Escitalopram-Teva

Escitalopram

Use with MAO inhibitors

Escitalopram should not be co-administered with MAO inhibitors due to the risk of developing serotonin syndrome. Escitalopram can be prescribed 14 days after stopping treatment with irreversible MAO inhibitors and at least 1 day after stopping treatment with reversible MAO type A inhibitors (moclobemide).

At least 7 days must pass after stopping escitalopram before treatment with non-selective MAO inhibitors can be started. Use of the drug in children and adolescents under 18 years of age Antidepressants are contraindicated in children and adolescents under 18 years of age due to an increased risk of suicidal behavior (suicide attempts and suicidal thoughts), hostility (with a predominance of aggressive behavior, a tendency to confrontation and irritation) .

In young people under 25 years of age with depression and other mental disorders, antidepressants, compared with placebo, increase the risk of suicidal thoughts and behavior. Therefore, when prescribing the drug and any other antidepressants to young people under 25 years of age, the risk of suicide should be weighed against the benefits of their use. If a decision is made to initiate antidepressant therapy, the patient should be closely monitored for early detection of disturbances or changes in behavior, as well as suicidality.

Paradoxical anxiety

When using drugs belonging to the therapeutic group of SSRIs, including escitalopram, it should be taken into account that some patients with panic disorders may experience increased anxiety when starting treatment with SSRIs. This paradoxical reaction usually disappears within the first two weeks of treatment. To reduce the likelihood of an anxiogenic effect, it is recommended to use low initial doses.

Epileptic seizures

Escitalopram should be discontinued if the patient experiences an epileptic seizure for the first time or if seizures become more frequent (in patients with a history of epilepsy).

Patients with unstable epilepsy should avoid taking SSRIs, and patients with controlled epilepsy should be closely monitored.

Mania

Escitalopram is recommended to be prescribed with caution to patients with a history of mania or hypomania. If a manic state develops, escitalopram should be discontinued.

Diabetes

In patients with diabetes mellitus, treatment with escitalopram may alter plasma glucose levels. Therefore, dose adjustments of insulin and/or oral hypoglycemic drugs may be required.

Suicide/suicidal ideation or clinical worsening of depression

Careful monitoring of patients taking antidepressants is necessary, especially at the beginning of therapy, due to the possibility of clinical worsening and/or the emergence of suicidal thoughts and behavior. Clinical experience shows that increased risk of suicide tends to occur in the early stages of recovery.

Other psychiatric disorders for which escitalopram is prescribed may also be associated with an increased risk of suicidal behavior and behavior. In addition, these diseases may accompany severe depressive disorder. The precautions taken when treating patients with severe depressive disorder also need to be observed when treating patients with other mental disorders.

It is known that patients with a history of suicidal actions and symptoms, or those who exhibited suicidal ideation before treatment, are at greater risk of suicidal ideation or attempts and should therefore be closely monitored during treatment. A meta-analysis of placebo-controlled clinical trials of antidepressants in adult patients with mental disorders showed an increased risk of suicidal behavior with antidepressants compared with placebo in patients less than 25 years of age. Careful monitoring of patients, particularly those at high risk, should accompany drug therapy, particularly at the beginning of treatment and after dose changes.

Patients and their caregivers should be advised to monitor for any clinical worsening, suicidal behavior or intent, or unusual changes in behavior, and to seek immediate medical attention if such symptoms occur.

Akathisia/psychomotor agitation

SSRI use is associated with the development of akathisia, a condition characterized by unpleasant, debilitating feelings of restlessness and hyperactivity and often accompanied by an inability to sit or stand in one place. This condition most likely occurs during the first few weeks of therapy. Increasing the dose may be harmful to patients who experience these symptoms.

Hyponatremia

While taking the drug, hyponatremia occurs, possibly associated with impaired ADH secretion. Usually disappears when therapy is stopped. Caution must be exercised when prescribing the drug to patients with a history of or at risk of developing hyponatremia: elderly people, patients with liver cirrhosis.

Bleeding

While taking escitalopram, skin hemorrhages (ecchymosis and purpura) may develop. The drug should be used with caution in patients at risk of bleeding, as well as those taking oral coagulants and drugs that affect blood clotting.

Electroconvulsive therapy (ECT)

Caution should be exercised when using the drug concomitantly with electroconvulsive therapy (ECT) due to limited experience with use.

Serotonin syndrome

Patients taking escitalopram and other SSRIs concomitantly with serotonergic drugs may rarely develop serotonin syndrome. The development of this disease may be indicated by a combination of symptoms such as agitation, tremor, myoclonus and hyperthermia. In this situation, you should immediately stop taking the SSRI and the serotonergic drug and begin symptomatic treatment.

Withdrawal symptoms when stopping SSRI therapy

Withdrawal symptoms when stopping treatment are common, especially if treatment is stopped abruptly. In clinical studies, adverse events during treatment discontinuation were observed in approximately 25% of patients receiving escitalopram and in 15% of patients receiving placebo.

The risk of treatment discontinuation may depend on several factors, including duration, dose of treatment, and rate of dose reduction. The most commonly observed reactions include dizziness, sensory disturbances (including paresthesia and electric shock), sleep disturbances (including insomnia and vivid dreams), agitation or restlessness, nausea and/or vomiting, tremor, confusion, sweating, headache, diarrhea, rapid heartbeat, emotional instability, irritability and visual disturbances. Typically, these symptoms are mild to moderate in severity, but in some patients they can be severe.

They usually occur within the first few days after stopping treatment, and similar symptoms are much less commonly reported in patients who accidentally miss a dose.

