CIPRALEX 20MG BLSPK (30 TABLETS)

Generic Name: escitalopram
Brand Name: Cipralex
Drug class: Selective serotonin reuptake inhibitors

WHAT IS THE DOSAGE OF THIS MEDICATION?

Cipralex and its generic escitalopram tablets are available in the strength of 10 mg and 20 mg.

WHAT IS THIS MEDICATION USED FOR?

Escitalopram belongs to the group of medications called selective serotonin reuptake inhibitors (SSRIs). It is used to treat depression, obsessive-compulsive disorder (OCD), and generalized anxiety disorder (GAD). It works by increasing levels of a neurotransmitter called serotonin in the brain. Increased serotonin levels can lead to an improved mood.

Disturbances in the serotonin-system are considered an important factor in the development of depression and related diseases. Escitalopram works to increase serotonin levels in the brain by being a selective serotonin reuptake inhibitor. This medication binds to sites on the serotonin transporter preventing the reuptake of serotonin (5-HT) into the presynaptic terminals of serotonergic neurons. This may improve your energy levels, mood, appetite, sensation of anxiety/nervousness, and eventually overall general quality of life.

The medication usually begins to work within 2 to 4 weeks. However, it may take several weeks of treatment before the full effects are seen.

The recommended dose is usually started at 10 mg daily, preferably at the same time each day. Escitalopram should be taken once daily in the morning or evening, with or without food. The dose can be increased by your doctor as needed to a maximum of 20 mg daily. For seniors, people with liver problems, and people taking the medications omeprazole or cimetidine, the maximum recommended daily dose is 10 mg. In some cases, the doctor may recommend a 5 mg starting dose.

Regular tablets: The tablet should be swallowed whole (not chewed) with a glass of water.

Oral dispersible tablets: The tablet should be placed on the tongue. It will rapidly disintegrate and can be swallowed without water. The tablets break easily, so they should be handled carefully with dry hands.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, skip the missed dose and continue on with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children. The oral dispersible tablets should be kept in their original package. Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Cipralex is not for use in children under 18 years of age.

WHO SHOULD NOT TAKE THIS MEDICATION

Do not take escitalopram if you:

• are allergic to escitalopram, citalopram, or any ingredients of the medication

• have a condition known as congenital long QT syndrome or have a heart rhythm disturbance called QT prolongation

• are taking the medication pimozide

• have taken a MAO inhibitor medication (e.g., phenelzine, tranylcypromine, moclobemide) in the past 2 weeks – MAO inhibitors should not be taken until at least 2 weeks after stopping treatment with escitalopram

• Not for recommend for use in children under 18 years of age

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POTENTIAL INTERACTION WITH OTHER MEDICATION

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Inform your doctor about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

The following medications could potentially interact with escitalopram:

• acetylsalicylic acid (ASA)

• alcohol

• amiodarone

• amphetamines (e.g., dextroamphetamine, lisdexamfetamine)

• anticoagulants (e.g., apixaban, clopidogrel, dabigatran, rivaroxaban, warfarin)

• antihistamines (e.g., cetirizine, doxylamine, diphenhydramine, hydroxyzine, loratadine)

• antipsychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, paliperidone, pimozide, quetiapine, risperidone)

• anagrelide

• apalutamide

• asenapine

• barbiturates (e.g., butalbital, pentobarbital, phenobarbital)

• benzodiazepines (e.g., alprazolam, diazepam, lorazepam)

• bosentan

• buserelin

• buspirone

• chloral hydrate

• chloroquine

• cimetidine

• clonidine

• deferasirox

• desmopressin

• dextromethorphan

• diabetes medications (e.g., canagliflozin, chlorpropamide, glyburide, insulin, metformin, rosiglitazone)

• dipyridamole

• disopyramide

• dofetilide

• domperidone

• efavirenz

• entacapone

• enzalutamide

• ergot alkaloids (e.g., ergotamine, dihydroergotamine)

• etravirine

• flecainide

• fluconazole

• heparin

• herbal products that affect blood clotting (e.g., cat's claw, chamomile, fenugreek, evening primrose, feverfew, garlic, ginger, ginseng, glucosamine, turmeric)

