Lexapro

Generic Name: Escitalopram Oxalate
Class: Selective Serotonin-reuptake Inhibitors
VA Class: CN609
Chemical Name: 1-[3-(Dimethylamino)propyl]-1-(4-fluorophenyl)-1,3-dihydro-S-(+)-5-isobenzofurancarbonitrile oxalate
Molecular Formula: C₂₀H₂₁FN₂O•C₂H₂O₄
CAS Number: 219861-08-2

• Suicidality


• 
  

  Antidepressants may increase risk of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults (18–24 years of age) with major depressive disorder and other psychiatric disorders; balance this risk with clinical need.^{1 e f} Escitalopram is not approved for use in pediatric patients.¹ (See Pediatric Use under Cautions.)

  
  


• 
  

  In pooled data analyses, risk of suicidality was not increased in adults >24 years of age and apparently was reduced in adults ≥65 years of age with antidepressant therapy compared with placebo.^{e f}

  
  


• 
  

  Depression and certain other psychiatric disorders are themselves associated with an increased risk of suicide.^{e f g}

  
  


• 
  

  Appropriately monitor and closely observe all patients who are started on escitalopram therapy for clinical worsening, suicidality, or unusual changes in behavior; involve family members and/or caregivers in this process.^{1 e f g} (See Worsening of Depression and Suicidality Risk under Cautions.)

  
  

Introduction

Antidepressant; selective serotonin-reuptake inhibitor (SSRI) and S-enantiomer of citalopram.¹

Uses for Lexapro

Major Depressive Disorder

Management of major depressive disorder.¹

Efficacy in hospital settings not established.^{1 8}

Generalized Anxiety Disorder

Management of generalized anxiety disorder.¹

Lexapro Dosage and Administration

General

• 
  

  Allow at least 2 weeks to elapse between discontinuance of an MAO inhibitor and initiation of escitalopram, and vice versa.¹

  
  


• 
  

  Monitor for possible worsening of depression, suicidality, or unusual changes in behavior, especially at the beginning of therapy or during periods of dosage adjustments.^{1 e f g} (See Worsening of Depression and Suicidality Risk under Cautions.)

  
  


• 
  

  Sustained therapy may be required; monitor periodically for need for continued therapy.¹

  
  


• 
  

  Avoid abrupt discontinuance of therapy.¹ To avoid withdrawal reactions, taper dosage gradually.^{1 5 6 7} (See Worsening of Depression and Suicidality Risk and also see Withdrawal of Therapy under Cautions.)

  
  


• 
  

  Consider cautiously tapering dosage during third trimester of pregnancy prior to delivery.¹ (See Fetal/Neonatal Morbidity and Mortality under Cautions.)

  
  

Administration

Oral Administration

Administer orally once daily (morning or evening) without regard to meals.¹

Dosage

Available as escitalopram oxalate; dosage is expressed in terms of escitalopram.¹

Escitalopram dosages of 10 mg daily appear to be comparable to racemic citalopram dosages of 40 mg daily.²

Adults

Major Depressive Disorder

Oral

Initially, 10 mg daily.¹ May be increased to 20 mg daily after ≥1 week; no additional therapeutic benefit with higher dosages.¹

Optimum duration not established; may require several months of therapy or longer.^{1 5}

Generalized Anxiety Disorder

Oral

Initially, 10 mg daily.¹ Dosage may be increased to 20 mg daily after ≥1 week.¹

Not studied >8 weeks of therapy; periodically reevaluate need for therapy.¹

Special Populations

Hepatic Impairment

10 mg daily.¹

Renal Impairment

No dosage adjustment required in patients with mild to moderate renal impairment; not studied in patients with severe renal impairment (Cl_cr <20 mL/minute).¹

Geriatric Patients

10 mg daily.¹

Cautions for Lexapro

Contraindications

• 
  

  Concurrent or recent (i.e., within 2 weeks) therapy with an MAO inhibitor.¹ (See MAO Inhibitors under Warnings and see Specific Drugs under Interactions.)

