Citalex
Generic Name
Escitalopram
Manufacturer
Incepta Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| citalex 5 mg tablet | ৳ 6.00 | ৳ 60.00 |
Description
Overview of the medicine
Citalex 5 mg Tablet contains Escitalopram, a selective serotonin reuptake inhibitor (SSRI) used to treat major depressive disorder (MDD) and generalized anxiety disorder (GAD). It helps restore the balance of serotonin in the brain, improving mood and reducing anxiety.
Uses & Indications
Dosage
Adults
Initial dose: 10 mg once daily. May be increased to a maximum of 20 mg once daily after at least one week. For 5 mg, start with 5 mg once daily, may be increased to 10 mg after one week.
Elderly
Initial dose: 5 mg once daily. Maximum recommended dose: 10 mg once daily.
Renal_impairment
No dosage adjustment is needed for mild to moderate renal impairment. Use with caution in severe renal impairment (creatinine clearance <20 mL/min).
How to Take
Take Citalex orally, with or without food, preferably at the same time each day. Do not crush, chew, or break the tablet. Swallow it whole. Do not stop taking this medication suddenly without consulting your doctor.
Mechanism of Action
Escitalopram selectively inhibits the reuptake of serotonin (5-HT) into the presynaptic neuron, thereby increasing the concentration of 5-HT in the synaptic cleft. This leads to an enhancement of serotonergic neurotransmission in the central nervous system.
Pharmacokinetics
Onset
Antidepressant effects typically begin within 2-4 weeks, though some patients may experience benefits earlier.
Excretion
Primarily excreted in the urine (about 8% unchanged, 27% as metabolites), with some fecal excretion.
Half life
Approximately 27-32 hours, allowing for once-daily dosing.
Absorption
Well absorbed orally; absolute bioavailability is about 80%. Peak plasma concentrations are reached in about 4-5 hours.
Metabolism
Extensively metabolized in the liver, primarily by CYP2C19, CYP3A4, and CYP2D6, to inactive or weakly active metabolites.
Side Effects
Contraindications
- Hypersensitivity to escitalopram, citalopram, or any component of the formulation.
- Concomitant use with Monoamine Oxidase Inhibitors (MAOIs), including linezolid or intravenous methylene blue.
- Concomitant use with pimozide.
- Concomitant use with medications known to prolong the QT interval.
Drug Interactions
MAOIs
Risk of serotonin syndrome (hyperthermia, rigidity, myoclonus, autonomic instability, mental status changes). Allow at least 14 days between stopping MAOI and starting escitalopram, and vice versa.
Pimozide
Increased risk of QT prolongation and ventricular arrhythmias.
Warfarin, NSAIDs, Aspirin
Increased risk of bleeding due to effects on platelet aggregation.
Drugs that prolong QT interval (e.g., certain antipsychotics, antiarrhythmics)
Increased risk of QT prolongation and cardiac arrhythmias.
Other serotonergic drugs (e.g., SSRIs, SNRIs, Tryptophan, Tramadol, St. John's Wort)
Increased risk of serotonin syndrome.
Storage
Store below 30°C in a dry place, protected from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include dizziness, tremor, nausea, vomiting, somnolence, tachycardia, and rarely, seizures or QT prolongation. Treatment is symptomatic and supportive. Maintain airway, monitor cardiac and vital signs. Activated charcoal may be considered if ingested recently.
Pregnancy & Lactation
Pregnancy Category C. Use during pregnancy only if the potential benefit justifies the potential risk to the fetus. Escitalopram is excreted in human milk; therefore, it is not recommended during breastfeeding. Consult your doctor.
Side Effects
Contraindications
- Hypersensitivity to escitalopram, citalopram, or any component of the formulation.
- Concomitant use with Monoamine Oxidase Inhibitors (MAOIs), including linezolid or intravenous methylene blue.
- Concomitant use with pimozide.
- Concomitant use with medications known to prolong the QT interval.
Drug Interactions
MAOIs
Risk of serotonin syndrome (hyperthermia, rigidity, myoclonus, autonomic instability, mental status changes). Allow at least 14 days between stopping MAOI and starting escitalopram, and vice versa.
Pimozide
Increased risk of QT prolongation and ventricular arrhythmias.
Warfarin, NSAIDs, Aspirin
Increased risk of bleeding due to effects on platelet aggregation.
Drugs that prolong QT interval (e.g., certain antipsychotics, antiarrhythmics)
Increased risk of QT prolongation and cardiac arrhythmias.
Other serotonergic drugs (e.g., SSRIs, SNRIs, Tryptophan, Tramadol, St. John's Wort)
Increased risk of serotonin syndrome.
Storage
Store below 30°C in a dry place, protected from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include dizziness, tremor, nausea, vomiting, somnolence, tachycardia, and rarely, seizures or QT prolongation. Treatment is symptomatic and supportive. Maintain airway, monitor cardiac and vital signs. Activated charcoal may be considered if ingested recently.
Pregnancy & Lactation
Pregnancy Category C. Use during pregnancy only if the potential benefit justifies the potential risk to the fetus. Escitalopram is excreted in human milk; therefore, it is not recommended during breastfeeding. Consult your doctor.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 24 to 36 months from the date of manufacture. Refer to the packaging for the exact expiry date.
Availability
Pharmacies nationwide
Approval Status
FDA Approved
Patent Status
Generic available
Clinical Trials
Extensive clinical trials have demonstrated the efficacy and safety of escitalopram in the treatment of major depressive disorder, generalized anxiety disorder, social anxiety disorder, panic disorder, and obsessive-compulsive disorder.
Lab Monitoring
- Baseline and periodic monitoring of sodium levels, especially in elderly, dehydrated, or diuretic-treated patients, due to risk of hyponatremia.
- Liver function tests (LFTs) if there is pre-existing hepatic impairment or suspicion of liver injury.
Doctor Notes
- Counsel patients about the delayed onset of therapeutic effects and the importance of continued treatment, even if initial improvement is not seen.
- Emphasize the risk of suicidal ideation, especially in young adults, and instruct patients/caregivers to report any behavioral changes.
- Educate patients on potential discontinuation symptoms and the need for gradual dose reduction when discontinuing treatment.
- Monitor for hyponatremia, especially in elderly patients, and drug interactions with other serotonergic agents or QT-prolonging drugs.
Patient Guidelines
- Take Citalex exactly as prescribed by your doctor. Do not stop taking it suddenly, even if you feel better, without consulting your doctor.
- It may take 2-4 weeks to notice the full benefits of this medication. Continue taking it as prescribed.
- Be aware of worsening depression or suicidal thoughts, especially at the start of treatment or when the dose is changed, and report them to your doctor immediately.
- Avoid alcohol while taking Citalex.
- Inform your doctor about all other medications, supplements, and herbal products you are taking.
Missed Dose Advice
If you miss a dose of Citalex, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and resume your regular dosing schedule. Do not take a double dose to make up for a missed one.
Driving Precautions
Citalex may cause dizziness, drowsiness, or impaired judgment. Avoid driving or operating heavy machinery until you know how this medication affects you.
Lifestyle Advice
- Maintain a healthy and balanced diet and regular exercise routine.
- Practice stress management techniques such as meditation or yoga.
- Ensure adequate sleep (7-9 hours per night).
- Engage in social activities and seek support from friends and family.
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