ESCITALOPRAM- escitalopram oxalate tablet, film coated
Antidepressants increased the risk of suicidal thoughts and behaviors in pediatric and young adult patients in short-term studies. Closely monitor all antidepressant-treated patients for clinical worsening, and for emergence of suicidal thoughts and behaviors [see Warnings and Precautions (5.1)]. Escitalopram oxalate is not approved for use in pediatric patients less than 12 years of age [see Use in Specific Populations (8.4)].
Escitalopram tablet, is indicated for the acute and maintenance treatment of major depressive disorder in adults and in adolescents 12 to 17 years of age [ see Clinical Studies ( 14.1) ].
A major depressive episode (DSM-IV) implies a prominent and relatively persistent (nearly every day for at least 2 weeks) depressed or dysphoric mood that usually interferes with daily functioning, and includes at least five of the following nine symptoms: depressed mood, loss of interest in usual activities, significant change in weight and/or appetite, insomnia or hypersomnia, psychomotor agitation or retardation, increased fatigue, feelings of guilt or worthlessness, slowed thinking or impaired concentration, a suicide attempt or suicidal ideation.
Escitalopram tablet, is indicated for the acute treatment of Generalized Anxiety Disorder (GAD) in adults [ see Clinical Studies ( 14.2) ].
Generalized Anxiety Disorder (DSM-IV) is characterized by excessive anxiety and worry (apprehensive expectation) that is persistent for at least 6 months and which the person finds difficult to control. It must be associated with at least 3 of the following symptoms: restlessness or feeling keyed up or on edge, being easily fatigued, difficulty concentrating or mind going blank, irritability, muscle tension, and sleep disturbance.
Escitalopram tablets should be administered once daily, in the morning or evening, with or without food.
The recommended dose of escitalopram tablet is 10 mg once daily. A flexible-dose trial of escitalopram tablets (10 to 20 mg/day) demonstrated the effectiveness of escitalopram oxalate [ see Clinical Studies ( 14.1) ]. If the dose is increased to 20 mg, this should occur after a minimum of three weeks.
The recommended dose of escitalopram tablet is 10 mg once daily. A fixed-dose trial of escitalopram tablets demonstrated the effectiveness of both 10 mg and 20 mg of escitalopram tablets, but failed to demonstrate a greater benefit of 20 mg over 10 mg [ see Clinical Studies ( 14.1) ]. If the dose is increased to 20 mg, this should occur after a minimum of one week.
It is generally agreed that acute episodes of major depressive disorder require several months or longer of sustained pharmacological therapy beyond response to the acute episode. Systematic evaluation of continuing escitalopram tablets 10 or 20 mg/day in adults patients with major depressive disorder who responded while taking escitalopram tablets during an 8-week, acute-treatment phase demonstrated a benefit of such maintenance treatment [see Clinical Studies ( 14.114.1)]. Nevertheless, the physician who elects to use escitalopram tablets for extended periods should periodically re-evaluate the long-term usefulness of the drug for the individual patient. Patients should be periodically reassessed to determine the need for maintenance treatment.
The recommended starting dose of escitalopram tablet is 10 mg once daily. If the dose is increased to 20 mg, this should occur after a minimum of one week.
Generalized anxiety disorder is recognized as a chronic condition. The efficacy of escitalopram tablets in the treatment of GAD beyond 8 weeks has not been systematically studied. The physician who elects to use escitalopram tablets for extended periods should periodically re-evaluate the long-term usefulness of the drug for the individual patient.
Prior to initiating treatment with escitalopram tablets or another antidepressant, screen patients for a
personal family history of bipolar disorder, mania, or hypomania [see Warnings and Precautions ( 5.5)].
10 mg/day is the recommended dose for most elderly patients and patients with hepatic impairment.
No dosage adjustment is necessary for patients with mild or moderate renal impairment. Escitalopram
tablets should be used with caution in patients with severe renal impairment.
Symptoms associated with discontinuation of escitalopram tablets and other SSRIs and SNRIs have been
reported [see Warnings and Precautions ( 5.3)]. Patients should be monitored for these symptoms when
discontinuing treatment. A gradual reduction in the dose rather than abrupt cessation is recommended
whenever possible. If intolerable symptoms occur following a decrease in the dose or upon
discontinuation of treatment, then resuming the previously prescribed dose may be considered.
Subsequently, the physician may continue decreasing the dose but at a more gradual rate.
2.6 Switching a Patient to or from a Monoamine Oxidase Inhibitor (MAOI) Intended to Treat Psychiatric Disorders
At least 14 days should elapse between discontinuation of an MAOI intended to treat psychiatric disorders and initiation of therapy with escitalopram tablets. Conversely, at least 14 days should be allowed after stopping escitalopram tablets before starting an MAOI intended to treat psychiatric disorders [see Contraindications ( 4.1)].
Do not start escitalopram tablets in a patient who is being treated with linezolid or intravenous
methylene blue because there is an increased risk of serotonin syndrome. In a patient who requires
more urgent treatment of a psychiatric condition, other interventions, including hospitalization, should
be considered [see Contraindications ( 4.1)].
In some cases, a patient already receiving escitalopram tablets therapy may require urgent treatment
with linezolid or intravenous methylene blue. If acceptable alternatives to linezolid or intravenous
methylene blue treatment are not available and the potential benefits of linezolid or intravenous
methylene blue treatment are judged to outweigh the risks of serotonin syndrome in a particular patient,
escitalopram tablets should be stopped promptly, and linezolid or intravenous methylene blue can be
administered. The patient should be monitored for symptoms of serotonin syndrome for 2 weeks or
until 24 hours after the last dose of linezolid or intravenous methylene blue, whichever comes first. Therapy with escitalopram tablets may be resumed 24 hours after the last dose of linezolid or
intravenous methylene blue [see Warnings and Precautions ( 5.2)].
The risk of administering methylene blue by non-intravenous routes (such as oral tablets or by local
injection) or in intravenous doses much lower than 1 mg/kg with escitalopram tablet is unclear. The
clinician should, nevertheless, be aware of the possibility of emergent symptoms of serotonin
syndrome with such use [see Warnings and Precautions ( 5.2)].
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