Escitalopram

A small number of children, teenagers, and young adults (up to 24 years of age) who took antidepressants ('mood elevators') such as escitalopram during clinical studies became suicidal (thinking about harming or killing oneself or planning or trying to do so). Children, teenagers, and young adults who take antidepressants to treat depression or other mental illnesses may be more likely to become suicidal than children, teenagers, and young adults who do not take antidepressants to treat these conditions. However, experts are not sure about how great this risk is and how much it should be considered in deciding whether a child or teenager should take an antidepressant. Children younger than 12 years of age should not normally take escitalopram, but in some cases, a doctor may decide that escitalopram is the best medication to treat a child's condition.

You should know that your mental health may change in unexpected ways when you take escitalopram or other antidepressants even if you are an adult over 24 years of age. You may become suicidal, especially at the beginning of your treatment and any time that your dose is increased or decreased. You, your family, or your caregiver should call your doctor right away if you experience any of the following symptoms: new or worsening depression; thinking about harming or killing yourself, or planning or trying to do so; extreme worry; agitation; panic attacks; difficulty falling asleep or staying asleep; aggressive behavior; irritability; acting without thinking; severe restlessness; and frenzied abnormal excitement. Be sure that your family or caregiver knows which symptoms may be serious so they can call the doctor if you are unable to seek treatment on your own.

Your healthcare provider will want to see you often while you are taking escitalopram, especially at the beginning of your treatment. Be sure to keep all appointments for office visits with your doctor.

The doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with escitalopram. Read the information carefully and ask your doctor or pharmacist if you have any questions. You also can obtain the Medication Guide from the FDA website: https://www.fda.gov/Drugs/DrugSafety/ucm085729.htm.

No matter your age, before you take an antidepressant, you, your parent, or your caregiver should talk to your doctor about the risks and benefits of treating your condition with an antidepressant or with other treatments. You should also talk about the risks and benefits of not treating your condition. You should know that having depression or another mental illness greatly increases the risk that you will become suicidal. Tell your doctor if you or anyone in your family has or has ever had bipolar disorder (mood that changes from depressed to abnormally excited) or mania (frenzied, abnormally excited mood) or has thought about or attempted suicide. Talk to your doctor about your condition, symptoms, and personal and family medical history. You and your doctor will decide what type of treatment is right for you.

Escitalopram is used to treat depression in adults and children and teenagers 12 years of ago or older. Escitalopram is also used to treat generalized anxiety disorder (GAD; excessive worry and tension that disrupts daily life and lasts for 6 months or longer) in adults, teenagers, and children 7 years of age and older. Escitalopram is in a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs). It works by increasing the amount of serotonin, a natural substance in the brain that helps maintain mental balance.

Escitalopram comes as a tablet and a solution (liquid) to take by mouth. It is usually taken once a day with or without food. To help you remember to take escitalopram, take it at around the same time every day, in the morning or in the evening. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take escitalopram exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Your doctor may start you on a low dose of escitalopram and increase your dose after 1 week in adults and after 2 or 3 weeks in teenagers and children 7 years of age and older.

It may take 1 to 4 weeks or longer before you feel the full benefit of escitalopram. Continue to take escitalopram even if you feel well. Do not stop taking escitalopram without talking to your doctor. Your doctor will probably decrease your dose gradually. If you suddenly stop taking escitalopram, you may experience withdrawal symptoms such as mood changes, irritability, agitation, nausea, dizziness, burning, numbness, or tingling in the hands or feet, anxiety, confusion, headache, sweating, shaking, frenzied or abnormally excited mood, tiredness, and difficulty falling asleep or staying asleep. Tell your doctor if you experience any of these symptoms while you are decreasing your dose of escitalopram or soon after you stop taking escitalopram.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Before taking escitalopram,

