Inside, regardless of food intake, 1 time per day.

Depressive episodes: Usually 10 mg is given once a day. Depending on the individual patient's response, the dose can be increased to a maximum of 20 mg / day. The antidepressant effect usually develops 2–4 weeks after starting treatment. After the disappearance of the symptoms of depression, at least another 6 months, it is necessary to continue therapy to consolidate the effect obtained.

Panic disorder with or without agoraphobia: during the 1st week of treatment, a dose of 5 mg / day is recommended, which is then increased to 10 mg / day. Depending on the individual patient's response, the dose can be increased to a maximum of 20 mg / day. The maximum therapeutic effect is achieved approximately 3 months after the start of treatment. The therapy lasts for several months.

Social anxiety disorder (social phobia): Usually 10 mg is given once a day. Depending on the individual patient's response, the dose can be increased to a maximum of 20 mg / day. Relief of symptoms usually occurs 2–4 weeks after starting treatment. Since social anxiety disorder is a chronic disease, the minimum recommended course of treatment is 3 months. To prevent recurrence of the disease, the drug may be prescribed for 6 months or longer, depending on the individual patient's response. Regular evaluation of the treatment is recommended.

Generalized anxiety disorder: Usually 10 mg is given once daily. Depending on the individual patient's response, the dose can be increased to a maximum of 20 mg / day. The minimum recommended duration of a therapeutic course is 3 months. To prevent relapses of the disease, prolonged use of the drug is allowed (6 months or longer). Regular evaluation of the treatment is recommended.

Obsessive-compulsive disorder: Usually 10 mg is given once daily. Depending on the patient's individual response, the dose may subsequently be increased to a maximum of 20 mg / day. Because obsessive-compulsive disorder is a chronic disease, the course of treatment should be long enough to provide complete relief of symptoms and last at least 6 months. Treatment for at least 1 year is recommended to prevent recurrence.

Special patient groups

Elderly patients (over 65). It is recommended to use half of the usually recommended dose (i.e. only 5 mg / day) and a lower maximum dose (10 mg / day).

Children and adolescents (up to 18 years old). Cipralex should not be used in children and adolescents under 18 years of age. In addition, there is not enough data from long-term studies on the safety of the drug in children and adolescents regarding growth, maturation, cognitive and behavioral development.

Impaired renal function. No dose adjustment is required for mild to moderate renal impairment. Patients with severe renal impairment (Cl creatinine below 30 ml / min) should be prescribed Cipralex with caution.

Liver dysfunction. The recommended starting dose for the first 2 weeks of treatment is 5 mg / day. Depending on the patient's individual response, the dose may be increased to 10 mg / day.

Reduced activity of the isoenzyme CYP2C19. For patients with weak activity of the isoenzyme CYP2C19, the recommended initial dose during the first 2 weeks of treatment is 5 mg / day. Depending on the patient's individual response, the dose may be increased to 10 mg / day.

Termination of treatment

When discontinuing treatment with Cipralex, the dose should be reduced gradually over 1–2 weeks in order to avoid withdrawal symptoms.

Hypersensitivity to escitalopram and other components of the drug Cipralex;

simultaneous reception of non-selective irreversible MAO inhibitors;

simultaneous administration of pimozide;

children and adolescents (up to 18 years old).

With care: severe renal failure (Cl creatinine below 30 ml / min); mania and hypomania; pharmacologically uncontrolled epilepsy; pronounced suicidal behavior; diabetes; cirrhosis of the liver; bleeding tendency; simultaneous administration with an MAO A inhibitor (moclobemide) and an MAO B inhibitor (selegiline), serotonergic drugs, drugs that reduce the seizure threshold, lithium, tryptophan, drugs containing St. John's wort, oral anticoagulants and other drugs that affect blood , drugs that can cause hyponatremia, drugs metabolized with the participation of the CYP2C19 isoenzyme, ethanol; electroconvulsive therapy; elderly age; pregnancy; period of breastfeeding.

Side effects most often develop in the 1st or 2nd week of treatment and then usually become less intense and occur less often with continued therapy.

The following are the side effects that occur when taking drugs belonging to the SSRI class and noted when taking escitalopram. The information is presented based on data from placebo-controlled clinical trials and spontaneous reports. The frequency is indicated as: very often - ≥1 / 10; often - from ≥1 / 100 to

On the part of the blood and lymphatic system: unknown - thrombocytopenia.

From the immune system: rarely - anaphylactic reactions.

From the endocrine system: unknown - insufficient secretion of ADH.

