One of the most “popular” antidepressants among doctors. According to our data, this medicine is one of the ten most frequently prescribed drugs by psychiatrists.
Escitalopram
is produced under many names: cipralex (considered the original, since it was the very first), elicea, esipi, escitalopram, selectra, lenuxin, miracitol, etc.
All of these are analogues, that is, drugs with the same active ingredient, but produced at different factories by different manufacturers.
The drug was obtained as a result of a “modification” of another antidepressant from the group of selective serotonin reuptake inhibitors (SSRIs) - citalopram.
The mechanism of action is associated with a decrease in the flow of the neurotransmitter serotonin back into the neuron after it has entered the intercellular space - the synapse.
The drug promotes the accumulation of serotonin in the synapse (the junction of neurons), and if the painful condition caused the depletion of serotonin, then long-term use of escitalopram leads to the restoration of serotonin metabolism and a decrease in the symptoms of the disease. The main effect is antidepressant and anti-anxiety.
Available in the form of film-coated tablets in a dosage of the active substance of 10 milligrams.
Indications for taking escitalopram
- Endogenous depression of mild to moderate severity.
- Panic attacks, panic disorder, generalized anxiety disorder, phobias.
- Organic anxiety and depressive disorders.
- Neuroses, neurasthenia, mixed anxiety and depressive disorder, somatoform disorders, psychosomatic diseases, prolonged reactive states (mental trauma, adaptation disorders).
- Alcohol and drug addiction, substance abuse.
The convenience of taking ecitalopram is that you do not need to adjust the dose (recommended - 10 mg / 1 tablet once a day
), rarely have side effects, according to psychiatrists it gives a positive effect in the vast majority of cases of use.
The disadvantages include the slow onset of the therapeutic effect over the course of a month, and a slight increase in anxiety in the first days of use (which is very inconvenient when treating panic attacks, phobias and anxiety disorders).
Release form
The drug is available in the form of round or oval biconvex white film-coated tablets with different dosages:
- 5 mg of active substance (marked “EK”) – 14 tablets in a blister pack (usually made of aluminum foil or PVC), 2 packs in a cardboard box.
- Cipralex 10 mg (symmetrical o and “L” relative marks on one of the surfaces) – 14 tablets in a blister, 1, 2 or 4 contours in a box.
- 20 mg of biologically active component (marked “E” and “N” on both sides of the line on one side of the tablet) - in a box there are 2 blisters with 14 filled cells.
The most frequently asked questions about the use of escitalopram
Is escitalopram addictive?
The drug does not cause dependence. Those cases when painful symptoms went away while taking escitalopram, but returned after discontinuation of the drug, do not indicate the formation of addiction, but about too early cessation of treatment or insufficient therapy.
Can I take it on my own?
No. Only after prescription by a doctor.
Can a psychologist prescribe escitalopram?
No. Like any antidepressant, like any medicine, this drug can only be prescribed by a doctor - a person with a higher medical education, then completed specialization (internship or residency) and has a valid doctor’s certificate.
Psychiatrists are the most knowledgeable about the treatment of depression and anxiety disorders and the effects of antidepressants. But doctors of other specialties can also prescribe antidepressants. The psychologist does not have a medical education and therefore cannot make such appointments. Read more about the difference between a psychologist, psychotherapist and psychiatrist here.
How and where can I purchase it? What does this require?
It is sold in pharmacies. To purchase it you will need to present a prescription from a doctor.
Does escitalopram contribute to suicidal behavior?
There is no such data. The described isolated cases of suicide while taking this drug were explained by the fact that there were risks of suicide even before the start of treatment. Suicide was a consequence of illness (depression, psychosis), and not the effect of the drug.
Is it possible to drink alcohol during treatment with escitalopram?
Drinking alcohol neutralizes the therapeutic effect of the medicine and worsens the general condition of the brain. Therefore, drinking alcohol during treatment is not advisable.
How long to take escitalopram?
Treatment with this antidepressant takes several months. The therapeutic effect usually develops in the first 3 months of treatment; further use usually prevents the recurrence of symptoms.
If indicated, long-term use is possible. Even if there are no complaints about the condition during therapy with escitalopram, you need to see a doctor at least once every 2-3 months. The duration and regimen of administration is determined by the attending physician. On average it is about 6 months.
Is it possible to replace escitalopram with a similar drug with a different name during treatment?
This question often arises due to the large difference in price for the same drug, produced by different manufacturers and having a different name. As experience shows, no changes occur with such a change. But if such a question arises, it is best to consult your doctor.
What is better: the original drug Cipralex or its cheaper generic analogues?
According to the author of this material, there is no fundamental difference.
