GENERIC ESCITALOPRAM (DEXANIL-5, DEXANIL-10, DEXANIL-20)
Escitalopram is an antidepressant, suitable for the prevention and treatment of depression of various etiologies, depressive episodes of various degrees and forms. It is recommended for panic disorders, social phobia, general anxiety pathologies and OCD. The most well-known drug with the active ingredient Escitalopram is the brand name Tsipralex, distributed at a dosage of 10 mg – Tsipralex 10 . Also there are brand names – Lenuxin, Selectra, Elycea, Miracytol, Asipi. The site contains the Indian generic Estsitalopram 5 mg with the brand name DEXANIL-5. The cheapest equivalent on request tsipraleks price . Before buying, carefully read the instructions for the drug, as well as make a request online, for example, tsipraleks reviews, To finally determine whether this medicine is right for you.
Escitalopram is an antidepressant , a selective serotonin reuptake inhibitor (SSRI). Inhibition of serotonin reuptake leads to an increase in the concentration of this neurotransmitter in the synaptic cleft, enhances and prolongs its effect on postsynaptic receptor sites.
Escitalopram does not have any at all or has a very weak ability to bind to a number of receptors, including: serotonin 5 HT1A, 5 HT2 receptors, dopamine D2 and D2 receptors, α1, α2, β-adrenergic receptors, histamine H1, muscarinic cholinergic, benzodiazepine synoproteins, benzodiazepiptic syphilis, benzodiazine syringe, benzodiazine syringe, benzodiazepine syphilis, benzodiazine syringe.
Pharmacokinetics. Suction does not depend on food intake. The bioavailability of escitalopram is about 80%. The average time to reach the maximum plasma concentration (Tmax) is 4 hours after repeated use. The apparent volume of distribution (Vd, β / F) after oral administration is from 12 to 26 l / kg. The binding of escitalopram and its major metabolites to plasma proteins is below 80%. Escitalopram is metabolized in the liver to demethylated and dimethylated metabolites. They are both pharmacologically active. The main substance and its metabolites are partially excreted in the form of glucuronides.
After repeated use, the average concentration of demethyl and didemethyl metabolites is usually 28-31% and less than 5%, respectively, of the concentration of escitalopram. The biotransformation of escitalopram into the demethylated metabolite occurs mainly with the help of cytochrome P4502C19. Perhaps some involvement of the isoenzymes P4503A4 and P4502D6. In persons with weak P4502C19 activity, escitalopram concentration is twice as high as in cases with high activity of this isoenzyme. Significant changes in the concentration of the drug in cases with weak activity of the isoenzyme P4502D6 were not found.
The half-life (T1 / 2) after repeated use is about 30 hours. Oral clearance (cloral) is about 0.6 l / min. The major metabolites of escitalopram have a longer half-life. Escitalopram and its major metabolites are excreted by the liver (metabolic pathway) and the kidneys. Most are excreted as metabolites in the urine.
Escitalopram kinetics is linear. Equilibrium concentration (Css) is reached after about 1 week. The average Css50 nmol / l (from 20 to 125 nmol / l) is achieved with a daily dose of 10 mg.
In the elderly (over 65 years old), escitalopram appears more slowly than in younger patients. The amount of substance in the systemic circulation, calculated using the pharmacokinetic indicator “area under the curve” (AUC) in the elderly is 50% more than in young healthy volunteers.
INDICATIONS FOR USE
Depressive episodes of any severity.
Panic disorders with / without agoraphobia.
Social anxiety disorder (social phobia).
Generalized anxiety disorder.
Obsessive compulsive disorder.
Increased sensitivity to the drug or its components,
childhood and adolescence (up to 18 years),
simultaneous use with monoamine oxidase inhibitors (MAO).
Pregnancy, breastfeeding period.
METHOD OF ADMINISTRATION AND DOSES
Escitalopram is administered orally once a day, regardless of the meal.
Usually prescribed 10 mg once a day. Depending on the patient’s individual response, the dose may be increased to a maximum of 20 mg / day.
The antidepressant effect usually develops 2-4 weeks after the start of treatment. After the disappearance of the symptoms of depression, at least for another 6 months, it is necessary to continue therapy to consolidate the effect obtained.
Panic disorders with / without agoraphobia
During the first week of treatment, a dose of 5 mg / day is recommended, which then increases to 10 mg / day. Depending on the patient’s individual response, the dose may be increased to a maximum of 20 mg / day.
The maximum therapeutic effect is achieved approximately 3 months after the start of treatment. Therapy lasts for several months.
Social Anxiety Disorder (Social Phobia)
Usually, 10 mg is prescribed once a day. Symptom relief usually develops 2-4 weeks after starting treatment. Depending on the patient’s individual response, the dose can subsequently be reduced to 5 mg / day. or increased to a maximum of 20 mg / day.