Metabolic and eating disorders: often - decreased appetite, increased appetite, weight gain; infrequently - weight loss; unknown - hyponatremia, anorexia.

From the side of the psyche: often - anxiety, anxiety, unusual dreams, decreased libido, anorgasmia (in women); infrequently - bruxism, agitation, nervousness, panic attacks, confusion; rarely - aggression, depersonalization, hallucinations; unknown - mania, suicidal thoughts, suicidal behavior. Cases of the appearance of suicidal thoughts and behavior were noted with escitalopram and immediately after discontinuation of therapy.

From the nervous system: often - insomnia, drowsiness, dizziness, paresthesia, tremor; infrequently - disturbances in taste, sleep disturbances, syncope; rarely - serotonin syndrome; unknown - dyskinesia, movement disorders, convulsive disorders, psychomotor agitation / akathisia.

From the side of the organ of vision: infrequently - mydriasis (dilation of the pupil), visual impairment.

On the part of the organ of hearing and labyrinth disorders: infrequently - tinnitus (tinnitus).

From the CCC: infrequently - tachycardia; rarely - bradycardia; unknown - prolongation of the QT interval on the ECG, orthostatic hypotension.

From the respiratory system, chest and mediastinal organs: often - sinusitis, yawning; infrequently - nosebleeds.

From the gastrointestinal tract: very often - nausea; often - diarrhea, constipation, vomiting, dry mouth; infrequently - gastrointestinal bleeding (including rectal).

Liver and biliary tract disorders: unknown - hepatitis, impaired liver function.

On the part of the skin and subcutaneous tissues: often - increased sweating; infrequently - urticaria, alopecia, rash, itching; unknown - ecchymosis, angioedema.

Musculoskeletal and connective tissue disorders: often - arthralgia, myalgia.

From the kidneys and urinary tract: unknown - urinary retention.

Reproductive system and breast disorders: often - impotence, impaired ejaculation; infrequently - metrorrhagia (uterine bleeding), menorrhagia; unknown - galactorrhea, priapism.

From the side of the body as a whole and disorders at the injection site: often - weakness, hyperthermia; infrequently - edema.

In the post-registration period, there have been cases of prolongation of the QT interval, mainly in patients with pre-existing heart disease. In double-blind, placebo-controlled ECG studies in healthy volunteers, the change from the baseline QTc value (correction according to the Fridericia formula) was 4.3 ms at a dose of 10 mg / day and 10.7 ms at a dose of 30 mg / day.

Epidemiological studies with patients aged 50 years and older have shown an increased risk of bone fractures in patients taking SSRIs and tricyclic antidepressants. The mechanism behind this risk has not been established.

Cancellation (especially abrupt) of SSRI / SNRI drugs often leads to withdrawal symptoms. The most common occurrences are dizziness, sensitivity disorders (including paresthesia and sensations of current flow), sleep disorders (including insomnia and intense dreams), agitation or anxiety, nausea and / or vomiting, tremors, confusion, increased sweating, headache, diarrhea, palpitations, emotional instability, irritability, visual disturbances. As a rule, these effects are mild or moderate and quickly disappear, however, in some patients, they may appear in a more acute form and / or for a longer time. It is recommended to gradually withdraw the drug by reducing its dose.

  Pharmacodynamic interaction:

Non-selective, irreversible MAO inhibitors. Serious adverse reactions have been reported with the concomitant use of SSRIs and non-selective irreversible MAO inhibitors, as well as with the initiation of MAO inhibitors in patients who have recently stopped taking SSRIs. In some cases, patients have developed serotonin syndrome. It is prohibited to use escitalopram simultaneously with non-selective irreversible MAO inhibitors. Acitalopram can be started 14 days after discontinuation of irreversible MAO inhibitors. Before you start taking non-selective irreversible MAO inhibitors, at least 7 days should pass after you stop taking escitalopram.

Reversible selective MAO A inhibitor (moclobemide). Due to the risk of developing serotonin syndrome, it is not recommended to use escitalopram simultaneously with the MAO A inhibitor moclobemide. If the intake of such a combination of drugs is recognized as clinically necessary, it is recommended to start with the lowest possible doses, as well as to conduct continuous clinical monitoring of the patient's condition. You can start taking escitalopram at least one day after discontinuing the reversible MAO A inhibitor moclobemide.

Irreversible MAO B inhibitor (selegiline). Due to the risk of developing serotonin syndrome, care must be taken when taking escitalopram simultaneously with the irreversible MAO B inhibitor selegiline.

