Buy Lenuxin

The drug is taken orally 1 time / day, regardless of food intake.

Depression of moderate to severe severity

Usually prescribe 10 mg 1 time / day. Depending on the individual reaction of the patient, the dose may be increased to a maximum of 20 mg / day. The antidepressant effect usually develops in 2-4 weeks after the start of treatment. After the disappearance of the symptoms of depression should continue therapy to fix the effect for at least 6 months.

Panic disorder with or without agoraphobia

During the first week of treatment, a dose of 5 mg / day is recommended, which is then increased to 10 mg / day. Depending on the individual reaction of the patient, the dose may 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 prescribe 10 mg 1 time / day. Symptom weakening usually develops 2-4 weeks after the start of treatment. Depending on the individual reaction of the patient, the dose can subsequently be reduced to 5 mg / day or increased to a maximum of 20 mg / day. Because social anxiety disorder is a disease with chronic course, the minimum recommended duration of a therapeutic course is 12 weeks. To prevent recurrence of the disease, repeat therapy may be prescribed for 6 months or longer, depending on the individual reaction of the patient.

Before prescribing the drug, it is necessary to differentiate the social phobia with "ordinary" shyness or shyness.

Generalized anxiety disorder

The recommended initial dose is 10 mg 1 time / day. Depending on the individual reaction of the patient, the dose may be increased to a maximum of 20 mg / day. Long-term administration of the drug (6 months and longer) is possible at a dose of 20 mg / day.

Patients of advanced age (over 65 years) are recommended to appoint half of the usual recommended dose - 5 mg / day. The maximum dose is 10 mg / day.

In case of moderate renal insufficiency, dose adjustment is not required. Patients with severe renal insufficiency (CC below 30 ml / min) the drug is administered with caution.

For mild to moderate hepatic failure, the recommended initial dose for the first 2 weeks of treatment is 5 mg / day. Depending on the individual reaction of the patient, the dose may be increased to 10 mg / day. With severe hepatic insufficiency, care must be taken when titrating the dose.

For patients with a low activity of the isoenzyme CYP2C19, the recommended initial dose for the first 2 weeks of treatment is 5 mg / day. Depending on the individual reaction of the patient, the dose may be increased to 10 mg / day.

When discontinuing treatment, the dose should be reduced gradually within 1-2 weeks to avoid the occurrence of withdrawal syndrome.

Pharmaceutical interaction

Serotonergic drugs: simultaneous use with serotonergic drugs (eg, tramadol, sumatriptan and other triptans) may lead to the development of serotonin syndrome.

Drugs that reduce the threshold of convulsive readiness: escitalopram can reduce the threshold of convulsive readiness. Care should be taken when using other drugs that reduce the threshold of convulsive readiness (tricyclic antidepressants, SSRIs, neuroleptics - derivatives of phenothiazine, thioxanthene and butyrophenone, mefloquine and tramadol).

Lithium and tryptophan: with the simultaneous use of escitalopram and lithium or tryptophan, there have been cases of increased effects of the drug.

Hypericum perforatum (Hypericum perforatum): simultaneous use of escitalopram and preparations of St. John's wort can lead to an increase in the number of side effects.

Anticoagulants and other agents that affect blood clotting: when escitalopram is used simultaneously with indirect anticoagulants and other means that affect blood clotting (for example, atypical antipsychotics and phenothiazine derivatives, most tricyclic antidepressants, acetylsalicylic acid and NSAIDs, ticlopidine and dipyridamole) violation of blood clotting. In such cases, when initiating or completing therapy with escitalopram, regular monitoring of blood clotting is necessary.

Pharmacokinetic interaction

The effect of other drugs on the pharmacokinetics of escitalopram: simultaneous use of escitalopram and omeprazole (inhibitor of the isoenzyme CYP2C19) at a dose of 30 mg 1 time / day leads to a moderate (about 50%) increase in the concentration of escitalopram in blood plasma.

Simultaneous use of escitalopram and cimetidine (an inhibitor of isoenzymes CYP2D6, CYP3A4 and CYP1A2) at a dose of 400 mg 2 times / day leads to an increase (approximately 70%) in the concentration of escitalopram in the blood plasma. Therefore, escitalopram should be administered with caution at the same time as CYP2C19 isoenzyme inhibitors (eg, omeprazole, esomeprazole, fluvoxamine, lansoprazole, ticlopidine) and cimetidine. When concomitantly using escitalopram and the above drugs, a dose reduction of escitalopram may be required based on monitoring of side effects.

The effect of escitalopram on the pharmacokinetics of other drugs: escitalopram is an inhibitor of the CYP2D6 isoenzyme. Caution should be exercised when concomitant use of escitalopram and drugs metabolized with this isoenzyme and having a small therapeutic index, for example, flecainide, propafenone and metoprolol (in cases of heart failure) or drugs, mainly metabolized by the CYP2D6 isoenzyme and acting on CNS, for example, antidepressants (desipramine, clomipramine, nortriptyline) or neuroleptics (risperidone, thioridazine, haloperidol). In these cases, dose adjustment may be required.

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

Escitalopram can slightly inhibit the isoenzyme CYP2C19. Therefore, caution should be exercised while using escitalopram and drugs metabolized by CYP2C19.