Since social anxiety disorder is a chronic disease, the minimum recommended therapeutic course is 12 weeks. To prevent recurrence of the disease, the drug may be prescribed for 6 months or longer, depending on the individual response of the patient.
Generalized anxiety disorder The recommended initial dose is 10 mg once a day. Depending on the patient’s individual response, the dose may be increased to a maximum of 20 mg / day. Allowed long-term use of the drug (6 months or longer) at a dose of 20 mg / day.
Obsessive Compulsive Disorder
Usually, 10 mg is prescribed once a day. Depending on the patient’s individual response, the dose can subsequently be increased to a maximum of 20 mg / day.
Since obsessive-compulsive disorder is a chronic disease, the course of treatment must be long enough to ensure complete relief from the symptoms and last for at least 6 months. To prevent recurrence, treatment for at least 1 year is recommended.
Elderly patients (over 65)
It is recommended to use half the usually recommended dose (i.e. only 5 mg / day) and a lower maximum dose (10 mg / day).
Reduced renal function
In case of mild and moderate renal insufficiency, dosage adjustment is not required. Patients with severe renal insufficiency (creatinine clearance (CK) below 30 ml / min) should be prescribed Escitalopram with caution.
Reduced liver function
With mild and moderate liver failure, the recommended initial dose for the first two weeks of treatment is 5 mg / day. Depending on the patient’s individual response, the dose may be increased to 10 mg / day. In severe liver failure, care must be taken when titrating the dose.
Reduced activity of cytochrome P4502 C 19
For patients with weak activity of the isoenzyme P4502C19, the recommended initial dose during the first two weeks of treatment is 5 mg / day.
Depending on the patient’s individual response, the dose may be increased to 10 mg / day.
Discontinuation of treatment
When discontinuing treatment with Escitalopram, the dose should be gradually reduced over a period of 1-2 weeks in order to avoid the occurrence of the syndrome of “withdrawal”.
Side effects most often occur in the first or second week of treatment and then usually become less intense and occur less frequently with continued therapy.
On the part of the psyche: decreased libido, anorgasmia (in women).
On the part of the nervous system: insomnia or drowsiness, dizziness; less often there are disturbances of taste and sleep disorders.
On the part of the respiratory system: sinusitis, yawning.
On the part of the digestive system: nausea, diarrhea, constipation.
From the side of the skin: excessive sweating.
Reproductive system: impotence, impaired ejaculation.
On the part of the body as a whole: weakness, hyperthermia.
Metabolic disorders and eating disorders: loss of appetite. When taking medications belonging to the class of SSRIs, including Escitalopram, it is also possible:
Metabolic disorders and eating disorders: hyponatremia, insufficient secretion of antidiuretic hormone (ADH).
On the mental side: hallucinations, mania, confusion, agitation, anxiety, depersonalization, panic attacks, irritability.
On the part of the nervous system: seizures, tremor, motor impairment, serotonin syndrome (see “Special instructions”).
On the part of the organs of vision: visual impairment.
Since the cardiovascular system: orthostatic hypotension.
On the part of the digestive system: vomiting, dry mouth, anorexia. Hepatic and hepatobiliary disorders: changes in laboratory parameters of liver function.
On the part of the skin: skin rash, itching, ecchymosis, angioedema, sweating.
From the musculoskeletal system: arthralgia, myalgia.
Reproductive system: galactorrhea, impotence, impaired ejaculation, anorgasmia.
On the part of the urinary system: urinary retention.
On the part of the body as a whole: insomnia, dizziness, drowsiness, anaphylactic reactions.
In addition, after long-term use, abrupt cessation of estsitalopram therapy in some patients may lead to a withdrawal reaction. With an abrupt cessation of escitalopram, such adverse reactions as dizziness, headaches, and nausea may occur, the severity of which is low, and the duration is limited. To avoid the occurrence of withdrawal reactions, it is recommended that the drug be gradually discontinued within 1–2 weeks.
OVERDOSE BY PREPARATION
Symptoms Dizziness, tremor, agitation, drowsiness, stupefaction, convulsive seizures, tachycardia, ECG changes (change ST T, expansion of the QRS complex, prolongation of the QT interval), arrhythmias, respiratory depression, vomiting, rhabdomyolysis, metabolic acidosis, hypokalemia.
Treatment. There is no specific antidote. Symptomatic and supportive treatment: gastric lavage, adequate oxygenation. Monitoring the function of the cardiovascular and respiratory systems.
Coated Tablets, 5 mg, 10 mg and 20 mg.
At temperatures no higher than 25 ° C.
Keep out of reach of children.
Shelf life is
Do not use after the expiration date printed on the package.