Serotonergic drugs. Concomitant use with serotonergic drugs (for example, tramadol, sumatriptan, and other triptans) can lead to the development of serotonin syndrome.

Medicines that lower the seizure threshold. SSRIs can lower the seizure threshold. It is required to exercise caution with the simultaneous use of other drugs with escitalopram that reduce the seizure threshold (tricyclic antidepressants, SSRIs, mefloquine, bupropion, tramadol and antipsychotic drugs (neuroleptics) - derivatives of phenothiazine, thioxanthene and butyrophenone).

Lithium, tryptophan. Since there have been cases of increased action with the simultaneous use of SSRIs and lithium or tryptophan, it is recommended to exercise caution when using escitalopram with lithium and tryptophan.

St. John's wort. The simultaneous use of SSRIs and preparations containing St. John's wort (Hypericum perforatum) may lead to an increase in the number of side effects.

Anticoagulants and other drugs that affect blood clotting. Blood clotting disorders can occur with the simultaneous use of escitalopram with oral anticoagulants and other drugs that affect blood clotting (for example, atypical antipsychotics and phenothiazine derivatives, most tricyclic antidepressants, acetylsalicylic acid and other NSAIDs, ticlopidamoline) and dipyridamoline. In such cases, when starting or ending therapy with escitalopram, careful monitoring of blood clotting is necessary. Concomitant use with NSAIDs can lead to an increase in the number of bleeding.

  Pharmacokinetic interaction:

The effect of other drugs on the pharmacokinetics of escitalopram. The metabolism of escitalopram is mainly carried out with the participation of the isoenzyme CYP2C19. To a lesser extent, the isoenzymes CYP3A4 and CYP2D6 can participate in metabolism. The metabolism of the main metabolite, demethylated escitalopram, appears to be partially catalyzed by the CYP2D6 isoenzyme.

The simultaneous use of escitalopram and omeprazole (an inhibitor of the isoenzyme CYP2C19) leads to a moderate (approximately 50%) increase in the concentration of escitalopram in the blood plasma.

The simultaneous administration of escitalopram and cimetidine (an inhibitor of isoenzymes CYP2D6, CYP3A4 and CYP1A2) leads to an increase (approximately 70%) in the concentration of escitalopram in blood plasma.

Thus, the maximum possible dose of escitalopram should be used concomitantly with inhibitors of the isoenzyme CYP2C19 (eg omeprazole, fluoxetine, fluvoxamine, lansoprazole, ticlopidine) and cimetidine with caution. With the simultaneous administration of escitalopram and the above drugs, based on clinical assessment, a dose reduction of escitalopram may be required.

The effect of escitalopram on the pharmacokinetics of other drugs. Escitalopram is an inhibitor of the CYP2D6 isoenzyme. Caution must be exercised with the simultaneous use of escitalopram and drugs that are metabolized by this isoenzyme and have a low therapeutic index, such as flecainide, propafenone and metoprolol (in cases of use in heart failure) or drugs that are mainly metabolized by CYP2D6 and acting on the central nervous system, for example antidepressants: desipramine, clomipramine, nortriptyline, or antipsychotic drugs: risperidone, thioridazine, haloperidol. In these cases, dose adjustment may be required.

The simultaneous use of escitalopram and desipramine or metoprolol leads to a twofold increase in the concentration of the last two drugs.

Escitalopram may slightly inhibit the CYP2C19 isoenzyme. Therefore, it is recommended to exercise caution with the simultaneous use of escitalopram and drugs that are metabolized by the CYP2C19 isoenzyme.

Data on escitalopram overdose are limited, in many such cases there was also an overdose of other drugs. In most cases, overdose symptoms do not appear or are mild. Cases of escitalopram overdose (without taking other drugs) with a lethal outcome are rare, in most cases there is also an overdose of other drugs.

Symptoms: mainly from the central nervous system (from dizziness, tremor and agitation to rare cases of serotonin syndrome, seizure disorders and coma), from the gastrointestinal tract (nausea / vomiting), CVS (hypotension, tachycardia, lengthening of the QT interval and arrhythmia) and disorders electrolyte balance (hypokalemia, hyponatremia).

Treatment: there is no specific antidote to the drug. Ensure normal airway patency, oxygenation and ventilation of the lungs. Gastric lavage and activated charcoal should be administered. Gastric lavage should be carried out as soon as possible after taking the drug. It is recommended to monitor the performance of the heart and other vital organs and carry out symptomatic and supportive therapy.