Lenuxin®
- Escitalopram should not be prescribed concomitantly with MAO inhibitors due to the risk of developing serotonin syndrome. Escitalopram can be prescribed 14 days after stopping treatment with irreversible MAO inhibitors and at least 1 day after stopping treatment with a reversible MAO type A inhibitor (moclobemide). At least 7 days must pass after stopping escitalopram before treatment with non-selective MAO inhibitors can be started.
- In children, adolescents and young adults (under 24 years of age) with depression and other mental disorders, antidepressants, compared with placebo, increase the risk of suicidal thoughts and behavior. Therefore, when prescribing Lenuxin® or any other antidepressants to children, adolescents and young adults (under 24 years of age), the risk of suicide should be weighed against the benefits of their use. If a decision is made to initiate antidepressant therapy, the patient should be closely monitored for early detection of disturbances or changes in behavior, as well as suicidality.
- When using drugs belonging to the therapeutic group of SSRIs, including escitalopram, the following should be considered: some patients with panic disorder may experience increased anxiety when starting treatment with SSRIs. This paradoxical reaction usually disappears within the first two weeks of treatment. To reduce the likelihood of an anxiogenic effect, it is recommended to use low initial doses. The drug should be discontinued if seizures develop. Use in patients with unstable epilepsy is not recommended; Controlled seizures require careful monitoring. If the frequency of seizures increases, SSRIs, including escitalopram, should be discontinued.
- SSRIs and SNRIs (selective norepinephrine reuptake inhibitors) have been associated with the development of akathisia, a condition characterized by unpleasant, debilitating restlessness and hyperactivity, often accompanied by an inability to sit or stand in one place. This condition most likely occurs during the first few weeks of therapy. Increasing the dose may be harmful to patients who experience these symptoms.
- Escitalopram should be used with caution in patients with a history of mania/hypomania. If a manic state develops, escitalopram should be discontinued.
- In patients with diabetes, treatment with escitalopram may change blood glucose levels. Therefore, dose adjustments of insulin and/or oral hypoglycemic drugs may be required.
— The risk of committing suicide is inherent in depression and can persist until a significant improvement in the condition occurs spontaneously or as a result of therapy. Careful monitoring of patients being treated with antidepressants is necessary, especially at the beginning of treatment, due to the possibility of clinical deterioration and/or the emergence of suicidal manifestations (thoughts and behavior). This precaution should also be observed when treating other mental disorders due to the possibility of concurrent depressive episodes.
- Hyponatremia, possibly associated with impaired secretion of antidiuretic hormone (ADH), occurs rarely when taking escitalopram and usually disappears when therapy is discontinued. Caution should be exercised when prescribing escitalopram and other SSRIs to persons at risk of developing hyponatremia: the elderly, patients with cirrhosis, and those taking drugs that can cause hyponatremia.
- When taking escitalopram, skin hemorrhages (ecchymosis and purpura) may develop. Escitalopram should be used with caution in patients with a tendency to bleed, as well as those taking oral anticoagulants and medications that affect blood clotting.
- Since clinical experience with the simultaneous use of escitalopram and ECT (electroconvulsive therapy) is limited, caution should be exercised in such cases.
- In rare cases, patients taking escitalopram and other SSRIs concomitantly with serotonergic drugs may develop serotonin syndrome. Escitalopram should be used with caution concomitantly with drugs that have serotonergic effects.
— Due to limited clinical experience, caution is recommended when using the drug in patients with coronary heart disease (CHD).
- After long-term use, abrupt cessation of escitalopram therapy in some patients may lead to a “withdrawal” reaction; gradual withdrawal of the drug over 1-2 weeks is recommended.
— Interaction with alcohol:
escitalopram does not interact pharmacodynamically or pharmacokinetically with alcohol. However, as with other antidepressants, you should avoid drinking alcohol during the entire period of treatment with the drug.
Lenuksin
Use during pregnancy and breastfeeding
The use of the drug during pregnancy is not recommended due to insufficient data on efficacy and safety.
While using the drug, breastfeeding should be discontinued.
Use for liver dysfunction
For mild to moderate liver failure, 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. In cases of severe liver failure, care must be taken during titration.
For patients with low activity of the CYP2C19 isoenzyme, 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.
Use for renal impairment
For moderate renal failure, no dose adjustment is required. In patients with severe renal failure (creatinine clearance below 30 ml/min), the drug is prescribed with caution.
Use in children
Contraindicated in children under 18 years of age.
Use in elderly patients
Elderly patients (over 65 years of age) are recommended to be prescribed half the usual recommended dose of 5 mg/day. The maximum dose is 10 mg/day.
special instructions
Escitalopram should not be co-administered with MAO inhibitors due to the risk of developing serotonin syndrome. Escitalopram can be prescribed 14 days after stopping treatment with irreversible MAO inhibitors and at least 1 day after stopping treatment with a reversible MAO type A inhibitor (moclobemide). At least 7 days must pass after stopping escitalopram before treatment with non-selective MAO inhibitors can be started.
In children, adolescents and young adults (<24 years of age) with depression and other mental disorders, antidepressants, compared with placebo, increase the risk of suicidal thoughts and behavior. Therefore, when prescribing Lenuxin® or any other antidepressants to children, adolescents and young adults (under 24 years of age), the risk of suicide should be weighed against the benefits of their use. If a decision is made to initiate antidepressant therapy, the patient should be closely monitored for early detection of disturbances or changes in behavior, as well as suicidality.
