Post by James on Sept 3, 2015 1:24:25 GMT
Escitalopram
a) Is the medication a typical / atypical antipsychotic?
• Escitalopram is a selective serotonin reuptake inhibitor (SSRIs) antidepressant.
b) Common brand name
• Escitalopram Oxalate ( Escicor, Esipram, Esitalo, Lexam, Lexapro, Laxalate).
c) Normal dose ranges
• For major depression, social or generalised anxiety disorder, initially 10 mg orally daily, increasingly gradually to a daily maximum of 20 mg.
d) Common side effect
• Palpitation, tachycardia, hypotension (including postural hypotension)
• Dizziness, tremor, headache, migraine, asthenia, twitching, amnesia, apathy, anxiety, nervousness, aggravated depression, fatigue, agitation, impaired concentration, confusion.
• Anorexia, nausea, vomiting, abdominal pain, diarrhoea, altered test, dry mouth, flatulence, increased appetite, increased salvia, constipation.
• Hot flushes, increased sweats
e) Contraindication
• Contraindicated with or within 14 days of stopping (Monoamine Oxidase Inhibitors) MAOIs, because of increased risk of serotonin syndrome.
• Contraindicated with or within 1 day of stopping moclobemide
• Moclobemide should not be started within 14 days of stopping SSRIs
• Use with alcohol should be avoided
• Not recommended with SNRIs due to risk of serotonin syndrome and increased serum level and toxicity of SNRIs
• Not recommended with TCAs or antipsychotic agents
f) Special monitoring / nursing care requirement
• All patients should be carefully monitored during initial stages of therapy or when dosage is changed, because the risk of suicide remains high. Family members / carers should be alerted to this possibility. Prescription usually written for the smallest quantity to decrease risk of overdose.
• Observe for a beneficial elevation in mood (although this may take weeks to become apparent).
• Maintenance therapy should continue for at least 6-12 months after depressive symptoms have abated to avoid relapse.
• Observe for mania, hypomania, hallucination, delusion and suicidal tendencies, which will necessitate discontinuation of therapy (especially for those with pre-existing schizophrenia, bipolar disorder or paranoid delusion.
• When stopping therapy, dose should be slowly tapered to prevent withdrawal symptoms, which include dizziness, paraesthesia, tremor, anxiety, nausea and palpitation. Risk of withdrawal symptom dependent on dose, duration of therapy and how slow3 tapering regimen has been.
• Caution if used to treat depression in those with schizophrenia as psychotic symptoms may be intensified; in manic depression there may be a shift toward mania; and paranoid delusion may be aggravated.
• Caution if used for those with kidney or liver impairment. Liver and kidney function should be monitored regularly during therapy.
g) Education requirement for patient / families / carers
• Patient should be advised that antidepressant effect are usually seen after 7-10 days and progress over 2-4 weeks, whereas sedative effect is seen almost immediately and disappear with time.
• Patient or carer should be advised to report
Any thoughts / talks about self-harm, harm to others, suicide or death or recent attempt at self-harm or increase in aggression or hostility.
Change in mood, abnormal thinking or hallucination
Worsening of depression
• Warn the patient against driving a vehicle or operating machinery if dizziness, drowsiness, visual disturbances or concentration is impaired especially during the initial period of treatment when sedation is common and if dose is being increased.
• Advise patient to avoid dizziness, lightheadness and / or fainting (due to hypotension) by moving gradually to setting or standing position. Especially after sleep. Warn patient that postural hypotension is made worse by prolonged standing, hot baths or showers, hot weather physical exertion, large meal and drinking alcohol.
• Warn patient to avoid drinking alcohol during therapy
• Advise patient against abruptly stopping therapy
Escitalopram.docx (15.58 KB)
a) Is the medication a typical / atypical antipsychotic?
• Escitalopram is a selective serotonin reuptake inhibitor (SSRIs) antidepressant.
b) Common brand name
• Escitalopram Oxalate ( Escicor, Esipram, Esitalo, Lexam, Lexapro, Laxalate).
c) Normal dose ranges
• For major depression, social or generalised anxiety disorder, initially 10 mg orally daily, increasingly gradually to a daily maximum of 20 mg.
d) Common side effect
• Palpitation, tachycardia, hypotension (including postural hypotension)
• Dizziness, tremor, headache, migraine, asthenia, twitching, amnesia, apathy, anxiety, nervousness, aggravated depression, fatigue, agitation, impaired concentration, confusion.
• Anorexia, nausea, vomiting, abdominal pain, diarrhoea, altered test, dry mouth, flatulence, increased appetite, increased salvia, constipation.
• Hot flushes, increased sweats
e) Contraindication
• Contraindicated with or within 14 days of stopping (Monoamine Oxidase Inhibitors) MAOIs, because of increased risk of serotonin syndrome.
• Contraindicated with or within 1 day of stopping moclobemide
• Moclobemide should not be started within 14 days of stopping SSRIs
• Use with alcohol should be avoided
• Not recommended with SNRIs due to risk of serotonin syndrome and increased serum level and toxicity of SNRIs
• Not recommended with TCAs or antipsychotic agents
f) Special monitoring / nursing care requirement
• All patients should be carefully monitored during initial stages of therapy or when dosage is changed, because the risk of suicide remains high. Family members / carers should be alerted to this possibility. Prescription usually written for the smallest quantity to decrease risk of overdose.
• Observe for a beneficial elevation in mood (although this may take weeks to become apparent).
• Maintenance therapy should continue for at least 6-12 months after depressive symptoms have abated to avoid relapse.
• Observe for mania, hypomania, hallucination, delusion and suicidal tendencies, which will necessitate discontinuation of therapy (especially for those with pre-existing schizophrenia, bipolar disorder or paranoid delusion.
• When stopping therapy, dose should be slowly tapered to prevent withdrawal symptoms, which include dizziness, paraesthesia, tremor, anxiety, nausea and palpitation. Risk of withdrawal symptom dependent on dose, duration of therapy and how slow3 tapering regimen has been.
• Caution if used to treat depression in those with schizophrenia as psychotic symptoms may be intensified; in manic depression there may be a shift toward mania; and paranoid delusion may be aggravated.
• Caution if used for those with kidney or liver impairment. Liver and kidney function should be monitored regularly during therapy.
g) Education requirement for patient / families / carers
• Patient should be advised that antidepressant effect are usually seen after 7-10 days and progress over 2-4 weeks, whereas sedative effect is seen almost immediately and disappear with time.
• Patient or carer should be advised to report
Any thoughts / talks about self-harm, harm to others, suicide or death or recent attempt at self-harm or increase in aggression or hostility.
Change in mood, abnormal thinking or hallucination
Worsening of depression
• Warn the patient against driving a vehicle or operating machinery if dizziness, drowsiness, visual disturbances or concentration is impaired especially during the initial period of treatment when sedation is common and if dose is being increased.
• Advise patient to avoid dizziness, lightheadness and / or fainting (due to hypotension) by moving gradually to setting or standing position. Especially after sleep. Warn patient that postural hypotension is made worse by prolonged standing, hot baths or showers, hot weather physical exertion, large meal and drinking alcohol.
• Warn patient to avoid drinking alcohol during therapy
• Advise patient against abruptly stopping therapy
Escitalopram.docx (15.58 KB)