Compound
The composition of the drug is given equivalent to the three main forms of release (see the next paragraph) based on the mass calculation per one tablet of the active substance escitalopram oxalate - 6.39/12.77/25.54 mg:
- fine crystalline cellulose (MCC) – 72.49/97.49/195 mg;
- ordinary talc 5.04/7/14 mg;
- croscarmellose sodium – 3.24/4.5/9 mg;
- Magnesium stearate – 0.9/1.25/2.5 mg.
The film coating of the tablets is an important component of the drug Cipralex. It consists of:
- hypromellose 5cP – 1.58/2.19/3.51 mg;
- titanium dioxide (E171) – 0.526/0.73/1.17 mg;
- macrogol 400 – 0.146/0.2/0.325 mg.
Contraindications
Pharmacological treatment with Cipralex should be abandoned if:
- hypersensitivity or intolerance to the constituent components of the drug;
- childhood and adolescence (the therapeutic course is not recommended for those under 18 years of age);
- simultaneous treatment with monoamine oxidase (antidepressants) or p imozide (antipsychotic medications);
- acute or chronic renal failure with creatine clearance below 30 ml/min;
- epilepsy , which is not controlled by pharmacological agents.
Cipralex should only be taken under the supervision of qualified medical personnel in one of the following situations:
- non-insulin-dependent diabetes mellitus (for type I, consultation with an endocrinologist is required);
- elderly age;
- cirrhosis , acute or chronic liver failure ;
- tendency to frequent hemorrhages due to insufficiency of the blood coagulation system;
- hereditary and acquired metabolic diseases .
Pharmacological action
Cipralex belongs to the pharmacological group of potent antidepressants . serotonin transporter enzyme , the drug inhibits the reuptake of the neurotransmitter in synaptic structures (the drug has a greater effect on the metabolic pathways of serotonin than on any other messengers). Accordingly, the physiological transmitter of the impulse is located in the synaptic cleft of the neuronal contact for a longer period of time, which causes an enhanced, prolonged effect on the postsynaptic membrane .
It should be noted that the drug is strong and long-acting, as it binds in two places to the serotonin transport enzyme. First of all, the main active component has high affinity for the primary amino acid sequence of the transporter protein. Also, the components of Cipralex bind to the allosteric center of this molecule, which secondarily enhances the effect of the drug, that is, leads to a more complete inhibition of neurotransmitter reuptake.
Cipralex exhibits weak activity to receptors as:
- serotonin 5-HT1A and 5-HT2;
- dopamine D1 and D2;
- alpha and beta adrenergic synapses;
- histamine H1 receptor cells;
- opioids and benzodiazepines;
- m-cholinergic receptors.
special instructions
Cipralex does not have a depressing effect on the patient’s intellectual or psychomotor sphere, however, while continuing the course of conservative treatment, it is recommended to refrain from driving a car or operating technical devices that require prolonged concentration and fine motor skills.
The drug can contribute to a change in the concentration of glucose (a significant increase) and insulin (a relative decrease in the hormone) in the systemic circulation, and accordingly, such treatment requires a certain correction of hypoglycemic drugs in patients with diabetes mellitus .
Antidepressant therapy can lead to suicidal thoughts in the early stages of the rehabilitation course. An increased risk of self-inflicted bodily harm and suicidal tendencies persist until remission of the underlying disease, therefore conservative treatment with Cipralex should be carried out in special departments under the supervision of qualified medical personnel.
Overdose
In clinical practice, cases of overdose of Cipralex are known, which usually manifest themselves as follows:
- darkened consciousness, soporosity ;
- tremor of the limbs , impaired fine motor skills;
- seizures;
- agitation (strong emotional arousal, which is accompanied by a feeling of anxiety and an unreasonable need to move);
- significant changes in the electrocardiogram (expansion of the ventricular complex, depolarization of the depolarization segment);
- arrhythmias of the tachycardia ;
- metabolic acidosis , hypokalemia ;
- depression of the respiratory function of the respiratory system.
There is no specific antidote or antagonist for Cipralex, so treatment of overdose is based on symptomatic and palliative care for the patient. First of all, you should rinse the stomach in order to evacuate unabsorbed remnants of the pharmaceutical drug from the body. Next, it is necessary to ensure sufficient oxygenation and constant monitoring of the vital systems of the human body.
Side effects
Cipralex is a strong drug, therefore its action can be characterized by a large number of unwanted reactions from the body. For example, it is noted:
- dyspeptic disorders ( nausea , vomiting , diarrhea , abdominal pain);
- asthenic syndrome ( insomnia or drowsiness , headache, constant fatigue, dizziness );
- metabolic disorders in the form of sweating , hyperthermia and hyponatremia ;
- thrombocytopenia and, as a consequence, insufficiency of the blood coagulation system;
- orthostatic collapse or hypotension ;
- decreased reproductive function ( decreased libido and potency in both men and women);
- allergic reactions (the range of undesirable effects includes manifestations from angioedema, angioedema , up to anaphylactic shock );
- arthralgia and myalgia of idiopathic origin , which are not associated with stress on the joints or muscles;
- skin rash , purpura , ecchymosis .
