1. About escitalopram

    Escitalopram is a type of antidepressant known as an SSRI (selective serotonin reuptake inhibitor).

    It is often used to treat depression and is sometimes used for anxiety, obsessive compulsive disorder or panic attacks.

    Escitalopram helps many people recover from depression, and it has fewer unwanted effects than older antidepressants.

    Escitalopram is available on prescription. It comes as tablets and as liquid drops that you put in a drink.

  2. Key facts

    • It usually takes 4 to 6 weeks for escitalopram to work.
    • Side effects such as nausea and headache are common. They are usually mild and go away after a couple of weeks.
    • Escitalopram can cause withdrawal symptoms so don't stop taking it without talking to your doctor.
    • Escitalopram is called by the brand name Cipralex.
  3. Who can and can't take escitalopram

    Escitalopram can be taken by adults over the age of 18.

    Escitalopram isn't suitable for some people. Check with your doctor before starting to take escitalopram if you:

    • have had an allergic reaction to escitalopram or any other medicines in the past
    • have epilepsy - as escitalopram can increase your seizures
    • have a heart problem - as escitalopram can speed up or change your heartbeat
    • have a low heart rate plus you have had severe diarrhoea and vomiting for a long time or take water tablets
    • have liver or kidney problems - your doctor may need to change your dose
    • have been told you have low sodium (salt) levels
    • bruise or bleed easily
    • are having electroconvulsive treatment
    • have ever taken any other medicines for depression - some rarely used antidepressants can interact with escitalopram to cause very high blood pressure even when they've been stopped for a few weeks
    • are trying to become pregnant, are already pregnant or are breastfeeding
    • have an eye problem called glaucoma because escitalopram can increase the pressure in your eye

    If you have diabetes, escitalopram can make it more difficult to keep your blood sugar stable. Monitor your blood sugar more often for the first few weeks of treatment with escitalopram and adjust your diabetes treatment if necessary.

  4. How and when to take it

    Take escitalopram once a day. You can take it with or without food.

    You can take escitalopram at any time of day, as long as you stick to the same time every day. If you have trouble sleeping, it's best to take it in the morning.

    How much will I take?

    Escitalopram tablets come in different strengths ranging from 5mg to 20mg.

    The usual dose of escitalopram is 10mg a day in adults. However, you may start on a lower dose and increase to a maximum dose of 20mg a day. If you have liver problems, the maximum recommended dose is 10mg a day.

    With liquid drops of escitalopram, 1 drop is equivalent to 1mg, 10 drops is 10mg, 20 drops is 20mg.

    What if I forget to take it?

    Do not take a double dose to make up for forgotten doses. If you do forget to take a dose, and you remember before you go to bed, take it straight away. Carry on as usual the next day. If you only remember during the night, or the next day, leave out the missed dose and carry on as usual.

    If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

    What if I take too much?

    Ask your doctor for advice straight away. An overdose can lead to potentially serious symptoms such as:

    • agitation
    • being sick (vomiting)
    • shaking
    • fast heart rate
    • seizures
  5. Side effects

    Like all medicines, escitalopram can cause side effects in some people, but many people have no side effects or only minor ones. Some of the common side effects of escitalopram will gradually improve as your body gets used to it.

    Common side effects

    Common side effects may happen in more than 1 in 10 people. Keep taking the medicine but talk to your doctor or pharmacist if these side effects bother you or don't go away:

    • dry mouth
    • sweating a lot
    • being unable to sleep
    • feeling sleepy
    • feeling tired or weak

    Serious side effects

    Serious side effects are rare and happen in less than 1 in 1,000 people. Tell a doctor straight away if you get:

    • headache, trouble focusing, memory problems, not thinking clearly, weakness, seizures or losing your balance - these can be signs of low sodium levels
    • thoughts about harming yourself or ending your life
    • a high temperature (above 38C) with agitation, confusion, trembling and twitching
    • severe dizziness or passing out
    • weight gain or loss without trying to
    • changes in your periods such as heavy bleeding, spotting or bleeding between periods
    • painful erections that last longer than 4 hours - this may happen even when you are not having sex

    Or, if you develop any signs of abnormal bleeding including:

    • vomiting blood or dark vomit, coughing up blood, blood in your pee, black or red poo - these can be signs of bleeding from the gut
    • bleeding from the gums or bruises that appear without a reason or that get bigger
    • any bleeding that is very bad or that you cannot stop

    Serious allergic reaction

    In rare cases, it’s possible to have a serious allergic reaction to escitalopram.

    A serious allergic reaction is an emergency. Contact a doctor straight away if you think you or someone around you is having a serious allergic reaction.

    The warning signs of a serious allergic reaction are:

    • getting a skin rash that may include itchy, red, swollen, blistered or peeling skin
    • wheezing
    • tightness in the chest or throat
    • having trouble breathing or talking
    • swelling of the mouth, face, lips, tongue, or throat

    These are not all the side effects of escitalopram. For a full list see the leaflet inside your medicines packet.

    You can report any suspected side effect to the UK safety scheme.

  6. How to cope with side effects

    What to do about:

    • feeling sleepy - cut down the amount of alcohol you drink
    • dry mouth - chew sugar-free gum or sugar-free sweets
    • being unable to sleep - take escitalopram first thing in the morning

    Except for problems getting to sleep, you can reduce the chance of having a side effect that bothers you if you take escitalopram in the evening. That way you're asleep when the level of medicine in your body is highest.

  7. Pregnancy and breastfeeding

    It's important for you and your baby that you stay well during your pregnancy. If you become pregnant while taking escitalopram speak to your doctor. Do not stop taking your medicine unless your doctor tells you to.

    Escitalopram has been linked to a very small increased risk of problems for your unborn baby. However if your depression is not treated during pregnancy this can also increase the chance of problems.

    You may need to take escitalopram during pregnancy if you need it to remain well. Your doctor can explain the risks and the benefits, and will help you decide which treatment is best for you and your baby.

    For more information about how escitalopram can affect you and your baby during pregnancy, read this leaflet about the best use of medicines in pregnancy (BUMPS).

    Escitalopram and breastfeeding

    If your doctor or health visitor says your baby is healthy, escitalopram can be used during breastfeeding.

    Escitalopram passes into breast milk in small amounts, and has been linked with side-effects in very few breastfed babies.

    It is important to continue taking escitalopram to keep you well. Breastfeeding will also benefit both you and your baby.

    If you notice that your baby isn’t feeding as well as usual, or seems unusually sleepy, or if you have any other concerns about your baby, then talk to your health visitor or doctor as soon as possible.

    Tell your doctor if you're trying to get pregnant, are already pregnant or if you're breastfeeding.

  8. Cautions with other medicines

    Some medicines and escitalopram can interfere with each other and increase the chances of you having side effects.

    Tell your doctor if you're taking these medicines before you start escitalopram:

    • any medicines that affect your heartbeat - as escitalopram can speed up or change your heartbeat
    • any other medicines for depression - some rarely used antidepressants can interact with escitalopram to cause very high blood pressure even when they have been stopped for a few weeks

    These are not all the medicines that can interfere with escitalopram. For a full list see the leaflet inside your medicine packet or check with your pharmacist.

    Mixing escitalopram with herbal remedies and supplements

    Don't take St John's wort, the herbal remedy for depression, while you are being treated with escitalopram as this will increase your risk of side effects.

    Tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.

  9. Common questions