• itraconazole

• ketoconazole

• laxatives

• lanreotide

• linezolid

• lithium

• lopinavir

• low molecular weight heparins (e.g., dalteparin, enoxaparin, tinzaparin)

• macrolide antibiotics (e.g., clarithromycin, erythromycin)

• metoclopramide

• methadone

• methylphenidate

• metoclopramide

• mexiletine

• mifepristone

• mirtazapine

• mitotane

• monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, rasagiline, selegiline, tranylcypromine, methylene blue)

• multivitamin supplements

• modafinil

• muscle relaxants (e.g., baclofen, cyclobenzaprine, methocarbamol, orphenadrine)

• narcotic pain relievers (e.g., codeine, fentanyl, morphine, oxycodone)

• nefazodone

• non-steroidal anti-inflammatory medications (NSAIDs; e.g., diclofenac, ibuprofen, naproxen)

• obinutuzumab

• octreotide

• omeprazole

• pasireotide

• pentamidine

• pentoxifylline

• procainamide

• propafenone

• protein kinase inhibitors (e.g., crizotinib, nilotinib, lapatinib, pazopanib, sunitinib)

• quinidine

• quinine

• quinolone antibiotics (e.g., ciprofloxacin, ofloxacin)

• rifampin

• St. John's wort

• saquinavir

• scopolamine

• seizure medications (e.g., clobazam, levetiracetam, phenobarbital, phenytoin, primidone, topiramate, valproic acid, zonisamide)

• other selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, fluoxetine, paroxetine, sertraline)

• serotonin antagonists (anti-emetic medications; e.g., dolasetron, granisetron, ondansetron)

• serotonin/norepinephrine reuptake inhibitors (SNRIs; e.g., desvenlafaxine, duloxetine, venlafaxine)

• siltuximab

• sotalol

• stiripentol

• sulfonamide antibiotics ("sulfas"; e.g., sulfisoxazole, sulfamethoxazole)

• tapentadol

• tetrabenazine

• thiazide diuretics (water pills; e.g., hydrochlorothiazide, indapamide, metolazone)

• thyroid replacements (e.g., desiccated thyroid, levothyroxine)

• tipranavir

• tocilizumab

• tolcapone

• tramadol

• trazodone

• tricyclic antidepressants (e.g., clomipramine, desipramine, imipramine)

• triptans (e.g., naratriptan, sumatriptan, zolmitriptan)

• tryptophan

• vitamin E

• voriconazole

• zolpidem

• zopiclone

WHAT ARE THE SIDE EFFECTS OF THIS MEDICATION?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Inform your doctor about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

This is not a complete list of possible side effects. If you notice other effects not listed, please contact your doctor or pharmacist.

Possible side effects include:

• changes in heart rate

• congested or runny nose

• constipation

• diarrhea

• difficulty sleeping

• dizziness

• drowsiness

• dry mouth

• fatigue

• fever

• heartburn

• increased sweating

• insomnia

• loss of appetite

• muscle or joint pain

• nausea

• sexual dysfunction including:

  • decreased libido (sex drive)

  • erectile dysfunction (difficulty getting or keeping an erection)

  • inability to have an orgasm

• stomach pain

• stomach upset

• yawning

• anxiety

• bruising or unusual bleeding from the skin or other areas

• difficulty controlling blood sugar levels

• feeling of skin prickling

• hallucinations

• inability to urinate

• involuntary movements of the body or face

• low blood sodium (confusion, seizures, drowsiness, dryness of mouth, increased thirst, lack of energy)

• mania (overactive behavior and thoughts)

• new or worsening emotional symptoms

• severe agitation or restlessness

• symptoms of glaucoma, e.g.:

  • increased pressure in the eye

  • eye pain

  • blurred vision

• symptoms of liver damage, e.g.:

  • abdominal pain

  • dark urine

  • clay-coloured stools

  • itching

  • loss of appetite

  • nausea and vomiting

  • yellow skin or eyes

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