• tell your doctor or pharmacist if you are allergic to escitalopram, citalopram (Celexa), any other medications, or any of the ingredients in the tablets or solution. Ask your pharmacist or check the Medication Guide for a list of the ingredients.
• tell your doctor or pharmacist if you are taking the following medications or have stopped taking them within the past two weeks: a monoamine oxidase (MAO) inhibitor such as isocarboxazid (Marplan), linezolid (Zyvox), methylene blue, phenelzine (Nardil), selegiline (Emsam, Zelapar), and tranylcypromine (Parnate).
• you should know that escitalopram is very similar to another SSRI, citalopram (Celexa). You should not take these two medications together.
• Some medications should not be taken with escitalopram. Other medications may cause dosing changes or extra monitoring when taken with escitalopram. Make sure you have discussed any medications you are currently taking or plan to take before starting escitalopram with your doctor and pharmacist. Before starting, stopping, or changing any medications while taking escitalopram, please get the advice of your doctor or pharmacist.
• The following nonprescription or herbal products may interact with escitalopram: aspirin, ibuprofen (Advil, Motrin IB), naproxen (Aleve), St. John's wort, or tryptophan. Be sure to let your doctor and pharmacist know that you are taking these medications before you start taking escitalopram. Do not start any of these medications while taking escitalopram without discussing with your healthcare provider.
• tell your doctor if you have a low level of sodium in your blood, if you drink or have ever drunk large amounts of alcohol, or use or have ever used street drugs or have ever overused prescription medications. Also tell your doctor if you have recently had a heart attack and if you have or have ever had bleeding problems; seizures; glaucoma (a condition in which increased pressure in the eye can lead to gradual loss of vision); or liver, kidney, or heart disease.
• tell your doctor if you are pregnant, especially if you are in the last few months of your pregnancy, or if you plan to become pregnant or are breast-feeding. If you become pregnant while taking escitalopram, call your doctor. Escitalopram may cause problems in newborns following delivery if it is taken during the last months of pregnancy.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking escitalopram.
• you should know that escitalopram may make you drowsy and may affect your judgment, thinking, and movements. Do not drive a car or operate machinery until you know how this medication affects you.
• remember that alcohol can add to the drowsiness caused by this medication.
• you should know that escitalopram may cause angle-closure glaucoma (a condition where the fluid is suddenly blocked and unable to flow out of the eye causing a quick, severe increase in eye pressure which may lead to a loss of vision). Talk to your doctor about having an eye examination before you start taking this medication. If you have nausea, eye pain, changes in vision, such as seeing colored rings around lights, and swelling or redness in or around the eye, call your doctor or get emergency medical treatment right away.

Unless your doctor tells you otherwise, continue your normal diet.

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

Escitalopram may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• nausea
• diarrhea
• constipation
• sexual problems in males; decreased sex drive, inability to get or keep an erection, or delayed or absent ejaculation
• sexual problems in females; decreased sex drive, or delayed orgasm or unable to have an orgasm
• drowsiness
• yawning
• shaking
• difficulty falling asleep or staying asleep
• increased sweating
• dizziness
• heartburn
• stomach pain
• excessive tiredness
• dry mouth
• decreased appetite
• weight loss
• flu-like symptoms
• runny nose
• sneezing

Some side effects can be serious. If you experience either of the following symptoms or those listed in the IMPORTANT WARNING or SPECIAL PRECAUTIONS sections, call your doctor immediately:

• unusual excitement
• seeing things or hearing voices that do not exist (hallucinating)
• rash
• hives or blisters
• itching
• fever
• joint pain
• difficulty breathing or swallowing
• swelling of the face, throat, tongue, lips, or eyes
• fever, sweating, confusion, fast or irregular heartbeat, severe muscle stiffness or twitching, agitation, hallucinations, loss of coordination, nausea, vomiting, or diarrhea
• abnormal bleeding or bruising
• nose bleeding
• headache
• unsteadiness
• problems with thinking, concentration, or memory
• seizures
• difficult or painful urination

Escitalopram may decrease appetite and cause weight loss and height in children. Your child's doctor will watch his or her growth carefully. Talk to your child's doctor if you have concerns about your child's growth or weight while he or she is taking this medication. Talk to your child's doctor about the risks of giving escitalopram to your child.

Escitalopram may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (https://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (https://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. https://www.upandaway.org

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include:

• dizziness
• nausea
• vomiting
• drowsiness
• fast or pounding heartbeat
• seizures
• coma (loss of consciousness for a period of time)

Keep all appointments with your doctor.

Before having any laboratory test (especially those that involve methylene blue), tell your doctor and the laboratory personnel that you are taking escitalopram.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

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