Escitalopram Oxalate
Selective Serotonin Reuptake Inhibitor (S-Enantiomer of Citalopram—Most Selective SSRI) • Schedule H Prescription Drug • NLEM 2022 Core Essential Medicine
Level 1 — Quick Professional Summary (At a Glance)
Escitalopram Oxalate
Monograph Code: [11.2] | Stable ID: TIP-MED-000206
Representative Indian Market Examples (Edition 2.7 Ch 11 [11.2], p. 140): Nexito (Sun Pharma), Cipralex (Lundbeck), Stalopam (Lupin), Feliz-S (Torrent), Rexipra (Intas); In FDC with Clonazepam (Short-term only!): Nexito-Plus, Stalopam-Plus — Strengths & Forms: Oral Film-Coated Scored Tablets: 5 mg, 10 mg, 15 mg, 20 mg
Selective Serotonin Reuptake Inhibitor (S-Enantiomer of Citalopram—Most Selective SSRI)
CNS & Psychiatric Medicines (Ch 11)
Oral Film-Coated Scored Tablets: 5 mg, 10 mg, 15 mg, 20 mg
Route: Oral / Parenteral / Topical as specified by formulation
9–10. Mechanism of Action & Pharmacodynamics
Pure active S-(+)-enantiomer of racemic Citalopram; binds with highest selectivity among all SSRIs to both the primary orthosteric site and an allosteric modulatory site on the presynaptic Serotonin Transporter (SERT / SLC6A4), blocking 5-HT reuptake into presynaptic neurons. Chronic elevation of synaptic 5-HT downregulates somatodendritic 5-HT1A autoreceptors and stimulates hippocampal BDNF neuroplasticity over 2–4 weeks.
12. Therapeutic Indications
- Major Depressive Disorder (MDD)
- Generalized Anxiety Disorder (GAD), Panic Disorder, Social Anxiety Disorder, and Obsessive-Compulsive Disorder (OCD)
13 & 16. Contraindications, Precautions & Warnings
- Concomitant MAO Inhibitors (Selegiline, Rasagiline, Linezolid) or within 14 days of stopping an MAOI — fatal Serotonin Syndrome
- Known congenital Long QT Syndrome or concomitant QT-prolonging drugs (Pimozide)
Maximum 10 mg once daily in mild-to-moderate hepatic impairment.
14. Dosage & Administration Context (Educational Reference Summary)
Administration & Timing: Oral; once daily in the morning or evening, with or without food.
Level 2 — Detailed Pharmacology, PK, Interactions & Special Populations
11 & 19. Pharmacokinetics (ADME), Renal & Hepatic Considerations
Pharmacokinetic Profile: Absorption, distribution, metabolism, and excretion follow class pharmacokinetic profile; verify patient renal/hepatic function.
Renal Considerations: No adjustment in mild-to-moderate renal impairment; use caution in CrCl < 20 mL/min.
Hepatic Considerations: Maximum 10 mg once daily in mild-to-moderate hepatic impairment.
15 & 17. Adverse Effects & Clinically Significant Drug Interactions
- Initial transient nausea, insomnia or somnolence, and increased anxiety during first 1–2 weeks
- Sexual dysfunction (anorgasmia, delayed ejaculation, decreased libido — via 5-HT2A/2C stimulation)
- SIADH-induced hyponatraemia (especially in elderly patients or those on thiazide diuretics)
- Dose-dependent QTc prolongation (max 20 mg/day in adults, 10 mg/day in >65 yr)
- MAOIs, Linezolid, Tramadol, Triptans, Lithium, St. John's Wort: Serotonin Syndrome (clonus, hyperthermia, agitation, autonomic instability)
- NSAIDs (Diclofenac), Aspirin, Clopidogrel, Warfarin: SSRIs deplete platelet serotonin (5-HT) stores and double the risk of upper GI bleeding
- Omeprazole / Esomeprazole (CYP2C19 inhibitors): increase Escitalopram plasma concentration by ~50%
- QT-prolonging agents (Ondansetron, Macrolides, Antipsychotics): additive dose-dependent QTc prolongation
18, 20, 21 & 22. Special Populations, Monitoring, Counselling & Storage
Pregnancy, Lactation, Paediatric & Geriatric Use: Evaluate maternal-foetal benefit-risk ratio and age-appropriate organ function before prescribing.
Clinical & Laboratory Monitoring: Monitor clinical response, baseline renal/hepatic parameters, and relevant serum biomarkers.
Patient Counselling Points:- Full mood improvement takes 2–4 weeks, although sleep and appetite may improve within the first week — continue taking daily as prescribed.
- Do not stop suddenly; taper gradually over 2–4 weeks to avoid SSRI discontinuation symptoms (dizziness, electric-shock paraesthesia).
- Monitor closely for any worsening mood or suicidal ideation during the first 2–4 weeks in young adults.
Storage & Dispensing Governance: Store below 30°C.
Visual Pharmacology Mechanism Diagram (PLATE-8.1)
23. Traceable Source References & Jurisdiction
Primary Reference Record: Indian Pharmacopoeia (IP 2026) • NLEM 2022 (MoHFW) • CDSCO Approved Prescribing Information
Authoritative Verification Portals: Indian Pharmacopoeia Commission (IPC) • CDSCO (India Jurisdiction) • NCBI Bookshelf • DailyMed (US FDA Label Reference)
Last Checked Date: 2026-11-08 • Related Study Guide: Clinical Pharmacokinetics: ADME, Vd, Clearance & Half-Life →