It should be noted that the adverse effects of treatment usually occur in the first or second week of a conservative therapeutic course and significantly reduce their manifestations if the rehabilitation is continued according to a given plan.
Since the drug belongs to list B of pharmacological products, if you abruptly stop taking Cipralex after long-term treatment with the drug, withdrawal syndrome . That is, the body does not have enough active substance. This manifests itself in the form of severe headaches, irritability, nausea and frequent dizziness.
Cipralex price, where to buy
The price of Cipralex, of course, depends on the dosage of the biologically active component. You can buy it in Moscow for 900/1400/1800 rubles, respectively 5/10/20 mg of the active ingredient. In Ukraine, the cost of an antidepressant varies from 270 to 500 hryvnia, but the vast majority of pharmacies sell the drug for 400 hryvnia.
- Online pharmacies in RussiaRussia
- Online pharmacies in UkraineUkraine
ZdravCity
- Cipralex tablets p.p.o.
10 mg 14 pcs. Lundbeck RUB 1,093 order - Cipralex tablets p.p.o. 10mg 28 pcs.Lundbeck
RUB 2,206 order
Pharmacy Dialogue
- Cipralex (tab.p/vol.10mg No. 14)Lundbeck
RUB 1,096 order
- Cipralex (tab.p/vol.10mg No. 28)Lundbeck
RUB 2,082 order
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Cipralex's analogs
Level 4 ATC code matches:
Actaparoxetine
Plizil
Fluxen
Paroxin
Surlift
Asentra
Elycea
Fluoxetine
Lenuksin
Escitalopram
Adepress
Selectra
Stimuloton
Citalopram
Cipramil
Zoloft
Paroxetine
Prozac
Paxil
Rexetine
Currently, the following analogues of Cipralex can be found on pharmacy shelves: Escitolopram-Teva, Selectra, Elitseya, Miracitol .
Interaction
The simultaneous use of Cipralex and drugs that irreversibly inhibit monoamine oxidase , since the percentage of severe side effects increases several times (the percentage of respiratory or heart failure ).
Based on pharmacological studies, it is not recommended to include Cipralex and reversible MAO inhibitors due to the risk of serotonin syndrome (a potentially fatal situation).
The drug with escitalopram in parallel with anticoagulants or drugs that reduce blood clotting , as this can lead to severe hemorrhagic syndrome and anemia as an outcome of the pathological situation, which will complicate the treatment of the patient.
There are a number of pharmaceutical drugs that, by interacting with the allosteric centers of carrier proteins, increase the activity of Cipralex. For example, Omeprazole (an anti-ulcer drug) leads to a twofold increase in the concentration of the active substance in the systemic circulation, and Cimetidine (a H2-histamine receptor blocker, which is prescribed for pathology of the gastrointestinal tract) - by 70%.
Drugs that inhibit serotonin , and Cipralex, as a typical representative of this pharmacological group, reduces the threshold of convulsive activity, that is, tremor and/or convulsive syndrome may manifest itself in response to less intense excitation. This effect will be potentiated if Cipralex and other strong antipsychotic substances ( neuroleptics ) are taken simultaneously, for example Tramadol, Phenothiazine, Butyrophenone, and so on.
Pharmacodynamics and pharmacokinetics
The absorption of the active ingredients does not depend on food intake, since the drug is an extremely strong pharmaceutical drug. Absolute bioavailability is about 80 percent, and the average half-life is 4 hours (however, this parameter may vary depending on the individual parameters of the body and environmental conditions).
Cipralex is metabolized in the liver . The constituent elements of the drug, even after oxidation, remain biologically active and, undergoing some changes in metabolic processes, are released in the form of glucuronides . Next, the metabolites are sent to the kidneys, which excrete waste drug residues through urine. Clearance after oral administration of the drug is 0.6 l/min.
The kinetics of escitalopram oxalate is described linearly. Equilibrium concentration in the systemic circulation, with a daily dose of 10 mg (the optimal amount of the active ingredient for an adult), is achieved after just one week of a conservative course of treatment with Cipralex.
In elderly patients (over 65 years of age), the pharmacological drug is eliminated somewhat more slowly. Clinical trials have shown that during a therapeutic dose, after a single dose of Cipralex, the amount of the active component in the systemic bloodstream of elderly people is 50 percent greater than in young volunteers.
