Eslo-20 Hetero drugs treat depression, anxiety disorders (3 blisters x 10 tablets)

EscitalPram is contraindicated in patients who have shown to extend the QT range or long -term QT ​​syndrome due to congenital.

EscitalPram is contraindicated for use with proven drugs that extend the QT range.

Precautions when using

Special warnings and cautions are especially applicable to SSRI treatment (selective inhibitors to restore serotonin).

Used in children and teenagers under 18 years of age: Escitalopram is not used in the treatment of children and teenagers under 18 years old. Behavior related to suicide (suicide behavior and suicide thoughts), and hostile thoughts (mainly quarrels, hostile and angry acts) are more popular in children's clinical trials and teenagers treated with antidepressants compared to placebo.

Paradoxical anxiety

Some patients with panic disorders may increase anxiety symptoms when they start treatment with antidepressants. These paradoxical reactions usually reduce within two weeks during continuing treatment. Recommended low starting dose to reduce symptoms of anxiety effects in patients.

convulsions

It is necessary to stop the EscitalPram if the patient develops convulsions for the first time or increases the frequency of convulsions (on patients who have been diagnosed with epilepsy earlier). SSRIs should be avoided in patients with instability epilepsy, and need to be closely monitored in patients with controlled epilepsy.

Heart

Need to use SSRI cautiously in patients with a history of manic/mild manic. The scales stop using SSRI on any patient to enter the revival stage.

diabetes

In patients with diabetes, SSRI treatment may change glucose control (reducing or increasing blood glucose). It may be necessary to adjust insulin and/or oral blood glucose doses.

suicide

The thought of suicide or clinical progression: Depression can be accompanied by an increased risk of suicide thoughts, self -injuries and suicide (phenomena related to suicide). The risk lasts until the disease is relieved. Because improvements may not occur in the first few weeks or later weeks of treatment, closely monitor patients until they progress well. Clinical experience they show that suicide rate may increase in early recovery stages. Other mental conditions that are based on which EscitalPram is prescribed treatment may be accompanied by an increased risk of phenomena that accompany suicide. In addition, the above phenomena can be infected with major depression disorders.

Need to prevent the same when treating patients with other mental disorders. Patients with a history of suicide -related phenomena and patients with higher suicidal thoughts before the beginning of treatment have been shown to be at risk of suicide behavior and higher suicide thoughts and need to be carefully monitored during treatment. The metabolic analysis of clinical trials on the placebo is verified by antidepressants in adult patients suffering from mental disorders, showing the risk of higher suicide behavior on antidepressants compared to placebo on patients under 25 years old. Closely monitoring in these patients and especially in patients with high risk of having to be accompanied by special drug therapy during early treatment and dose changes.

A warning to patients (and patient care) should be warned of the need to monitor clinical bad progress, suicide behavior or suicide thoughts and abnormal changes in behavior and seek medical help immediately if the symptoms occur.

Disregard not sitting/mental movement

The use of SSRIs/SNRIS comes with the development of not sitting still, characterized by the subjects in an unpleasant state and not sitting in danger and the need to move continuously and it is impossible to sit or stand still. This usually happens in the first few weeks of treatment. In patients developing these symptoms, increasing the dose may be harmful.

Hemorrhage reduction

Hemorrhage reduction, possibly due to the unreasonable anti -urinary hormone (SIADH), which has been reported rare when using SSRIs and often lost when stopped using therapy. Precautions need to be used in patients at risk, especially in the elderly, patients with cirrhosis, or use in combination with other drugs that can cause sodium hypoglycemia.

Bleeding:

There have been reports on rinal bleeding abnormalities such as bruising and hemorrhage when using SSRI. Caution recommended in patients using SSRIs, especially when used with oral anticoagulant drugs, with drugs that are shown to affect platelet function (such as non-symbolic anti-mental illness and phenothiazine, three rounds and antidepressants acetylsalicylic acid and non-dastoidal anti-inflammatory drugs (NSAIDs), ticlopidine and on the occasion of the patient) Knowing bleeding.

ECT (Electric convulsions)

Clinical experience on the use of SSRI and ECT is very criticized, so it is recommended to be cautious.