  
  


• 
  

  Concurrent pimozide therapy.¹ (See Specific Drugs under Interactions.)

  
  


• 
  

  Known hypersensitivity to escitalopram, citalopram, or any ingredient in the formulation.¹

  
  

Warnings/Precautions

Warnings

MAO Inhibitors

Concomitant use with MAO inhibitors associated with serious, sometimes fatal reactions, including manifestations resembling serotonin syndrome (e.g., hyperthermia, rigidity, myoclonus, autonomic instability, mental status changes) or neuroleptic malignant syndrome (NMS).¹ (See Serotonin Syndrome under Cautions and also see Specific Drugs under Interactions.)

Serotonin Syndrome

Potentially life-threatening serotonin syndrome reported during concurrent therapy with SSRIs or selective serotonin- and norepinephrine-reuptake inhibitors (SNRIs) and other serotonergic drugs (e.g., 5-HT₁ receptor agonists [“triptans”] or drugs that impair serotonin metabolism (e.g., MAO inhibitors).^{1 18} Symptoms may include mental status changes (e.g., agitation, hallucinations, coma), autonomic instability (e.g., tachycardia, labile BP, hyperthermia), neuromuscular aberrations (e.g., hyperreflexia, incoordination), and/or GI symptoms (e.g., nausea, vomiting, diarrhea).^{1 18} (See Specific Drugs under Interactions.)

Worsening of Depression and Suicidality Risk

Possible worsening of depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior in both adult and pediatric patients with major depressive disorder, whether or not they are taking antidepressants; may persist until clinically important remission occurs.^{1 e f g h} However, suicide is a known risk of depression and certain other psychiatric disorders, and these disorders themselves are the strongest predictors of suicide.^{e f g}

Appropriately monitor and closely observe patients receiving escitalopram for any reason, particularly during initiation of therapy (i.e., the first few months) and during periods of dosage adjustments.^{1 e f g} (See Boxed Warning and also see Pediatric Use under Cautions.)

Anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia, hypomania, and/or mania may be precursors to emerging suicidality.^{f g} Consider changing or discontinuing therapy in patients whose depression is persistently worse or in those with emerging suicidality or symptoms that might be precursors to worsening depression or suicidality, particularly if severe, abrupt in onset, or not part of patient’s presenting symptoms.^{1 e f g} If decision is made to discontinue therapy, taper escitalopram dosage as rapidly as is feasible but consider risks of abrupt discontinuance.^{1 f} (See Withdrawal of Therapy under Cautions.)

Prescribe in smallest quantity consistent with good patient management to reduce risk of overdosage.^{1 f}

Observe these precautions for patients with psychiatric (e.g., major depressive disorder, obsessive-compulsive disorder) or nonpsychiatric disorders.^{1 f}

Bipolar Disorder

May unmask bipolar disorder.^{1 f} (See Activation of Mania or Hypomania under Cautions.) Escitalopram is not approved for use in treating bipolar depression.¹

Screen for risk of bipolar disorder by obtaining detailed psychiatric history (e.g., family history of suicide, bipolar disorder, depression) prior to initiating therapy.^{1 f}

Fetal/Neonatal Morbidity and Mortality

Possible complications, sometimes severe and requiring prolonged hospitalization, respiratory support, enteral nutrition, and other forms of supportive care, reported in neonates exposed to escitalopram, other SSRIs, or SNRIs late in the third trimester; may arise immediately upon delivery.¹

Increased risk of persistent pulmonary hypertension of the newborn (PPHN) in infants exposed to SSRIs during late pregnancy; PPHN is associated with substantial morbidity and mortality.^{1 25 27}

Increased risk of depression relapse observed in women who discontinued antidepressant therapy during pregnancy compared with those who remained on antidepressant therapy.^{1 25 26}

