Escitalopram belongs to the group of medications called selective serotonin reuptake inhibitors (SSRIs). It is used to treat depression, obsessive-compulsive disorder (OCD), and generalized anxiety disorder (GAD). It works by increasing levels of a neurotransmitter called serotonin in the brain. Increased serotonin levels can lead to an improved mood.

The medication usually begins to work within 2 to 4 weeks. However, it may take several weeks of treatment before the full effects are seen.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

The recommended dose is usually started at 10 mg daily, preferably at the same time each day. Escitalopram should be taken once daily in the morning or evening, with or without food. The dose can be increased by your doctor as needed to a maximum of 20 mg daily. For seniors, people with liver problems, and people taking the medications omeprazole or cimetidine, the maximum recommended daily dose is 10 mg. In some cases, the doctor may recommend a 5 mg starting dose.

Regular tablets: The tablet should be swallowed whole (not chewed) with a glass of water.

Oral dispersible tablets: The tablet should be placed on the tongue. It will rapidly disintegrate and can be swallowed without water. The tablets break easily, so they should be handled carefully with dry hands.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, skip the missed dose and continue on with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children. The oral dispersible tablets should be kept in their original package.

10 mg
Each white, oval, biconvex, film-coated tablet, engraved "APO" on one side and scored and engraved "ESC" over "10" on the other side, contains 10 mg of escitalopram (as escitalopram oxalate). Nonmedicinal ingredients: croscarmellose sodium, hydroxypropyl cellulose, hydroxypropyl methylcellulose, lactose monohydrate, magnesium stearate, microcrystalline cellulose, polyethylene glycol, and titanium dioxide.

20 mg
Each white, oval, biconvex, film-coated tablet, engraved "APO" on one side and scored and engraved "ESC" over "20" on the other side, contains 20 mg of escitalopram (as escitalopram oxalate). Nonmedicinal ingredients: croscarmellose sodium, hydroxypropyl cellulose, hydroxypropyl methylcellulose, lactose monohydrate, magnesium stearate, microcrystalline cellulose, polyethylene glycol, and titanium dioxide.

Do not take this medication if you:

• are allergic to escitalopram, citalopram, or any ingredients of the medication
• have a condition known as congenital long QT syndrome or have a heart rhythm disturbance called QT prolongation
• are taking the medication pimozide
• have taken a MAO inhibitor medication (e.g., phenelzine, tranylcypromine, moclobemide) in the past 2 weeks – MAO inhibitors should not be taken until at least 2 weeks after stopping treatment with escitalopram

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• changes in heart rate
• congested or runny nose
• constipation
• diarrhea
• difficulty sleeping
• dizziness
• drowsiness
• dry mouth
• fatigue
• fever
• heartburn
• increased sweating
• insomnia
• loss of appetite
• muscle or joint pain
• nausea
• sexual dysfunction including:
• decreased libido (sex drive)
• erectile dysfunction (difficulty getting or keeping an erection)
• inability to have an orgasm
• stomach pain
• stomach upset
• yawning

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• anxiety
• bruising or unusual bleeding from the skin or other areas
• difficulty controlling blood sugar levels
• feeling of skin prickling
• hallucinations
• inability to urinate
• involuntary movements of the body or face
• low blood sodium (confusion, seizures, drowsiness, dryness of mouth, increased thirst, lack of energy)
• mania (overactive behavior and thoughts)
• new or worsening emotional symptoms
• severe agitation or restlessness
• symptoms of glaucoma, e.g.:
• increased pressure in the eye
• eye pain
• blurred vision
• symptoms of liver damage, e.g.:
• abdominal pain
• dark urine
• clay-coloured stools
• itching
• loss of appetite
• nausea and vomiting
• yellow skin or eyes

Stop taking the medication and seek immediate medical attention if any of the following occur:

