Escitalopram Oxalate (Page 4 of 10)

Dose Dependency of Adverse Reactions

The potential dose dependency of common adverse reactions (defined as an incidence rate of ≥5% in either the 10 mg or 20 mg escitalopram groups) was examined on the basis of the combined incidence of adverse reactions in two fixed-dose trials. The overall incidence rates of adverse events in 10 mg escitalopram-treated patients (66%) was similar to that of the placebo-treated patients (61%), while the incidence rate in 20 mg/day escitalopram-treated patients was greater (86%). Table 4 shows common adverse reactions that occurred in the 20 mg/day escitalopram group with an incidence that was approximately twice that of the 10 mg/day escitalopram group and approximately twice that of the placebo group.

TABLE 4

Incidence of Common Adverse Reactions in Patients with Major Depressive Disorder

Adverse Reaction

Placebo

10 mg/day

20 mg/day

(N=311)

Escitalopram

Escitalopram

(N=310)

(N=125)

Insomnia

4%

7%

14%

Diarrhea

5%

6%

14%

Dry Mouth

3%

4%

9%

Somnolence

1%

4%

9%

Dizziness

2%

4%

7%

Sweating Increased

<1%

3%

8%

Constipation

1%

3%

6%

Fatigue

2%

2%

6%

Indigestion

1%

2%

6%

Male and Female Sexual Dysfunction with SSRIs

Although changes in sexual desire, sexual performance, and sexual satisfaction often occur as manifestations of a psychiatric disorder, they may also be a consequence of pharmacologic treatment. In particular, some evidence suggests that SSRIs can cause such untoward sexual experiences.

Reliable estimates of the incidence and severity of untoward experiences involving sexual desire, performance, and satisfaction are difficult to obtain, however, in part because patients and physicians may be reluctant to discuss them. Accordingly, estimates of the incidence of untoward sexual experience and performance cited in product labeling are likely to underestimate their actual incidence.

TABLE 5

Incidence of Sexual Side Effects in Placebo-Controlled Clinical Trials

Adverse Event

Escitalopram

Placebo

In Males Only

(N=407)

(N=383)

Ejaculation Disorder (primarily ejaculatory delay)

12%

1%

Libido Decreased

6%

2%

Impotence

2%

<1%

In Females Only

(N=737)

(N=636)

Libido Decreased

3%

1%

Anorgasmia

3%

<1%

There are no adequately designed studies examining sexual dysfunction with escitalopram treatment.

Priapism has been reported with all SSRIs.

While it is difficult to know the precise risk of sexual dysfunction associated with the use of SSRIs, physicians should routinely inquire about such possible side effects.

Vital Sign Changes

Escitalopram and placebo groups were compared with respect to (1) mean change from baseline in vital signs (pulse, systolic blood pressure, and diastolic blood pressure) and (2) the incidence of patients meeting criteria for potentially clinically significant changes from baseline in these variables. These analyses did not reveal any clinically important changes in vital signs associated with escitalopram treatment. In addition, a comparison of supine and standing vital sign measures in subjects receiving escitalopram indicated that escitalopram treatment is not associated with orthostatic changes.

Weight Changes

Patients treated with escitalopram in controlled trials did not differ from placebo-treated patients with regard to clinically important change in body weight.

Laboratory Changes

Escitalopram and placebo groups were compared with respect to (1) mean change from baseline in various serum chemistry, hematology, and urinalysis variables, and (2) the incidence of patients meeting criteria for potentially clinically significant changes from baseline in these variables. These analyses revealed no clinically important changes in laboratory test parameters associated with escitalopram treatment.

ECG Changes

Electrocardiograms from escitalopram (N=625) and placebo (N=527) groups were compared with respect to outliers defined as subjects with QT c changes over 60 msec from baseline or absolute values over 500 msec post-dose, and subjects with heart rate increases to over 100 bpm or decreases to less than 50 bpm with a 25% change from baseline (tachycardic or bradycardic outliers, respectively). None of the patients in the escitalopram group had a QT c F interval >500 msec or a prolongation >60 msec compared to 0.2% of patients in the placebo group. The incidence of tachycardic outliers was 0.2% in the escitalopram and the placebo group. The incidence of bradycardic outliers was 0.5% in the escitalopram group and 0.2% in the placebo group.

QT c F interval was evaluated in a randomized, placebo and active (moxifloxacin 400 mg) controlled cross-over, escalating multiple-dose study in 113 healthy subjects. The maximum mean (95% upper confidence bound) difference from placebo arm were 4.5 (6.4) and 10.7 (12.7) msec for 10 mg and supratherapeutic 30 mg escitalopram given once daily, respectively. Based on the established exposure-response relationship, the predicted QT c F change from placebo arm (95% confidence interval) under the C max for the dose of 20 mg is 6.6 (7.9) msec. Escitalopram 30 mg given once daily resulted in mean C max of 1.7-fold higher than the mean C max for the maximum recommended therapeutic dose at steady state (20 mg). The exposure under supratherapeutic 30 mg dose is similar to the steady state concentrations expected in CYP2C19 poor metabolizers following a therapeutic dose of 20 mg.

Other Reactions Observed During the Premarketing Evaluation of Escitalopram Tablets

Following is a list of treatment-emergent adverse events, as defined in the introduction to the ADVERSE REACTIONS section, reported by the 1,428 patients treated with escitalopram tablets for periods of up to one year in double-blind or open-label clinical trials during its premarketing evaluation. The listing does not include those events already listed in Tables 2 & 3 , those events for which a drug cause was remote and at a rate less than 1% or lower than placebo, those events which were so general as to be uninformative, and those events reported only once which did not have a substantial probability of being acutely life threatening. Events are categorized by body system. Events of major clinical importance are described in the Warnings and Precautions section ( 5).

Cardiovascular — hypertension, palpitation.

Central and Peripheral Nervous System Disorders — light-headed feeling, migraine.

Gastrointestinal Disorders — abdominal cramp, heartburn, gastroenteritis.

General — allergy, chest pain, fever, hot flushes, pain in limb.

Metabolic and Nutritional Disorders — increased weight.

Musculoskeletal System Disorders — arthralgia, myalgia jaw stiffness.

Psychiatric Disorders — appetite increased, concentration impaired, irritability.

Reproductive Disorders/Female — menstrual cramps, menstrual disorder.

Respiratory System Disorders — bronchitis, coughing, nasal congestion, sinus congestion, sinus headache.

Skin and Appendages Disorders — rash.

Special Senses — vision blurred, tinnitus.

Urinary System Disorders — urinary frequency, urinary tract infection.

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