Sensitivity Reactions

Hypersensitivity Reactions

Possible anaphylaxis, allergic reactions, and angioedema.¹

General Precautions

Withdrawal of Therapy

Possibly severe withdrawal reactions (e.g., dysphoric mood, irritability, agitation, dizziness, sensory disturbances, anxiety, confusion, headache, lethargy, emotional lability, insomnia, hypomania); avoid abrupt discontinuance of therapy.¹ Taper dosage gradually (e.g., over a period of several weeks).^{1 5 6 7}

Abnormal Bleeding

Possible increased risk of bleeding, including upper GI bleeding; use with caution.¹

Concomitant use of an NSAIA (e.g., aspirin) or warfarin may potentiate such risk.¹ (See Interactions.)

SIADH or Hyponatremia

Possible SIADH secretion or hyponatremia requiring medical intervention and/or escitalopram discontinuance.¹

Activation of Mania or Hypomania

Possible activation of mania and hypomania in major depressive disorder; use with caution in patients with a history of mania.¹ (See Bipolar Disorder under Cautions.)

Seizures

Risk of seizures not systematically evaluated; use with caution in patients with a history of seizures.¹

Cognitive/Physical Impairment

Risk of impaired mental alertness or physical coordination required for performing hazardous tasks (e.g., driving, operating machinery).¹

Concomitant Disease

Limited experience; use with caution in patients with altered metabolism or hemodynamics.¹

Electroconvulsive Therapy (ECT)

Effects of concomitant use with ECT not studied.¹

Specific Populations

Pregnancy

Category C.¹ (See Fetal/Neonatal Morbidity and Mortality under Cautions.)

Increased risk of depression relapse observed in women who discontinued antidepressant therapy during pregnancy compared with those who remained on antidepressant therapy.^{1 25 26}

Lactation

Distributed into milk;^{23 24} possible serious adverse reactions (e.g., excessive somnolence, decreased feeding, weight loss) in nursing infants.¹ Discontinue nursing or the drug.¹

Pediatric Use

Safety and efficacy not established in children <18 years of age.^{1 8} The manufacturer states that escitalopram was not demonstrated to be effective in a placebo-controlled trial in children and adolescents with major depressive disorder.¹

FDA warns that a greater risk of suicidal thinking or behavior (suicidality) occurred during first few months of antidepressant treatment (4%) compared with placebo (2%) in children and adolescents with major depressive disorder, obsessive-compulsive disorder (OCD), or other psychiatric disorders based on pooled analyses of 24 short-term placebo-controlled trials of 9 antidepressant drugs (SSRIs and others).^{1 f} However, a more recent meta-analysis of 27 placebo-controlled trials of 9 antidepressants (SSRIs and others) in patients <19 years of age with major depressive disorder, OCD, or non-OCD anxiety disorders suggests that the benefits of antidepressant therapy in treating these conditions may outweigh the risks of suicidal behavior or suicidal ideation.^h No suicides occurred in these pediatric trials.^{1 f h}

Carefully consider these findings when assessing potential benefits and risks of escitalopram in a child or adolescent for any clinical use.^{1 e f g h} (See Worsening of Depression and Suicidality Risk under Cautions.)

Geriatric Use

No substantial differences in safety and efficacy relative to younger adults, but increased sensitivity cannot be ruled out.¹

Titrate dosage carefully.¹ (See Geriatric Patients under Dosage and Administration.)

In pooled data analyses, a reduced risk of suicidality was observed in adults ≥65 years of age with antidepressant therapy compared with placebo.^{e f} (See Boxed Warning and also see Worsening of Depression and Suicidality Risk under Cautions.)

Hepatic Impairment

Systemic exposure to escitalopram may be increased.¹ (See Elimination: Special Populations, under Pharmacokinetics.) Use with caution.¹

Renal Impairment

Use with caution in patients with severe renal impairment (Cl_cr <20 mL/minute).¹ (See Elimination: Special Populations, under Pharmacokinetics.)

