Escitalopram belongs to the group of medications called selective serotonin reuptake inhibitors (SSRIs). It is used to treat depression. It works by increasing levels of a neurotransmitter called serotonin in the brain. Increased serotonin levels can lead to an improved mood.

The medication usually begins to work within 2 to 4 weeks. However, it may take several weeks of treatment before the full effects are seen.

Your doctor may have suggested this medication for conditions other than the ones listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Escitalopram should be taken once daily in the morning or evening, with or without food. The dose is usually started at 10 mg daily and increased by your doctor as needed. In some cases, the doctor may recommend a 5 mg starting dose. The tablets should be swallowed whole (not chewed) with a glass of water.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important that this medication be taken exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue on with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue on with your regular dosing schedule. Do not take a double dose to make up for a missed one.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

Cipralex® is available in strengths of 10 mg and 20 mg.

10 mg: Each film-coated, white, oval, scored tablet, marked "EL" on one side, contains 10 mg of escitalopram (as oxalate).

20 mg: Each film-coated, white, oval, scored tablet, marked "EN" on one side, contains 20 mg of escitalopram (as oxalate).

Nonmedicinal ingredients: microcrystalline cellulose, colloidal silicon dioxide, croscarmellose sodium, talc, magnesium stearate, hydroxypropyl methyl cellulose, titanium dioxide (white E-171), and polyethylene glycol 400.

Escitalopram should not be used by anyone who:

• is allergic to escitalopram, citalopram, or any of the ingredients of the medication
• is taking the medication pimozide
• has taken an MAO inhibitor medication (e.g., phenelzine, tranylcypromine, moclobemide) in the past 2 weeks.

MAO inhibitors should not be taken until at least 2 weeks after stopping treatment with escitalopram.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your health professional. They may be able to help you to deal with some of the effects.

The following side effects may go away as your body becomes used to the medication; check with your doctor if they continue or become bothersome.

More common
• headache
• nausea

Less common
• abdominal pain
• constipation
• diarrhea
• difficulty sleeping
• dizziness
• drowsiness
• dry mouth
• fatigue
• indigestion
• sexual dysfunction including:
  • erectile dysfunction (difficulty getting or keeping an erection)
  • decreased libido (sex drive)
  • inability to have an orgasm
• increased sweating

Frequency unknown
• abnormal vision
• bronchitis
• eye infection
• fever
• gas
• hot flushes
• increased appetite
• migraine
• nervousness
• numbness
• palpitation (feeling of rapid heartbeat)
• strange dreams
• tremor (shaking)
• yawning

Contact medical help immediately if any of the following side effects occur:

• confusion
• feeling of being very hot
• involuntary muscle movements or muscle stiffness
• severe agitation
• seizures
• suicidal feelings

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Bleeding disorders: Other medications from the same class as escitalopram may cause bleeding disorders of the skin. Report any unusual bruising or bleeding to your doctor, especially if you are taking medications that affect platelets (special blood cells that help the blood to clot). These medications include ASA, clopidogrel, dipyridamole, nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., ibuprofen or naproxen), and certain antipsychotic drugs.

Diabetes: People with diabetes should be closely monitored by their doctor while taking escitalopram, as it may occasionally lower blood sugar levels (hypoglycemia).

Kidney function: People with severely reduced kidney function should be closely monitored by their doctor while they are taking this medication.

Liver function: People with reduced liver function should use escitalopram with caution and take a lower-than-usual dose as prescribed by their doctor.

Mania: Escitalopram may cause activation of mania. This means that people who are prone to mania may be more likely to have their mania start up again. People with a history or mania or bipolar disorder should be closely monitored by their doctor if they take this medication.

Seizures: People with a history of seizures should be closely monitored by their doctor when taking escitalopram. If you develop seizures, stop taking the medication and contact your doctor.

Stopping the medication: Escitalopram should not be stopped abruptly, due to the risk of discontinuation symptoms (dizziness, abnormal dreams, numbness, electric shock feelings, agitation, anxiety, difficulty concentrating, headache, tremor, nausea, vomiting, and sweating). A gradual reduction in dose over a period of time is recommended. If you are thinking of stopping the medication, talk to your doctor or pharmacist about how to do this safely.

Suicidal or agitated behaviour: Adults and children taking this medication may feel agitated (restless, anxious, aggressive, emotional, and feeling not like themselves), or they may want to hurt themselves or others. These symptoms may occur within several weeks after people start taking this medication. People should be closely monitored by their doctor for emotional and behavioural changes.

Pregnancy: The safe use of escitalopram during pregnancy has not been established. It has been reported that babies born to pregnant women who have taken citalopram during the last trimester of pregnancy may be adversely affected. Some babies needed to stay in hospital longer and required breathing support and tube feeding. As well, babies experienced symptoms such as problems with breathing and feeding, seizures (convulsions), muscle stiffness, constant crying, and feeling "jittery." Physicians and pregnant women should carefully consider the benefits and the risks of all treatment options.

Breast-feeding: It is known that the medication citalopram, which is similar to escitalopram, passes into breast milk; therefore escitalopram should not be taken by breast- feeding women unless, in the opinion of their doctor, the expected benefits outweigh the risks.

Children and adolescents: The safety and efficacy of this medication for children and adolescents under 18 years of age have not been established. It may cause behavioural and emotional changes, such as suicidal thoughts and behaviour.

The following medications may affect how escitalopram works or increase the risk of side effects:

• cimetidine
• erythromycin
• fluconazole
• itraconazole
• ketoconazole
• lithium
• MAO inhibitors (e.g., selegiline, moclobemide, phenelzine, tranylcypromine)
• medications that affect platelets (e.g., ASA, nonsteroidal anti-inflammatory drugs [NSAIDs], tricyclic antidepressants, some antipsychotic drugs)
• omeprazole
• other SSRI medications (e.g., citalopram, fluoxetine, sertraline)
• St. John's Wort
• sumatriptan

The following medications may be affected by escitalopram:

• desipramine
• imipramine
• ketoconazole
• metoprolol
• pimozide

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. In many cases, interactions are intended or are managed by close monitoring. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.