Typically, these symptoms are self-limiting and usually go away within 2 weeks, although some people may experience them for longer (2-3 months or more). It is therefore recommended to gradually reduce the dose of escitalopram after discontinuation of treatment over several weeks or months, depending on the patient's needs.

Cardiac ischemia

Due to limited experience with use, caution should be exercised when using the drug in patients with coronary heart disease (CHD).

Cases of QT prolongation

It was found that escitalopram causes a dose-dependent prolongation of the QT interval. Cases of QT prolongation and ventricular arrhythmias, including torsade de pointes, have been reported during the postmarketing period, predominantly in female patients with hypokalemia or pre-existing QT prolongation or other cardiovascular disease. It is recommended to exercise caution when recommending the drug to patients with severe bradycardia, patients after a recent acute myocardial infarction, or with uncompensated heart failure.

Electrolyte disturbances, such as hypokalemia and hypomagnesemia, increase the risk of dangerous arrhythmias, and these conditions should be corrected before escitalopram is prescribed.

If the drug is prescribed to patients with persistent heart disease, an ECG should be performed before starting treatment.

Escitalopram does not interact pharmacodynamically or pharmacokinetically with alcohol. However, as with other psychotropic drugs, the simultaneous use of escitalopram and alcohol is not recommended.

Escitalopram-Teva

Antidepressants should not be prescribed to children and adolescents under the age of 18 years due to an increased risk of suicidal behavior (suicidal attempts and thoughts), hostility (with a predominance of aggressive behavior, a tendency to confrontation and irritation), data on the effectiveness and safety of the drug Escitalopram -Teva are absent in this age group.

In patients with panic disorders, symptoms of anxiety may increase at the beginning of therapy with Escitalopram-Teva. This paradoxical reaction usually disappears within 2 weeks of continued therapy. A low initial dose reduces the likelihood of an anxiogenic effect of the drug.

The risk of suicidal thoughts, self-harm, and suicide attempts is inherent in depression and may persist until significant remission is achieved. Since clinical improvement may not occur at the beginning of treatment, continuous monitoring of the patient is necessary until clinically significant remission occurs. The likelihood of suicidal behavior increases during the initial stages of treatment for depression. Patients with a history of suicidal behavior or who demonstrate such behavior before starting treatment should be closely monitored during therapy with Escitalopram-Teva. This precaution should also be observed when treating other mental disorders due to the possibility of simultaneous development of depressive syndrome. The risk of suicidal behavior is higher in patients under 25 years of age.

The use of serotonin uptake inhibitors may lead to the development of akathisia, especially during the first weeks of therapy. Increasing the dose of Escitalopram-Teva is contraindicated in this case.

If epileptic seizures develop, Escitalopram-Teva should be discontinued. This group of drugs is contraindicated in patients with unstable epilepsy. Patients receiving adequate treatment for epilepsy and the drug Escitalopram-Teva should be under constant medical supervision. If the frequency of epileptic seizures increases, Escitalopram-Teva should be discontinued.

Escitalopram-Teva should be administered with caution to patients with a history of mania or hypomania. At the onset of the manic phase, treatment should be discontinued.

In patients with diabetes mellitus, treatment with Escitalopram-Teva may change the concentration of glucose in the blood. Therefore, dose adjustments of insulin and/or oral hypoglycemic agents may be necessary.

Hyponatremia, possibly associated with a decrease in ADH secretion, occurs rarely when taking Escitalopram-Teva and usually disappears when therapy is discontinued. Caution should be exercised when prescribing Escitalopram-Teva to persons at risk of developing hyponatremia: elderly patients, patients with liver cirrhosis and those taking drugs that can cause hyponatremia.

When taking Escitalopram-Teva, bleeding time may be prolonged or skin hemorrhages may develop. The drug should be used with caution in patients with a tendency to bleeding, as well as those taking oral anticoagulants and drugs that affect platelet function.

Since clinical experience with the simultaneous use of Escitalopram-Teva and electroconvulsive therapy is limited, caution should be exercised in such cases.

In rare cases, patients taking Escitalopram-Teva concomitantly with serotonergic drugs may develop serotonin syndrome. Escitalopram-Teva should be used with caution concomitantly with drugs that have serotonergic effects. A combination of symptoms such as anxiety, tremor, myoclonus, hyperthermia may indicate the development of serotonin syndrome. If this occurs, concomitant treatment with Escitalopram-Teva and serotonergic drugs should be immediately discontinued and symptomatic treatment initiated.

The drug Escitalopram-Teva does not interact pharmacodynamically or pharmacokinetically with alcohol. However, as with other psychotropic drugs, the simultaneous use of Escitalopram-Teva and alcohol is not recommended.

Escitalopram-Teva should be prescribed to patients with coronary heart disease with caution.

When you stop taking Escitalopram-Teva, especially suddenly, withdrawal syndrome develops. Its clinical manifestations include dizziness, sensory disturbances including paresthesia, sleep disturbances, agitation or anxiety, nausea and/or vomiting, tremor, blurred consciousness, skin hyperhidrosis, headache, diarrhea, palpitations, emotional lability, increased irritability, and visual disturbances. . Usually these symptoms are mild or moderate, but they can develop into a severe condition. In rare cases, withdrawal syndrome is possible when you miss the next dose of the drug. The withdrawal syndrome resolves on its own within 2 weeks, but can last up to 2-3 months. To reduce the risk of withdrawal syndrome, treatment should be discontinued for several weeks or months, gradually reducing the dose of the drug in accordance with the patient's clinical condition.