Escitalopram is administered as a single daily dose and may be taken with or without food.
Major depressive episodes: For the acute and maintenance treatment of MDD in adults. Usual dosage is 10 mg once daily. Depending on individual patient response, the dose may be increased to a maximum of 20 mg daily after a minimum of 1 week. Although efficacy has been established at dosages of 10 or 20mg once daily, no additional benefit was observed with the 20-mg dosage in a fixed-dose study.
For the acute management of major depressive disorder in adolescents 12-17 years of age, the recommended initial dosage of escitalopram is 10mg once daily. Efficacy has been established at dosages of 10-20mg daily in a flexible-dose study. If dosage is increased to 20mg daily, this should occur after a minimum of 3 weeks.
Generalized anxiety disorder: For the management of generalized anxiety disorder in adults, the recommended initial dosage of escitalopram is 10mg once daily. If no clinical improvement is apparent, dosage may be increased to 20mg daily after a minimum of 1 week.
Panic disorder with or without agoraphobia: An initial dose of 5 mg is recommended for the first week before increasing the dose to 10 mg daily. The dose may be further increased, up to a maximum of 20 mg daily, dependent on individual patient response.
Maximum effectiveness is reached after about 3 months. The treatment lasts several months.
Social anxiety disorder: Usual dosage is 10 mg once daily. Usually 2-4 weeks are necessary to obtain symptom relief. The dose may subsequently, depending on individual patient response, be decreased to 5 mg or increased to a maximum of 20 mg daily.
Social anxiety disorder is a disease with a chronic course, and treatment for 12 weeks is recommended to consolidate response. Long-term treatment of responders has been studied for 6 months and can be considered on an individual basis to prevent relapse; treatment benefits should be re-evaluated at regular intervals.
Social anxiety disorder is a well-defined diagnostic terminology of a specific disorder, which should not be confounded with excessive shyness. Pharmacotherapy is only indicated if the disorder interferes significantly with professional and social activities.
The place of this treatment compared to cognitive behavioural therapy has not been assessed. Pharmacotherapy is part of an overall therapeutic strategy.
Obsessive-compulsive disorder: Initial dosage is 10 mg once daily. Depending on the individual patient response, the dose may be increased to a maximum of 20 mg daily.
As OCD is a chronic disease, patients should be treated for a sufficient period to ensure that they are symptom free.
Treatment benefits and dose should be re-evaluated at regular intervals.
Elderly patients (> 65 years of age): Initial dosage is 5 mg once daily. Depending on individual patient response the dose may be increased to 10 mg daily.
Children and adolescents (12-17 years): Major depressive disorder: Initial dosage – 10mg once daily. Dosage titration – If the dose is increased to 20mg this should occur a minimum of 3 weeks.
Reduced renal function: Dosage adjustment is not necessary in patients with mild or moderate renal impairment. Caution is advised in patients with severely reduced renal function (CLcr less than 20 ml/min).
Reduced hepatic function: An initial dose of 5 mg daily for the first two weeks of treatment is recommended in patients with mild or moderate hepatic impairment. Depending on individual patient response, the dose may be increased to 10 mg daily. Caution and extra careful dose titration is advised in patients with severely reduced hepatic function.
Poor metabolisers of CYP2C19: For patients who are known to be poor metabolisers with respect to CYP2C19, an initial dose of 5 mg daily during the first two weeks of treatment is recommended. Depending on individual patient response, the dose may be increased to 10 mg daily.
Discontinuation symptoms seen when stopping treatment: Because withdrawal effects may occur with discontinuance of escitalopram and other SSRIs and selective serotonin- and norepinephrine-reuptake inhibitors (SNRIs), abrupt discontinuance should be avoided whenever possible. When escitalopram therapy is discontinued, the dosage should be reduced gradually and the patient monitored for possible withdrawal symptoms. If intolerable symptoms occur following dosage reduction or upon discontinuance of therapy, the drug may be reinstituted at the previously prescribed dosage. Subsequently, the clinician may continue decreasing the dosage, but at a more gradual rate. Withdrawal symptoms, including dysphoric mood, irritability, agitation, dizziness, sensory disturbances (e.g., paresthesia such as electric shock sensations), sleep disturbances (including insomnia), anxiety, confusion, headache, lethargy, emotional instability, hypomania, tinnitus, and seizures are the most common reactions, particularly when discontinuance of these drugs is abrupt. While these reactions are generally self-limiting, there have been reports of serious discontinuance symptoms. Therefore, patients should be monitored for such symptoms when discontinuing escitalopram therapy. A gradual reduction in dosage rather than abrupt cessation is recommended whenever possible.
MODE OF ADMINISTRATION: Escitalopram oxalate is administered orally once daily, in the morning or evening.