When using drugs belonging to the therapeutic group of SSRIs, including escitalopram, the following should be considered: some patients with panic disorder may experience increased anxiety when starting treatment with SSRIs. This paradoxical reaction usually disappears within the first two weeks of treatment. To reduce the likelihood of an anxiogenic effect, it is recommended to use low initial doses.
The drug should be discontinued if seizures develop. Use in patients with unstable epilepsy is not recommended; Controlled seizures require careful monitoring. If the frequency of seizures increases, SSRIs, including escitalopram, should be discontinued.
SSRIs and SNRIs (selective norepinephrine reuptake inhibitors) have been associated with the development of akathisia, a condition characterized by unpleasant, debilitating restlessness and hyperactivity, often accompanied by an inability to sit or stand in one place. This condition most likely occurs during the first few weeks of therapy. Increasing the dose may be harmful to patients who experience these symptoms.
Escitalopram should be used with caution in patients with a history of mania/hypomania. If a manic state develops, escitalopram should be discontinued.
In patients with diabetes mellitus, treatment with escitalopram may change blood glucose levels. Therefore, dose adjustments of insulin and/or oral hypoglycemic drugs may be required.
The risk of committing suicide is inherent in depression and may persist until the condition significantly improves, either spontaneously or as a result of therapy. Careful monitoring of patients being treated with antidepressants is necessary, especially at the beginning of treatment, due to the possibility of clinical deterioration and/or the emergence of suicidal manifestations (thoughts and behavior). This precaution should also be observed when treating other mental disorders due to the possibility of concurrent depressive episodes.
Hyponatremia, possibly associated with impaired ADH secretion, occurs rarely with escitalopram and usually disappears when therapy is discontinued. Caution should be exercised when prescribing escitalopram and other SSRIs to persons at risk of developing hyponatremia: the elderly, patients with cirrhosis, and those taking drugs that can cause hyponatremia.
When taking escitalopram, skin hemorrhages (ecchymosis and purpura) may develop. Escitalopram should be used with caution in patients with a tendency to bleed, as well as those taking oral anticoagulants and medications that affect blood clotting.
Since clinical experience with the simultaneous use of escitalopram and ECT (electroconvulsive therapy) is limited, caution should be exercised in such cases.
In rare cases, patients taking escitalopram and other SSRIs concomitantly with serotonergic drugs may develop serotonin syndrome. Escitalopram should be used with caution concomitantly with drugs that have serotonergic effects.
Due to limited clinical experience, caution is recommended when using the drug in patients with coronary artery disease.
After long-term use, abrupt cessation of escitalopram therapy may lead to a withdrawal reaction in some patients. Undesirable reactions such as dizziness, headaches and nausea may occur. The severity of these reactions is usually mild and their duration is limited. To avoid withdrawal reactions, gradual withdrawal of the drug over 1-2 weeks is recommended.
Interaction with ethanol
Escitalopram does not interact pharmacodynamically or pharmacokinetically with ethanol. However, as with other antidepressants, you should avoid drinking alcohol during the entire period of treatment with the drug.
Impact on the ability to drive vehicles and operate machinery
During the treatment period, it is necessary to refrain from driving vehicles and engaging in potentially hazardous activities that require increased concentration and speed of psychomotor reactions.
Lenuxin, 28 pcs., 10 mg, film-coated tablets
Inside,
1 time per day, regardless of meals.
Moderate to severe depression
Usually prescribed 10 mg once daily. Depending on the patient’s individual response, the dose can be increased to a maximum of 20 mg/day. The antidepressant effect usually develops 2–4 weeks after the start of treatment. After the symptoms of depression disappear, it is necessary to continue therapy to consolidate the effect for at least 6 months.
Panic disorders with or without agoraphobia
During the 1st week of treatment, a dose of 5 mg/day is recommended, which is then increased to 10 mg/day. Depending on the patient’s individual response, the dose can 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 several months.
Social anxiety disorder (social phobia)
Usually prescribed 10 mg 1 time per day. Relief of symptoms usually develops 2–4 weeks after the start of treatment. Depending on the patient's individual response, the dose may 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 duration of treatment is 12 weeks. To prevent relapse of the disease, repeated therapy may be prescribed for 6 months or longer, depending on the individual patient's response.
Before prescribing the drug, it is necessary to differentiate social phobia from ordinary shyness or timidity.
Generalized anxiety disorder
The recommended starting dose is 10 mg 1 time per day. Depending on the patient’s individual response, the dose can be increased to a maximum of 20 mg/day. Long-term administration of the drug (6 months or longer) at a dose of 20 mg/day is allowed.
Special patient groups
Elderly (over 65 years old).
It is recommended to use half the usual recommended dose of 5 mg/day. The maximum dose is 10 mg/day.
Reduced kidney function.
For moderate renal failure, no dose adjustment is required. In patients with severe renal failure (creatinine Cl below 30 ml/min), the drug is prescribed with caution.
Decreased liver function.
For mild to moderate liver failure, the recommended initial dose for the first 2 weeks of treatment is 5 mg/day. Depending on the patient's individual response, the dose may be increased to 10 mg/day. In cases of severe liver failure, care must be taken during titration.
Reduced activity of the CYP2C19 isoenzyme.
For patients with low activity of the CYP2C19 isoenzyme, the recommended initial dose during the first 2 weeks of treatment is 5 mg/day. Depending on the patient's individual response, the dose may be increased to 10 mg/day.
Stopping treatment.
When stopping treatment, the dose should be gradually reduced over 1–2 weeks to avoid withdrawal syndrome.
