EscitalopramEscitalopram Oxalate

About Escitalopram

Escitalopram is the S-enantiomer, one of the two mirror-image forms, of citalopram, and it is presumed to work by blocking the reuptake of serotonin in the brain. It is labeled for major depressive disorder in adults and children 12 and older, and for generalized anxiety disorder (GAD) in adults and children 7 and older; the pediatric GAD use was approved in May 2023. Every age group starts at 10 mg once a day, and the dose can be raised to the maximum of 20 mg after at least one week in adults, two weeks in children with GAD and three weeks in adolescents with depression. The recommended dose for most older adults and for people with liver impairment is 10 mg a day, and mild or moderate kidney impairment needs no dose change.

The boxed warning says antidepressants increased the risk of suicidal thoughts and behaviors in pediatric and young adult patients in short-term studies, and that Lexapro is not approved for children under 7; everyone taking it is watched for worsening mood or new suicidal thoughts, especially early on and after dose changes. It must not be taken with an MAO inhibitor or within 14 days of stopping one, started in someone receiving linezolid or intravenous methylene blue, taken with pimozide, or taken by anyone allergic to escitalopram or citalopram. Other warnings cover serotonin syndrome, discontinuation symptoms, seizures, mania, low sodium, bleeding, effects on judgment and driving, angle-closure glaucoma and sexual dysfunction. In adults, insomnia, ejaculation problems, nausea, sweating, tiredness, sleepiness, decreased libido and difficulty reaching orgasm are the most common side effects.

Lexapro tablets come in 5 mg (not scored) and scored 10 and 20 mg strengths. The FDA lists the Lexapro oral solution as discontinued and its label says it is not currently marketed, but generic escitalopram oral solution of the same strength, 5 mg per 5 mL, is sold by several makers. The dose is lowered gradually rather than stopped abruptly. QT prolongation and torsade de pointes have been reported since approval. Use in the month before delivery may raise the risk of postpartum hemorrhage, and late-pregnancy exposure is linked to complications in the newborn. Escitalopram passes into breast milk, so a breastfed infant is watched for excess sleepiness, restlessness, agitation and poor feeding or weight gain. The label says alcohol is not recommended.

Taking Escitalopram

How to take it

Once a day, in the morning or evening, with or without food. Keep taking it as prescribed, and do not stop it without talking to the prescriber, since the dose is lowered gradually.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose and carry on as usual. Do not take a double dose.

Storage

At room temperature in the original, tightly closed container, away from excess heat and moisture (not in a bathroom), and out of reach of children.

Interactions to know about

MAO inhibitors, including linezolid and methylene blue, and pimozide are not combined with it. Triptans, tricyclic antidepressants, fentanyl, tramadol, meperidine, methadone, lithium, buspirone, amphetamines, tryptophan and St. John’s wort raise the risk of serotonin syndrome, and aspirin, NSAIDs such as ibuprofen and naproxen, and warfarin add to bleeding risk. It raises desipramine and metoprolol levels, carbamazepine may lower its levels, and alcohol is not recommended.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Escitalopram differs from pharmacy to pharmacy

Each pharmacy sets its own cash price for generic escitalopram from what it paid its supplier plus its own dispensing fee and markup, so quotes for the same tablets can differ. A prescription that names Lexapro and does not allow substitution has to be filled with the brand.

The oral solution is a different product from the tablets, with its own makers, so it is quoted separately, and moving between tablets and solution needs a new prescription.

Ways to pay less for Escitalopram without insurance

• Ask for generic escitalopram, and make sure the prescription does not block substitution.
• Ask whether escitalopram is on the pharmacy’s flat-price generic list, and compare more than one pharmacy.
• If the oral solution is prescribed for someone who can swallow tablets, ask the prescriber whether tablets would suit.
• Once your dose is stable, ask for a ninety-day supply.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Escitalopram

1. 1.Is my prescription for tablets or the oral solution, and how do I measure the liquid?
2. 2.Do any of my migraine medicines, pain relievers or blood thinners interact with it?
3. 3.How long should I wait before my dose is raised?
4. 4.How should my dose be lowered if I need to stop?

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