Serotonin syndrome

Caution recommends using Escitalopram along with medical products that affect serotonin such as sumatriptan or other triptan, tramadol and tryptophan. In rare cases, Serotonin syndrome has been reported in patients using SSRIs simultaneously with serotoninergic agreements. The combination of symptoms such as agitation, tremor, vibration, high fever may show the development of this phenomenon. If occurred, SSRI treatment and serotoninergic shipping owners should stop and immediately perform the treatment of the above symptoms.

st. John's Wort

SSRI's simultaneous use and herbs containing St. John's Wort (Hypericum Perforatum) may increase the risk of unwanted effects.

Symptoms of stopping drugs at treatment

Symptoms of stopping drugs when stopping treatment are very common when sudden treatment. In clinical trials, noted the undesirable effects in clinical trials when stopping treatment accounts for 25% of patients with EscitalPram and 15% of patients use placebo. The risk of symptoms when stopping treatment may depend on a few factors during treatment and dosage and dose reduction rate.

Dizziness, sensory disorders (including abnormalities and electric shock), sleep disorders (including insomnia and horrific dreams), agitation and anxiety, vomiting and/or nausea, tremor, confusion, sweating, diarrhea, fast heartbeat, unstable emotions, irritability, visual disorders are unwanted effects. In general, the above symptoms are moderate from mild to moderate level, but in some patients with the above symptoms may be severe. It usually occurs in the first few days of stopping treatment but there are very rare reports on these symptoms in patients who do not intentionally abandon the dose.

In general, the above symptoms are self-limited and usually within 2 weeks, although in some patients may be longer (2-3 months or more). Therefore, it is recommended to gradually reduce EscitalPrams when stopping treatment for several weeks or months depending on patient needs. Cardiovascular disease: Due to limited clinical experiences, be careful to use in patients with cardiovascular disease.

extends the range of qt

EscitalPram shows that the QT is extended, dependent on doses. There have been reports on cases that extend the QT interval and ventricular disorders including twisted spots during the time after bringing the drug to the market mainly in female patients with the phenomenon of hypokalemia, or on patients with a history of a QT range or other heart diseases. Precautions for use in patients with significant slow heart rate or on new patients undergoing acute myocardial infarction or non -compensated heart failure.

Electrolysis disorders such as hypokalemia or hypoglycemia increases the risk of malignant arrhythmia and needs to be adjusted before treatment and start using EscitalPram. If a patient with a stable heart disease has been treated, it is necessary to consider ECG values ​​before treatment. If the arrhythmia phenomenon during treatment with EscitalPram, it is necessary to withdraw from treatment and perform ECG measurement.

The ability to drive and operate machinery

although EscitalPram has not shown the impact on intelligence or mental abilities, mental drugs can impair assessment or career skills. Patients should be cautious about potential risks on driving and operating machinery.

Pregnancy

for EscitalPram, only very limited data related to pregnant patients. In reproductive studies conducted on mice using Escitalopram, embryonic poisoning has not recorded the increase in the rate of fetal defects. Escitalopram is not used during pregnancy unless it is really necessary and after careful consideration of risks/benefits. Neonatal monitoring should be monitored if the mother has used Escitalopram to continue to use during the later pregnancy period, especially in the last 3 months of pregnancy.

It is necessary to avoid sudden stopping during pregnancy. The following symptoms can occur in newborns when mothers use SSRI/SNRI in the late stage of pregnancy: Emergency respiratory, purple, apnea, convulsions, unstable temperature, difficulty breastfeeding, nausea, reducing blood glucose, reducing tone, increasing reflexes, tremor, irritation, uneasiness, frequent crying, sleeping chicken and sleeping hard. These symptoms may be caused by serotonin effects or symptoms when stopping treatment. In most cases, complications begin immediately or early (

Epidemiological data shows that the use of SSRIs during pregnancy, especially during the end of pregnancy may increase the risk of continuous lung hypertension in infants (PPHN). The risks recorded about 5 cases on 1,000 pregnant mothers. Meanwhile, this rate is 1 to 2 cases on 1,000 pregnant mothers who do not use SSRIs.

Breastfeeding period

expected EscitalPram will excrete in breast milk. Therefore, no breastfeeding during treatment.