Common Adverse Effects

Insomnia,¹ nausea,¹ increased sweating,¹ sexual dysfunction (ejaculation disorder [primarily ejaculatory delay], decreased libido, anorgasmia),¹ fatigue,¹ and somnolence.¹

Interactions for Lexapro

Extensively metabolized in the liver, principally by CYP2C19 and 3A4.¹ Does not inhibit CYP1A2, 2C9, 2C19, 2E1, or 3A4 in vitro and exhibits only modest inhibition against CYP2D6.¹

Drugs Affecting Hepatic Microsomal Enzymes

Inhibitors of CYP2C19 and 3A4: clinically important pharmacokinetic interaction unlikely since escitalopram is metabolized by multiple enzyme systems.¹

Drugs Metabolized by Hepatic Microsomal Enzymes

Substrates of CYP2D6: potential pharmacokinetic (increased peak plasma concentrations and AUC of the substrate) interactions.¹ Use with caution.¹

Drugs Affecting Hemostasis

Potential pharmacologic interaction (increased risk of bleeding) with drugs that affect coagulation; use with caution.^{1 11}

Drugs Associated with Serotonin Syndrome

Potential pharmacologic interaction (serotonin syndrome) with serotonergic agents.^{1 18} Avoid such use, or use with caution.^{1 18} (See Serotonin Syndrome under Cautions.)

Specific Drugs

Drug	Interaction	Comment
Alcohol	Does not potentiate the cognitive and motor effects of alcohol1	Concomitant use not recommended1
Antidepressants, tricyclics (TCAs) (e.g., desipramine, imipramine)	Possible increased plasma TCA concentrations with TCAs that are substrates of CYP2D61 c	Use with caution1
Carbamazepine	Possible increased escitalopram clearance1
Cimetidine	Increased racemic citalopram AUC and peak plasma concentrations1 7
Citalopram	Therapeutic duplication; escitalopram is the more active isomer of racemic citalopram1	Concomitant use not recommended1
CNS drugs	Potentially additive CNS effects1	Use with caution1
Digoxin	Pharmacokinetic interaction unlikely1
5-HT1 receptor agonists (“triptans”)	Potentially life-threatening serotonin syndrome1 18	Observe carefully if used concomitantly, particularly during treatment initiation, dosage increases, or when another serotonergic agent is initiated1 18
Isoniazid	Possible serotonin syndromed
Ketoconazole	Decreased peak plasma concentrations and AUC of ketoconazole1
Linezolid	Possible serotonin syndrome1 19 20 21 22	Use with caution1
Lithium	Enhanced serotonergic effects of escitalopram1 Pharmacokinetic interaction unlikely1	Use with caution1
MAO inhibitors	Possible serotonin syndrome or NMS1	Concomitant use contraindicated1 Allow at least 2 weeks to elapse between discontinuance of an MAO inhibitor and initiation of escitalopram, or vice versa1
Metoprolol	Increased plasma metoprolol concentrations possibly resulting in decreased cardioselectivity1
NSAIAs (e.g., aspirin)	Increased risk of bleeding1	Use with caution1
Pimozide	Possible increased risk of QTc interval prolongation with racemic citalopram1 Pharmacokinetic interactions unlikely with racemic citalopram1	Concomitant use contraindicated1
Ritonavir	Pharmacokinetic interactions unlikely1
Sibutramine	Possible serotonin syndrome18	Use with caution18
Theophylline	No effects evident on theophylline pharmacokinetics1
Triazolam	Pharmacokinetic interactions unlikely1
Tryptophan and other serotonin precursors	Possible serotonin syndrome1	Concomitant use not recommended1
Warfarin	Possible increased PT and risk of bleeding1 11 Pharmacokinetic interactions unlikely with racemic citalopram1 11	Use with caution1

Lexapro Pharmacokinetics

Absorption

Bioavailability

Well absorbed following oral administration, with peak plasma concentration usually attained within 5 hours.¹