• seizure or convulsions
• serotonin syndrome or neuroleptic malignant syndrome – signs include:
• agitation
• confusion
• diarrhea
• fever
• overactive reflexes
• poor coordination
• restlessness
• shivering
• sweating
• talking or acting with excitement you cannot control
• trembling or shaking
• twitching
• symptoms of an abnormal rhythm such as heart palpitations, dizziness, or fainting
• symptoms of a serious allergic reaction such as swelling of the face or throat, hives, or difficulty breathing
• thoughts of suicide or hurting yourself
• vomiting blood or presence of blood in the stool

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Abnormal heart rhythm: Escitalopram may cause an abnormal heart rhythm, especially at higher doses. Your doctor may occasionally monitor your heart rate and rhythm with a test called an electrocardiogram. People with a history of a heart rhythm disturbance called QT prolongation should not take this medication. If you have congestive heart failure, have slow heart rhythm, are at risk of low potassium or magnesium levels because of certain illnesses or medications, or are taking certain medications that can affect the heart rhythm (e.g., amiodarone, sotalol), you should discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Bleeding disorders: Other medications from the same class as escitalopram may cause bleeding disorders. Report any unusual bruising or bleeding to your doctor, especially if you are taking medications that affect platelets (special blood cells that help the blood to clot). These medications include ASA, clopidogrel, dipyridamole, nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., ibuprofen or naproxen), and certain antipsychotic medications.

Bone health: Studies have shown that there is an increased risk of bone fractures with the use of medications similar to escitalopram. If you have osteoporosis, or are at risk of developing osteoporosis, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Diabetes: If you have diabetes, your doctor should closely monitor your condition while you are taking escitalopram, as it may affect blood sugar control (either increase or decrease blood sugar levels).

Glaucoma: This medication may cause the symptoms of glaucoma (increased pressure in the eye) to become worse. If you have glaucoma, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Report any changes in vision to your doctor as soon as possible while you are taking this medication.

Kidney function: If you have severely reduced kidney function, your doctor should closely monitor your condition while you are taking this medication.

Liver function: Decreased liver function or liver disease may cause escitalopram to build up in the body, causing increased side effects. If you have reduced liver function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Mania: Escitalopram may cause activation of mania. This means that people who are prone to mania may be more likely to have their mania start up again. If you have a history of mania or bipolar disorder, your doctor should closely monitor your condition while you are taking this medication.

Neuroleptic malignant syndrome (NMS): Escitalopram, like other similar medications that act on serotonin, can cause a potentially fatal syndrome known as neuroleptic malignant syndrome (NMS). If you notice the symptoms of NMS such as high fever, muscle stiffness, confusion or loss of consciousness, sweating, racing or irregular heartbeat, or fainting, get immediate medical attention.

Seizures: If you have a history of seizures, your doctor should closely monitor your condition while you are taking escitalopram. If you develop seizures, stop taking the medication and contact your doctor.

Serotonin syndrome: Severe reactions are possible when escitalopram is combined with other medications that act on serotonin, such as tricyclic antidepressants and "triptan" migraine medications. Symptoms of a reaction may include muscle rigidity and spasms, difficulty moving, changes in mental state including delirium and agitation. Coma and death are possible.

Stopping the medication: Escitalopram should not be stopped abruptly due to the risk of discontinuation symptoms (dizziness, abnormal dreams, numbness, electric shock feelings, agitation, anxiety, difficulty concentrating, headache, tremor, nausea, vomiting, and sweating). A gradual reduction in dose over a period of time is recommended. If you are thinking of stopping the medication, talk to your doctor or pharmacist about how to do this safely.

Suicidal or agitated behaviour: Adults and children taking this medication may feel agitated (restless, anxious, aggressive, emotional, and feeling not like themselves), or they may want to hurt themselves or others. These symptoms may occur within several weeks after a person starts taking this medication or when doses are adjusted. People taking this medication should be closely monitored by their doctor for emotional and behavioural changes.

Pregnancy: The safe use of escitalopram during pregnancy has not been established. Newborn babies may experience serious adverse effects if the mother is taking citalopram during the 3 months before the baby is born. Doctors and pregnant women should carefully consider the benefits and the risks of all treatment options. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: It is known that the medication citalopram, which is similar to escitalopram, passes into breast milk. If you are a breast-feeding mother and are taking escitalopram, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children and adolescents: The safety and efficacy of this medication for children and adolescents under 18 years of age have not been established. It may cause behavioural and emotional changes, such as suicidal thoughts and behaviour.

