Nexcital is indicated for Major depressive disorder, Depression, Panic disorder, Obsessive compulsive disorder, Anxiety disorder

Precautions and warnings

History of mania or seizure disorders; work requiring mental alertness; renal and hepatic impairment; pregnancy, lactation; withdraw gradually. Children and adolescents

Side-effects

Nausea, diarrhoea, increased sweating, insomnia, impotence, ejaculation disorder, fatigue, somnolence; postural hypotension, sinusitis, taste disturbances. Increased appetite and wt gain.

Drug Interactions

Increased risk of bleeding when used with aspirin, NSAIDs or drugs that affect coagulation. Serum levels may be reduced by CYP2C19 inducers (e.g. carbamazepine, rifampin, phenytoin) or CYP3A4 inducers (e.g. nafcillin, nevirapine). Serum levels may also be increased by CYP2C19 inhibitors (e.g. fluconazole, fluvoxamine, omeprazole) or CYP3A4 inhibitors (e.g. azole antifungals, clarithromycin). May increase serum levels of desipramine or metoprolol. Increased risk of serotonin syndrome when used with linezolid or sibutramine. Escitalopram may enhance the sedative effects of alcohol.
Potentially Fatal: Concomitant administration with MAOIs may lead to serious or fatal reactions; should not be started until at least 2 wk after stopping escitalopram or vice versa. Moclobemide may increase the risk of serotonin syndrome.

Contraindications

Concomitant use with or within 2 wk of MAOI withdrawal.

Mode of actions

Escitalopram selectively inhibits CNS neuronal re-uptake of serotonin (5-HT) and potentiates serotonergic activity. It has minimal effects on norepinephrine and dopamine neuronal re-uptake.

Dosage & Administration

Adult: PO Depression; Anxiety; Obsessive compulsive disorder 10 mg once daily. Max: 20 mg/day.
Panic disorder Initial: 5 mg/day, up to 10 mg/day after 7 days if needed. Max: 20 mg/day.

Elderly: Half the adult dose.
Hepatic impairment: Dosage adjustments may be required.

Pregnancy & Lactation

Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks