Escitalopram

Source: UK SPC (eMC) for Cipralex 10 mg film-coated tablets, §4.2 (https://www.medicines.org.uk/emc/product/7718/smpc). MAJOR DEPRESSIVE EPISODES: usual dosage 10 mg once daily, which may be increased to a maximum of 20 mg daily depending on individual patient response. Usually 2-4 weeks are necessary to obtain antidepressant response; after symptoms resolve, treatment for at least 6 months is required for consolidation. PANIC DISORDER WITH OR WITHOUT AGORAPHOBIA: an initial dose of 5 mg is recommended for the first week before increasing to 10 mg daily, and may be further increased up to a maximum of 20 mg daily; maximum effectiveness is reached after about 3 months and treatment lasts several months. SOCIAL ANXIETY DISORDER: usual dosage 10 mg once daily; usually 2-4 weeks for symptom relief; the dose may subsequently be decreased to 5 mg or increased to a maximum of 20 mg daily; treatment for 12 weeks is recommended to consolidate response, and long-term treatment of responders has been studied for 6 months. GENERALISED ANXIETY DISORDER: initial 10 mg once daily, increased to a maximum of 20 mg daily depending on response; long-term treatment of responders studied for at least 6 months at 20 mg daily. OBSESSIVE-COMPULSIVE DISORDER: initial 10 mg once daily, increased to a maximum of 20 mg daily; as OCD is chronic, patients should be treated for a sufficient period to ensure they are symptom free. ELDERLY (>65 years): initial dosage 5 mg once daily, which may be increased to 10 mg daily depending on response; efficacy in social anxiety disorder has not been studied in the elderly. HEPATIC IMPAIRMENT: an initial dose of 5 mg daily for the first two weeks is recommended in mild or moderate impairment, which may be increased to 10 mg daily depending on response; caution and extra careful dose titration in severely reduced hepatic function. CYP2C19 POOR METABOLISERS: an initial dose of 5 mg daily during the first two weeks is recommended, which may be increased to 10 mg daily depending on response. PAEDIATRIC: should NOT be used in the treatment of children and adolescents under the age of 18 years — hence paedDose is null. Verify any under-18 use against a children's formulary. DISCONTINUATION: abrupt discontinuation should be avoided; the dose should be gradually reduced over a period of at least one to two weeks; if intolerable symptoms occur, resuming the previously prescribed dose may be considered, then decreasing at a more gradual rate. Note: §4.5 was not retrieved in this bundle — the interactions listed below are taken from §4.3 of the UK SPC and from the US label; verify the full §4.5.