There may be an interaction between escitalopram and any of the following:

• acetylsalicylic acid (ASA)
• alcohol
• amiodarone
• amphetamines (e.g., dextroamphetamine, lisdexamfetamine)
• anticoagulants (e.g., apixaban, clopidogrel, dabigatran, rivaroxaban, warfarin)
• antihistamines (e.g., cetirizine, doxylamine, diphenhydramine, hydroxyzine, loratadine)
• antipsychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, paliperidone, pimozide, quetiapine, risperidone)
• anagrelide
• apalutamide
• asenapine
• barbiturates (e.g., butalbital, pentobarbital, phenobarbital)
• benzodiazepines (e.g., alprazolam, diazepam, lorazepam)
• bosentan
• buserelin
• buspirone
• chloral hydrate
• chloroquine
• cimetidine
• clonidine
• deferasirox
• desmopressin
• dextromethorphan
• diabetes medications (e.g., canagliflozin, chlorpropamide, glyburide, insulin, metformin, rosiglitazone)
• dipyridamole
• disopyramide
• dofetilide
• domperidone
• efavirenz
• entacapone
• enzalutamide
• ergot alkaloids (e.g., ergotamine, dihydroergotamine)
• etravirine
• flecainide
• fluconazole
• heparin
• herbal products that affect blood clotting (e.g., cat's claw, chamomile, fenugreek, evening primrose, feverfew, garlic, ginger, ginseng, glucosamine, turmeric)
• itraconazole
• ketoconazole
• laxatives
• lanreotide
• linezolid
• lithium
• lopinavir
• low molecular weight heparins (e.g., dalteparin, enoxaparin, tinzaparin)
• macrolide antibiotics (e.g., clarithromycin, erythromycin)
• metoclopramide
• methadone
• methylphenidate
• metoclopramide
• mexiletine
• mifepristone
• mirtazapine
• mitotane
• monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, rasagiline, selegiline, tranylcypromine, methylene blue)
• multivitamin supplements
• modafinil
• muscle relaxants (e.g., baclofen, cyclobenzaprine, methocarbamol, orphenadrine)
• narcotic pain relievers (e.g., codeine, fentanyl, morphine, oxycodone)
• nefazodone
• non-steroidal anti-inflammatory medications (NSAIDs; e.g., diclofenac, ibuprofen, naproxen)
• obinutuzumab
• octreotide
• omeprazole
• pasireotide
• pentamidine
• pentoxifylline
• procainamide
• propafenone
• protein kinase inhibitors (e.g., crizotinib, nilotinib, lapatinib, pazopanib, sunitinib)
• quinidine
• quinine
• quinolone antibiotics (e.g., ciprofloxacin, ofloxacin)
• rifampin
• St. John's wort
• saquinavir
• scopolamine
• seizure medications (e.g., clobazam, levetiracetam, phenobarbital, phenytoin, primidone, topiramate, valproic acid, zonisamide)
• other selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, fluoxetine, paroxetine, sertraline)
• serotonin antagonists (anti-emetic medications; e.g., dolasetron, granisetron, ondansetron)
• serotonin/norepinephrine reuptake inhibitors (SNRIs; e.g., desvenlafaxine, duloxetine, venlafaxine)
• siltuximab
• sotalol
• stiripentol
• sulfonamide antibiotics ("sulfas"; e.g., sulfisoxazole, sulfamethoxazole)
• tapentadol
• tetrabenazine
• thiazide diuretics (water pills; e.g., hydrochlorothiazide, indapamide, metolazone)
• thyroid replacements (e.g., desiccated thyroid, levothyroxine)
• tipranavir
• tocilizumab
• tolcapone
• tramadol
• trazodone
• tricyclic antidepressants (e.g., clomipramine, desipramine, imipramine)
• triptans (e.g., naratriptan, sumatriptan, zolmitriptan)
• tryptophan
• vitamin E
• voriconazole
• zolpidem
• zopiclone

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.