Esram

Esram - Medicine for anxiety | social phobia

Esram is a medicine that contains the active substance called escitalopram. It belongs to a group of medicines called selective serotonin reuptake inhibitors. It is used to treat major depressive episode, anxiety, social phobia (excessive fear of social situations) and obsessive-compulsive disorder and panic disorder. 1,2,3

Precautions

Esram should be avoided in the following conditions:

  • In patients who are allergic to the active substance escitalopram or other similar medicines.
  • In patients with QT prolongation (heart rhythm disorder that can cause severe arrhythmias). This medicine may lead to QT prolongation 4 which can cause severe heart arrhythmias (irregular heartbeat) in patients who already have heart disease or heart rhythm disorders. Therefore this medicine should be used only with extra precautions in patients with heart diseases.
  • In patients taking MAO inhibitors (monoamine oxidase inhibitors), such as:
    • moclobemide,
    • selegiline (this medicine is used in the treatment of Parkinson's disease),
    • isocarboxazid,
    • linezolid (an antibiotic),
    • tranylcypromine, and others. Concomitant use of Esram with these medicines may cause serotonin syndrome. Serotonin syndrome can be life-threatening, therefore you should be aware of its symptoms:
      • diarrhea,
      • headache,
      • increased sweating,
      • agitation (feeling irritated, restless, confused, tense or excited),
      • tremors,
      • rapid heartbeat (tachycardia),
      • irregular heartbeat (arrhythmia),
      • high blood pressure and convulsions (seizures). Tell your doctor if you are experiencing any of the abovementioned symptoms.

This medicine should be used with extra precautions in the following conditions:

  • In patients with diabetes. Some studies have shown that this medicine may cause hyperglycemia (high blood sugar) in diabetic patients. 5
  • In patients under the age of 18. Safety in patients under the age of 18 has not been established.
  • Patients who have suicidal thoughts or if the patient has attempted suicide in the past. Suicidal thoughts may occur in the first two to four weeks of treatment. Immediately contact your doctor if you are experiencing suicidal thoughts.

This medicine can cause akathisia 6 - feeling of inner restlessness (it is also described as compelling need to be in constant motion).

Esram can cause hyponatremia (low sodium concentration in the blood) due to inappropriate secretion of antidiuretic hormone (also known as vasopressin).7 Symptoms of hyponatremia include:

  1. nausea,
  2. vomiting,
  3. confusion,
  4. drowsiness,
  5. seizures and coma. Tell your doctor if you are experiencing any of above mentioned symptoms.

Do not stop taking this medicine suddenly. If you abruptly stop taking Esram you may experience withdrawal symptoms:

  • nausea,
  • vomiting,
  • agitation,
  • confusion,
  • emotional lability,
  • insomnia,
  • tremor and others. The dosage should be gradually reduced over several weeks before stopping taking this medicine completely.

Your doctor will advise you how to gradually reduce the dose before stopping taking this stop medicine completely.

Use of Esram during pregnancy and breastfeeding

Esram can be used during pregnancy only if the benefit to the mother outweighs the risk to the child. This medicine increases the risk of perinatal complications.8 It should be avoided in the last three months of pregnancy because newborns whose mothers took this medicine in the last three months of pregnancy may experience following symptoms:

  1. vomiting,
  2. hypoglycemia (low blood sugar),
  3. difficulty breathing and convulsions in newborns.

This medicine probably passes into breast milk. Avoid breastfeeding while using this medicine.

How to use

Dosage:

Condition Dose
Major depressive disorder The usual initial dose is 10 mg once a day. If necessary, dosage may be increased up to a maximum recommended dose of 20 mg per day. It takes up to a 30 days to feel improvement in your symptoms. Treatment usually lasts for about 6 months.
Panic disorder The usual initial dose is 5 mg once a day. Dose may be increased gradually until the maximum therapeutic effect is achieved. It takes up to a three months to feel improvement in your symptoms.
Social phobia (excessive fear of social situations) The usual initial dose is 5 mg once a day. Dose may be increased gradually until the maximum therapeutic effect is achieved. It takes up to a 30 days to feel improvement in your symptoms. Treatment usually lasts for about 6 months.
Anxiety The usual initial dose is 10 mg once a day. Dose may be increased gradually until the maximum therapeutic effect is achieved.
Obsessive-compulsive disorders The usual initial dose is 5 mg once a day. Dose may be increased gradually until the maximum therapeutic effect is achieved.

The maximum daily dose is 20 mg! Do not take more than 20 mg per day.

Swallow the tablet whole with a glass of water. Do not crush or chew the tablet. It can be taken with or without food, because food does not affect the efficacy of this medicine.

