.

D