Escitalopram
The S-enantiomer of citalopram: an SSRI used for depression and anxiety disorders, including generalized anxiety disorder.
Drug card
- Class
- SSRI
- How it works
- Blocking serotonin reuptake, so serotonin stays longer in the synapse
- Used for
- Depression
- Generalized and social anxiety disorder
- Panic disorder
- Obsessive-compulsive disorder (OCD)
- Known for
- Trouble sleeping
- Delayed ejaculation, anorgasmia or low libido
Study it as a flashcard, and it comes back before you forget it.
Mechanism of action
How does escitalopram work?
Escitalopram is the active S-enantiomer of citalopram; it blocks serotonin reuptake a hundredfold or more as strongly as the R-enantiomer does. It is highly selective for the serotonin transporter, with minimal effect on norepinephrine or dopamine reuptake.
Like other selective serotonin reuptake inhibitors: SSRIs block the serotonin transporter (SERT) on presynaptic nerve endings, so released serotonin is cleared more slowly and acts longer on its receptors. The block is immediate but mood lifts only after weeks, so slower receptor adaptations are thought to matter; the exact mechanism is unknown. Unlike tricyclics, they barely affect norepinephrine reuptake or muscarinic, histamine and α1 receptors.
Uses
What is escitalopram used for?
- Depression
- Generalized and social anxiety disorder
- Panic disorder
- Obsessive-compulsive disorder (OCD)
Side effects
Side effects of escitalopram
- Trouble sleepingKnown for
- Delayed ejaculation, anorgasmia or low libidoKnown for
- Nausea
- Tiredness and drowsiness
- Heavy sweating
- Fast, irregular heartbeat (torsades de pointes), rarelySerious
- Serotonin syndromeSerious
- Suicidal thoughts in children and young adultsSerious
- Low sodium (hyponatremia)Serious
- Abnormal bleedingSerious
- Mania in people with bipolar disorderSerious
- Discontinuation symptoms if stopped suddenly
Known for marks what an exam expects you to know it for.
Watch for
Cautions and what sets it apart
- Contraindicated with MAOIs (leave 14 days either way) and with pimozide.
- Also contraindicated in people allergic to citalopram, since escitalopram is one of its two enantiomers.
- Take care in people with heart rhythm problems or on other QT-prolonging drugs.
Good to know: It is the single active enantiomer of citalopram; its US label covers depression from age 12 and generalized anxiety disorder in adults.
Remember it
A way to remember it
SSRI
- S
- Sexual problems
- S
- Serotonin syndrome
- R
- Reduced sodium (hyponatremia)
- I
- Increased bleeding risk
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Its class
Selective serotonin reuptake inhibitors
Other selective serotonin reuptake inhibitors with a card:
Easily mixed up with serotonin-norepinephrine reuptake inhibitors and tricyclic antidepressants.
Sources
Checked against
Written for biofideX in plain words, after checking these references:
For learning pharmacology, not for treatment decisions: no doses are given, and a prescriber, pharmacist or the product's own label is the word on any one patient. Spotted a mistake? Tell us and we'll correct it.
Depression, anxiety and sleep
Escitalopram is one of 15 drugs practiced together here: their classes, how they work, what they treat and what they're known for.
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