Escitalopram

Escitalopram is a type of antidepressant known as a selective serotonin reuptake inhibitor (SSRI).

It's often used to treat depression and is sometimes used for anxiety, obsessive compulsive disorder or panic attacks.

Escitalopram helps many people recover from depression and has fewer unwanted effects than older antidepressants.

Escitalopram is available on prescription. It comes as tablets and liquid drops that you put in a drink.

• It usually takes 4 to 6 weeks for escitalopram to work.
• Side effects such as feeling sick (nausea) and headache are common. They're usually mild and go away after a couple of weeks.
• If you and your doctor decide to take you off escitalopram, your doctor will probably recommend reducing your dose gradually to help prevent extra side effects.
• Escitalopram is also called by the brand name Cipralex.

Escitalopram can be taken by adults over the age of 18.

Check with your doctor before starting to take escitalopram if you:

• have had an allergic reaction to escitalopram or any other medicines in the past
• have epilepsy or are having electroconvulsive treatment – escitalopram may increase your risk of having a seizure
• have a heart problem – escitalopram can speed up or change your heartbeat
• have a low heart rate, plus you have had severe diarrhoea and vomiting for a long time or take tablets that make you pee more (diuretics)
• have ever taken any other medicines for depression – some rarely used antidepressants can interact with escitalopram to cause very high blood pressure even when they have been stopped for a few weeks
• are trying to become pregnant, already pregnant or breastfeeding
• have an eye problem called glaucoma – escitalopram can increase the pressure in your eye

If you have diabetes, escitalopram can make it more difficult to keep your blood sugar stable.

Monitor your blood sugar more often for the first few weeks of treatment with escitalopram and adjust your diabetes treatment if necessary.

Take escitalopram once a day. You can take it with or without food.

You can take escitalopram at any time of day, as long as you stick to the same time every day.

If you have trouble sleeping, it's best to take it in the morning.

How much to take

Escitalopram tablets come in different strengths ranging from 5mg to 20mg.

The usual dose of escitalopram is 10mg a day in adults. But you may start on a lower dose and increase to a maximum dose of 20mg a day.

If you have liver problems, the maximum recommended dose is 10mg a day.

With liquid drops of escitalopram, 1 drop is equivalent to 1mg, 10 drops is 10mg, 20 drops is 20mg.

What if I forget to take it?

Do not take a double dose to make up for forgotten doses.

If you do forget to take a dose and remember before you go to bed, take it straight away. Carry on as usual the next day.

If you only remember during the night or the next day, leave out the missed dose and carry on as usual.

If you forget doses often, it may help to set an alarm to remind you.

You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

What if I take too much?

The amount of escitalopram that can lead to an overdose varies from person to person.

Call your doctor straight away if:

Like all medicines, escitalopram can cause side effects in some people, but many people have no side effects or only minor ones.

Some of the common side effects of escitalopram will gradually improve as your body gets used to it.

Common side effects

Common side effects may happen in more than 1 in 10 people.

Keep taking the medicine, but talk to a doctor or pharmacist if these side effects bother you or don't go away:

• a dry mouth
• sweating a lot
• being unable to sleep
• feeling sleepy
• feeling tired or weak

Serious side effects

Serious side effects are rare and happen in less than 1 in 1,000 people.

Go to A&E immediately if you get:

• painful erections that last longer than 4 hours – this may happen even when you're not having sex
• severe dizziness or passing out
• any bleeding that's very bad or you can't stop, such as cuts or nosebleeds that don't stop within 10 minutes

Call a doctor straight away if you get:

• constant headaches, long-lasting confusion or weakness, or frequent muscle cramps – these can all be signs of low sodium levels in your blood (in severe cases, low sodium can lead to seizures)
• thoughts about harming yourself or ending your life
• a high temperature (38C and above) with agitation, confusion, trembling and twitching
• vomiting blood, coughing up vomit, blood in your pee, black or red poo – these can be signs of bleeding from the gut
• bleeding from the gums, or bruises that appear without a reason or get bigger

Book an appointment with your doctor if you experience:

• weight gain or loss without trying
• changes in your periods, such as heavy bleeding, spotting or bleeding between periods

Serious allergic reaction

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to escitalopram.

These aren't all the side effects of escitalopram.

For a full list, see the leaflet inside your medicines packet.

What to do about:

• a dry mouth – chew sugar-free gum or sugar-free sweets
• sweating a lot – try wearing loose clothing, using a strong anti-perspirant, and keeping cool using a fan, if possible. If this doesn't control the problem, talk to your doctor. You may need to try a different antidepressant.
• being unable to sleep – take escitalopram first thing in the morning
• feeling sleepy– take escitalopram in the evening and cut down the amount of alcohol you drink. Do not drive or use tools or machinery if you're feeling sleepy. If this doesn't help, talk to your doctor.
• feeling tired or weak – stop what you're doing and sit or lie down until you feel better. Do not drive or use tools or machinery if you're feeling tired. Do not drink alcohol as it'll make you feel worse.

Escitalopram in pregnancy

It's important for you and your baby that you stay well during your pregnancy.

If you become pregnant while taking escitalopram, speak to your doctor. Do not stop taking your medicine unless your doctor tells you to.

Escitalopram has been linked to a very small increased risk of problems for your unborn baby.

But if your depression isn't treated during pregnancy, this can also increase the chance of problems.

You may need to take escitalopram during pregnancy if you need it to remain well.

Your doctor can explain the risks and the benefits, and will help you decide which treatment is best for you and your baby.

For more information about how escitalopram can affect you and your baby during pregnancy, read this leaflet on the best use of medicines in pregnancy (BUMPs) website.

Escitalopram and breastfeeding

If your doctor or health visitor says your baby is healthy, escitalopram can be used during breastfeeding.

Escitalopram passes into breast milk in small amounts, and has been linked with side effects in very few breastfed babies.

It's important to continue taking escitalopram to keep you well. Breastfeeding will also benefit both you and your baby.

If you notice that your baby isn't feeding as well as usual, seems unusually sleepy or you have any other concerns about your baby, talk to your health visitor or doctor as soon as possible.

Some medicines and escitalopram can interfere with each other and increase the chances of you having side effects.

Tell your doctor if you're taking these medicines before you start escitalopram:

• any medicines that affect your heartbeat – escitalopram can speed up or change your heartbeat
• any other medicines for depression – some rarely used antidepressants can interact with escitalopram to cause very high blood pressure even when they have been stopped for a few weeks

These aren't all the medicines that can interfere with escitalopram.

For a full list, see the leaflet inside your medicine packet or check with your pharmacist.

Mixing escitalopram with herbal remedies and supplements

Do not take St John's wort, the herbal remedy for depression, while you're being treated with escitalopram as this will increase your risk of side effects.