Commercially available tablets and oral solution are bioequivalent.¹

Onset

Antidepressant effect usually occurs within 1–4 weeks.¹

Food

Food does not affect absorption.¹

Special Populations

In geriatric patients, AUC is increased approximately 50%.¹

Distribution

Extent

Crosses the placenta.¹

Distributed into breast milk.^{23 24}

Plasma Protein Binding

Approximately 56%.¹

Elimination

Metabolism

Extensively metabolized in the liver to less pharmacologically active metabolites by multiple enzyme systems, including CYP3A4 and CYP2C19.¹

Elimination Route

Eliminated principally in urine.¹

Half-life

27–32 hours.¹

Special Populations

In geriatric patients, half-life is increased by 50%.¹

Hepatic impairment decreases racemic citalopram oral clearance by 37% and doubles its half-life.¹

Mild to moderate renal impairment decreases racemic citalopram oral clearance by 17%.¹ Pharmacokinetics not studied in patients with severe renal impairment (Cl_cr <20 mL/minute).¹

Stability

Storage

Oral

Solution and Tablets

25°C; excursions permitted to 15–30°C.¹

ActionsActions

• 
  

  S-enantiomer of citalopram,¹ an SSRI that occurs as a 50:50 racemic mixture of the R- and S-enantiomers.^{1 4}

  
  


• 
  

  At least 100-fold more potent as an inhibitor of serotonin (5-hydroxytryptamine [5-HT]) reuptake at presynaptic membranes and 5-HT neuronal firing rate than R-enantiomer and is twice as potent as racemic mixture.^{1 2 9 b}

  
  


• 
  

  Mechanism of action as an antidepressant is presumed to be linked to potentiation of serotonergic activity in the CNS resulting from its inhibition of CNS neuronal reuptake of serotonin (5-HT).¹

  
  


• 
  

  Highly selective; minimal effects on norepinephrine (NE) and dopamine (DA) neuronal reuptake and little or no affinity for α- or β-adrenergic, dopamine D_1–5, histamine H_1–3, GABA-benzodiazepine, muscarinic M_1–5, or 5-HT_1–7 receptors or various ion channels (e.g., calcium, chloride, potassium, sodium channels).¹

  
  

Advice to Patients

• 
  

  Risk of suicidality; importance of patients, families, and caregivers being alert to and immediately reporting emergence of suicidality, worsening depression, or unusual changes in behavior, especially during the first few months of therapy or during periods of dosage adjustment.^{1 e f g} FDA recommends providing written patient information (medication guide) explaining risks of suicidality each time the drug is dispensed.^{1 e f g}

  
  


• 
  

  Risk of psychomotor impairment; importance of exercising caution while operating hazardous machinery, including automobile driving, until they gain experience with the drug’s effects.¹

  
  


• 
  

  Risks associated with concomitant use of escitalopram with alcohol or racemic citalopram.¹

  
  


• 
  

  Importance of continuing escitalopram therapy even if a response is not evident within 1–4 weeks, unless directed otherwise.¹

  
  


• 
  

  Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.¹

  
  


• 
  

  Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses (e.g., bipolar disorder) or personal or family history of suicidality or bipolar disorder.^{1 15}

  
  


• 
  

  Importance of informing patients of risk of serotonin syndrome with concurrent use of escitalopram and 5-HT₁ receptor agonists (“triptans”) or other serotonergic agents.^{1 18} Importance of seeking immediate medical attention if symptoms of serotonin syndrome develop.^{1 18}

  
  


• 
  

  Importance of informing patients of other important precautionary information.¹ (See Cautions.)

  
  

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Escitalopram Oxalate

Routes	Dosage Forms	Strengths	Brand Names	Manufacturer
Oral	Solution	5 mg (of escitalopram) per 5 mL	Lexapro (with parabens and propylene glycol)	Forest
	Tablets, film-coated	5 mg (of escitalopram)	Lexapro	Forest
		10 mg (of escitalopram)	Lexapro (scored)	Forest
		20 mg (of escitalopram)	Lexapro (scored)	Forest

Comparative Pricing

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 03/2011. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.