Do not stop taking this medicine suddenly, because you may have serious side effects. Dose should be gradually reduced before stopping taking this medicine completely.

Use with other medicines (Interactions)

Esram should be avoided in combination with the following medicines:

  • MAO inhibitors, medicines used in the treatment of depression, such as:
    • moclobemide,
    • isocarboxazid,
    • tranylcypromine, and others. Concomitant use of Esram with these medicine may lead to serotonin syndrome (in severe cases serotonin syndrome can be life-threatening).
  • Anticoagulant medicines, such as:
    • warfarin,
    • acenocoumarol and others. Concomitant use of Esram with these medicines increases the risk of bleeding.
  • Antibiotics, medicines used in the treatment of bacterial infections, such as:
    • erythromycin,
    • ciprofloxacin and moxifloxacin. Concomitant use of Esram with these medicines increases the risk of QT prolongation and arrhythmias (irregular heart beat)!
  • Antipsychotics, such as:
    • haloperidol and pimozide. Concomitant use of Esram with these medicines increases the risk of QT prolongation and arrhythmias (irregular heart beat)!
  • Other medications used in the treatment of depression (so-called tricyclic antidepressants), such as:
    • amitriptyline,
    • nortriptyline,
    • imipramine,
    • desipramine, and others. Concomitant use of Esram with these medicines increases the risk of QT prolongation and arrhythmias (irregular heart beat)!
  • Medicines used in the treatment of migraine, so-called triptans, such as:
    • sumatriptan,
    • zolmitriptan, and others. Concomitant use of Esram with these medicine may lead to serotonin syndrome.
  • Opioid analgesics, such as:
    • tramadol,
    • fentanyl and others. Concomitant use of Esram with these medicines may lead to serotonin syndrome.
  • Medicines that may cause potassium loss, such as diuretics (so-called water pills), such as:
    • furosemide (Lasix),
    • hydrochlorothiazide, and others. Concomitant use of Esram with these medicines increases the risk of arrhythmia (irregular heartbeat).
  • St. John's Wort. Concomitant use of this herb with Esram increases the risk of side effects.

Tell your doctor about all medications and herbal products you are taking.

Side effects

Esram may cause the following side effects:

  1. nausea,
  2. vomiting,
  3. diarrhea,
  4. constipation,
  5. decreased or increased appetite,
  6. weight loss,
  7. impaired taste,
  8. rapid heartbeat (tachycardia),
  9. QT prolongation,
  10. irregular heartbeat (arrhythmia),
  11. low sodium concentration in the blood (hyponatremia),
  12. nosebleeds,
  13. muscle pain,
  14. joint pain,
  15. urinary retention,
  16. menstrual periods with heavy bleeding (menorrhagia),
  17. headache,
  18. dizziness,
  19. serotonin syndrome,
  20. agitation,
  21. hallucinations,
  22. suicidal thoughts,
  23. aggressive behavior,
  24. panic attacks,
  25. decreased libido,
  26. priapism (abnormally prolonged and painful erection of the penis),
  27. allergy and others.

Tell your doctor if you are experiencing any side effects.

References:

  1. Waugh J, Goa KL. Escitalopram: a review of its use in the management of major depressive and anxiety disorders. CNS Drugs. 2003: 17(3): 343-62.
  2. Dhillon S, Scott LJ, Plosker Gl. Escitalopram: a review of its use in the management of anxiety disorders. CNS Drugs. 2006: 20(9): 763-90.
  3. Townsend HM, Conrad JE. The therapeutic potential of escitalopram in the treatment of panic disorder. Neuropsychiatr Dis Treat. 2007: 3(6): 835-838.
  4. Lam RW. Antidepressants and QTc prolongation. J Psychiatry Neurosci. 2013: 38: E5-6.
  5. Zuccoli ML, Milano G, Leone S, and others. A case report on escitalopram-induced hyperglycaemia in a diabetic patient. Int J Psychiatry Med. 2013: 46(2): 195-201.
  6. Albayrak Y, Ugurlu GK, Ekinci O. Escitalopram-Induced Severe Akathisia : A Case Report. Prim Care Companion J Clin Psychiatry. 2010: 12(6): 1010-1016.
  7. Nirmalani A, Stock SL, Catalano G. Syndrome of inappropriate antiduretic hormone associated with escitalopram therapy. CNS Spectr. 2006: 11(6): 429-32.
  8. Bellantuono C, Orsolini L, Bozzi F. The safety profile of escitalopram in pregnancy and breastfeeding. Riv Psychiatr. 2013: 48(6): 407-14.