Drug interaction

Pharmacological interaction

The combinations are contraindicated

Inhibitors inhibitors are not recovered and unsatisfied: There are serious reactions in patients using SSRI in combination with non -selective and non -recovery monoamine oxidase inhibitors)

In some cases, patients develop serotonin syndrome, EscitalPram is contraindicated when used in combination with non -recovery and non -selective Maoi inhibitors. Escitalopram may start 14 days after stopping treatment with non -recovery Mao inhibitors. After stopping the EscitalPram treatment, if relapses, at least 7 days after being treated with Maoi inhibitors are not recovered and not selected.

MA -A inhibitors can recover and be selected (moclobemid): Due to the risk of serotonin syndrome, the combination of Escitalopram with Mao -A inhibitors such as moclobemid is contraindicated. If the combination is necessary, it is necessary to start with the lowest recommended dose and closely clinically monitored.

Mao inhibitors can recover and not selectively (Linezolid): Linezolid antibiotic is a recovery and non -selective Mao inhibitor and is not used for patients with Escitalopram. If the combination is necessary, it is necessary to start with the lowest recommended dose and closely clinically monitored.

Mao -B inhibitors cannot recover and be selected (Selegilin): When combined with Selegilin (inhibitors that cannot be restored to Mao -B), be careful due to the risk of Serotonin syndrome. Use Selegilin simultaneously with a dose of up to 10 mg/day with Citalopram Racemic is safe.

extends the QT interval: Escitalopram's studies and pharmacokinetics combined with other drugs that extend the QT range have not been done. The additional exclusion of the EscitalPram and drugs cannot be excluded. Therefore, contraindicating the simultaneous use of EscitalPrams and drugs that extend the QT for example, anti -arrhyths of type II and III, mental anti -mental illness (such as phenothiazin extracts, pimozids, haloperidols), three -ring anti -depressive drugs, some anti -microbiological agents (such as Sparfloxacin, Moxifloxacin, erythromycincincin, erythromycincin IV, Pentamidin, anti -malarial treatment, especially Halofantrin), some antihistamines (such as Astemizol, Mizolastin).

Be cautious when used in combination with the following drugs

pharmacokinetic interaction

Effect of other products on EscitalPram pharmacokinetics

The metabolism of EscitalPram is mainly through CYP2C19. CYP3A4 and CYP2D6 can contribute to the transformation although the level is smaller. The metabolism of the main metabolites SDCT (Demethylated EscitalPram) seems to be partially catalyzed through CYP2D6.

Simultaneous use of EscitalPram with Omeprazol 30 mg/day (a CYP2C19 inhibitor) leads to a moderate increase (approximately 50%) in the plasma concentration of Escitalopram.

Simultaneous use of EscitalPram with cimetidin 400 mg, 2 times/day (potential systemic enzyme inhibitors in moderate level) leads to moderate increase (approximately 70%) in the blood concentration of Escitalopram. Precautions recommend using EscitalPram in combination with cimetidine. The dose can be adjusted. Therefore, it is necessary to be cautious when used simultaneously with CYP2C19 inhibitors (for example, omeprazol, esomeprazol, fluvoxamine, lansoprazol, ticlopidine) or cimetidine. Reducing the dose of Escitalopram may be necessary when monitoring side effects when treating simultaneously.

Efficiency of EscitalPram on the pharmacokinetic properties of other drugs

EscitalPram is a CYP2D6 enzyme inhibitor, which is careful when using EscitalPram with drugs that are mainly metabolized by this enzyme, and these products have a narrow treatment index such as flecainid, propafenon and metoprolol (used when heart failure), or some medications that affect the central nervous system that is metabolized through CYP2D6 Antidepressants such as desipramin, clomipramine and nortriptylin or mental anti -mental drugs such as Risperidon, Thioridazin and Haloperidol. The dose can be adjusted.

Simultaneously used with desipramine or metoprolol in both cases leads to twice the plasma level of these two CYP2D6 substrates. In vitro studies show that Escitalopram can cause CYP2C19 weak inhibition. Caution recommended when used simultaneously with metabolic drugs through CYP2C19.