Lexapro 10MG Tablets (FOREST): 30/$109.99 or 90/$289.97

Lexapro 20MG Tablets (FOREST): 30/$109.99 or 90/$309.97

Lexapro 5MG/5ML Solution (FOREST): 240/$169.99 or 720/$485.95

Lexapro 5MG Tablets (FOREST): 30/$99.99 or 90/$279.97

Disclaimer

This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.

The American Society of Health-System Pharmacists, Inc. and Drugs.com represent that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. and Drugs.com make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. and Drugs.com do not endorse or recommend the use of any drug. The information is not a substitute for medical care.

AHFS Drug Information. © Copyright, 1959-2011, Selected Revisions August 2007. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

References

1. Forest Pharmaceuticals, Inc. Lexapro (escitalopram oxalate) tablets/oral solution prescribing information. St. Louis, MO; 2006 Sep.

2. Burke WJ, Gergel I, Bose A. fixed-dose trial of the single isomer SSRI escitalopram in depressed outpatients. J Clin Psychiatry. 2002; 63:331-6. [IDIS 479908] [PubMed 12000207]

3. Anon. Forest Lexapro approval includes label claim of greater potency than celexa. FDC Rep. Aug 19, 2002:3.

4. Forest Pharmaceuticals, Inc. Celexa (citalopram hydrobromide) prescribing information. (dated 2000 Dec). In: Physicians’ desk reference. 56th ed. Montvale, NJ: Medical Economics Company Inc; 2002:1365-9.

5. American Psychiatric Association. Practice guideline for the treatment of patients with major depressive disorder (revision). Am J Psychiatry. 2000; 150(Suppl 4):1-45.

6. The European Agency for the Evaluation of Medicinal Products (EMEA). Committee for proprietary medicinal products (CPMP) position paper on selective serotonin uptake inhibitors (SSRIs) and dependency/withdrawal reactions. London, UK; 2000 Apr 12. From EMEA web site.

7. Lazowick AL, Levin GM. Potential withdrawal syndrome associated with SSRI discontinuation. Ann Pharmacother. 1995; 29:1284-5.

8. Forest Pharmaceuticals, Inc., St. Louis, MO: Personal communication.

9. Anon. Escitalopram (Lexapro) for depression. Med Lett Drugs Ther. 2002; 44:83-4. [PubMed 12360121]

10. Reviewers’ comments (personal observations).

11. Priskorn M, Sidhu JS, Larsen F et al. Investigation of multiple dose citalopram on the pharmacokinetics and pharmacodynamics of racemic warfarin. Br J Clin Pharmacol. 1997; 44:199-202.

12. Anon. FDA issues public health advisory entitled: Reports of suicidality in pediatric patients being treated with antidepressant medications for major depressive disorder (MDD). FDA Talk Paper. Rockville, MD: Food and Drug Administration; 2003 Oct 27. From the FDA website.

13. Anon. Reports of suicidality in pediatric patients being treated with antidepressant medications for major depressive disorder (MDD). FDA Public Health Advisory. Rockville, MD: Food and Drug Administration; 2003 Oct 27. From the FDA website.

14. Food and Drug Administration. Class suicidality labeling language for antidepressants. From the FDA website.

15. Food and Drug Administration. Medication guide: about using antidepressants in children or teenagers. Rockville, MD; 2005 Jan 16. From the FDA web site.

16. Lepola UM, Loft H, Reines EH. Escitalopram (10-20 mg/day) is effective and well tolerated in a placebo-controlled study in depression in primary care. Int Clin Psychopharmacol. 2003; 18:211-7. [PubMed 12817155]

17. Food and Drug Administration (FDA). FDA Public Health Advisory regarding worsening depression and suicidality in patients being treated with antidepressant medications. From FDA website. 2003 Mar 22.

18. Food and Drug Administration. Public health advisory: combined use of 5-hydroxytryptamine receptor agonists (triptans), selective serotonin reuptake inhibitors (SSRIs) or selective serotonin/norepinephirne reuptake inhibitors (SNRIs) may result in life-threatening serotonin syndrome. Rockville, MD; 2006 Jul 19. From the FDA website.

19. Clark DB, Andrus MR, Byrd DC. Drug interactions between linezolid and selective serotonin reuptake inhibitors: case report involving sertraline and review of the literature. Pharmacotherapy. 2006; 26:269-76. [PubMed 16466332]

20. Hachem RY, Hicks K, Huen A et al. Myelosuppression and serotonin syndrome associated with concurrent use of linezolid and selective seotonin reuptake inhibitors in bone marrow transplant recipients. CID. 2003; 37:e8-11.

21. Sola CL, Bostwick JM, Hart DA et al. Anticipating potential linezolid-SSRI interactions in the general hospital setting: an MAOI in disguise. Mayo Clin Proc. 2006; 81:330-4. [PubMed 16529136]

22. Taylor JJ, Wilson JW, Estes LL. Linezolid and serotonergic drug interactions: a retrospective survey. CID. 2006; 43:180-7.

23. Castberg I, Spigset O. Excretion of escitalopram in breast milk. J Clin Psychopharmacol. 2006; 26:536-8. [PubMed 16974204]

24. Rampono J, Hackett LP, Kristensen JH et al. Transfer of escitalopram and its metabolite demethylescitalopram into breastmilk. Br J Clin Pharmacol. 2006; 62:316-22. [PubMed 16934048]

25. Food and Drug Administration. Public health advisory: treatment challenges of depression in pregnancy. Rockville, MD; 2006 Jul 19. From the FDA website.

26. Cohen LS, Altshuler LL, Harlow BL et al. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA. 2006; 295:499-507. [PubMed 16449615]

27. Chambers CD, Hernandez-Diaz S, Van Marter LJ et al. Selective serotonin-reuptake inhibitors and risk of persistent pulmonary hypertension of the newborn. New Engl J Med. 2006; 354:579-87. [PubMed 16467545]

b. Burke WJ, Gergel I, Bose A. A fixed-dose trial of the single isomer SSRI escitalopram in depressed outpatients. J Clin Psychiatry. 2002; 63:331-6. [IDIS 479908] [PubMed 12000207]

c. Forest Pharmaceuticals, Inc. Celexa (citalopram hydrobromide) prescribing information. St. Louis, MO; 2002 Aug.

d. Evans ML, Kortas KJ. Potential interaction between isoniazid and selective serotonin-reuptake inhibitors. Am J Health Syst Pharm. 1995; 52:2135-6. [IDIS 354730] [PubMed 8535949]

e. Food and Drug Administration. FDA news: FDA proposes new warnings about suicidal thinking, behavior in young adults who take antidepressant medications. Rockville, MD; 2007 May 2. From the FDA web site.

f. Food and Drug Administration. Antidepressant use in children, adolescents, and adults: class revisions to product labeling. Rockville, MD; 2007 May 2. From the FDA web site.

g. Food and Drug Administration. Revisions to medication guide: antidepressant medicines, depression and other serious mental illnesses and suicidal thoughts or actions. Rockville, MD; 2007 May 2. From the FDA web site.

h. Bridge JA, Iyengar S, Salary CB. Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: a meta-analysis of randomized controlled trials. JAMA. 2007; 297:1683-96. [PubMed 17440145]

More Lexapro resources

• Lexapro Side Effects (in more detail)
• Lexapro Use in Pregnancy & Breastfeeding
• Drug Images
• Lexapro Drug Interactions
• Lexapro Support Group
• 419 Reviews for Lexapro - Add your own review/rating

• Lexapro Prescribing Information (FDA)


• Lexapro Advanced Consumer (Micromedex) - Includes Dosage Information


• Lexapro MedFacts Consumer Leaflet (Wolters Kluwer)


• Lexapro Consumer Overview

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