API: Escitalopram

What Is Escitalopram and How Does it Work?

Escitalopram is an antidepressant that belongs to the class of drugs known as serotonin-reuptake inhibitors (SSRIs). It is the S-stereoisomer of another common antidepressant, citalopram, which is a bicyclic phthalane derivative.1 Like citalopram and other SSRIs, escitalopram works by blocking the reuptake of the neurotransmitter serotonin into the presynaptic neuron. However, compared to all other SSRIs, escitalopram is the most selective for the serotonin transporter protein rather than the norepinephrine transporter protein, so the drug has fewer side effects.2 Also, escitalopram has a low affinity allosteric binding site on the serotonin transporter, which stabilizes the binding to its main high-affinity site, thereby increasing the duration of its effectiveness. Escitalopram is used to treat depression and anxiety disorders.3

Approved Indications

    • Depression: Escitalopram treats depression by changing the chemical balance of serotonin in the brain, which is thought to improve mood.  
  • Generalized Anxiety Disorder: The FDA has approved escitalopram to treat the symptoms of generalized anxiety disorder, which include excessive worry, sleep disruption, and irritability, among others.
  • Off-label Uses: Studies have also shown that escitalopram may be useful for treating specific anxiety disorders, including panic disorder,4 social anxiety disorder, post-traumatic stress disorder, obsessive-compulsive disorder, and bulimia.5 It may also help treat alcoholism.6 Escitalopram can also reduce the symptoms of premenstrual syndrome and menopause.7

Side Effects and Drug Interactions

Common side effects of escitalopram include:8

  • Drowsiness
  • Sleep disturbance (insomnia)
  • Nausea or upset stomach
  • Gas
  • Heartburn
  • Constipation
  • Weight changes
  • Dry mouth
  • Yawning
  • Ringing in the ears
  • Decreased sex drive, impotence, or difficulty having an orgasm

Patients who experience signs of an allergic reaction should contact a physician immediately. These signs include:

  • Skin rash or hives
  • Difficulty breathing
  • Swelling of the face, lips, tongue, or throat

Patients should also contact a doctor if they experience serious side effects, such as:

  • Rigid muscles
  • High fever or sweating
  • Fast or uneven heartbeats, tremors, or feeling like fainting
  • Nausea, vomiting, diarrhea, loss of appetite
  • Feeling unsteady, loss of coordination
  • Headache, trouble concentrating, memory problems, confusion, hallucination
  • Fainting, seizure, shallow breathing
  • Prolonged erection

Patients who experience new or worsening symptoms of anxiety or depression, or who have suicidal thoughts or ideation, should seek medical help as soon as possible.

Escitalopram should not be taken alongside a monoamine oxidase inhibitor (MAOI) such as furazolidone, isocarboxazid, phenelzine, rasagiline, selegiline, or tranylcypromine. It should also not be taken with other SSRIs.

Other medicines that may interact with escitalopram include:

  • Carbamazepine
  • Cimetidine
  • Lithium
  • Blood thinners such as warfarin
  • Migraine headache medicines such as almotriptan, frovatriptan, sumatriptan, naratriptan, rizatriptan, and zolmitriptan

Escitalopram may cause drowsiness, and other drugs that cause drowsiness can add to this effect. Taking nonsteroidal anti-inflammatory drugs (NSAIDs) alongside escitalopram may cause patients to bruise or bleed more easily. Drinking alcohol may increase the side effects of escitalopram. Patients should also avoid taking tryptophan supplements.9

Latest News and Research

The development of escitalopram began in 1997. It received FDA approval for treating depression in August 2002 and generalized anxiety disorder in December 2003. The development process was unusually fast because developers had already studied the pharmacological effects of citalopram, of which escitalopram is a stereoisomer.10 Because of its chemical similarity to citalopram, some have accused the developers of “evergreening”—that is, trying to extend the patent on the original drug by filing for a patent on a “new” version that is essentially the same.11 However, this claim remains controversial because studies have indicated that escitalopram is indeed more effective for treating depression than citalopram, likely because of its higher selectivity for the serotonin transporter protein and its allosteric binding site.12  

Recent studies have sought to determine whether escitalopram is effective for treating specific anxiety disorders. For instance, one showed that escitalopram relieved symptoms and reduced the risk of relapse in patients with body dysmorphic disorder.13 A study designed to assess the potential of escitalopram for treating alcoholism showed that when mouse models were fed a combination of escitalopram and acamprosate, they consumed less alcohol.14 Another clinical study has shown that escitalopram can decrease the severity of binge-eating disorder and help patients lose weight, but it does not reduce the obsessive-compulsive symptoms of the disease.15 The drug may also reduce stress-related heart problems in patients with stable coronary heart disease.16

There is also ongoing research to assess the safety of escitalopram use. In particular, studies have focused on the dangers of stopping use too abruptly, which can result in Antidepressant Discontinuation Syndrome.17 Many studies have also sought to assess the benefits and risks of using escitalopram while pregnant or breastfeeding, but results are mixed so no definitive conclusions can yet be drawn.

Buying Guide

Many compound pharmacists prefer amitriptyline hydrochloride, which also treats depression and anxiety, and can additionally help with pain management. Please find more information about our Bulk APIs here.

Show 17 footnotes

  1. “Lexapro,” 2016, http://www.rxlist.com/lexapro-drug.htm
  2. “Escitalopram: A New SSRI for the Treatment of Depresion in Primary Care,” 2002, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC315490/
  3. “Escitalopram,” April 25, 2016, https://ncit.nci.nih.gov/ncitbrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&ns=NCI_Thesaurus&code=C61754
  4. “Escitalopram in the Treatment of Panic Disorder: A Randomized, Double-Blid, Placebo-Controlled Trial,” 2003, http://www.psychiatrist.com/JCP/article/Pages/2003/v64n11/v64n1107.aspx
  5. “Escitalopram,” 2016, https://pubchem.ncbi.nlm.nih.gov/compound/Escitalopram#section=Top
  6. Treatment of alcohol dependence in patients with co-morbid major depressive disorder–predictors for the outcomes with memantine and escitalopram medication,” October 3, 2008, http://www.ncbi.nlm.nih.gov/pubmed/18834506
  7. “Selective serotonin reuptake inhibitors for premenstrual syndrome,” June 7, 2013, http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001396.pub3/abstract;jsessionid=74965D20529416C3A6C675FB5882AFB8.f03t01
  8. “Lexapro Side Effects Center,” May 2, 2015, http://www.rxlist.com/lexapro-side-effects-drug-center.htm
  9. “Lexapro Patiet Information Including If I Miss a Dose,” January 13, 2012, http://www.rxlist.com/lexapro-drug/patient-avoid-while-taking.htm#drugs
  10. “Escitalopram (Lexapro),” June 12, 2014, http://www.emedexpert.com/facts/escitalopram-facts.shtml
  11. “NHS pays millions of pounds more than it needs for drugs,” October 4, 2011, http://www.independent.co.uk/life-style/health-and-families/health-news/nhs-pays-millions-of-pounds-more-than-it-needs-to-for-drugs-2365615.html
  12. “Escitalopram is more effective than citalopram for the treatment of severe major depressive disorder,” March 2004, http://www.ncbi.nlm.nih.gov/pubmed/15107719
  13. “Long-term medication use reduces risk of relapse and improves symptoms in BDD patients,” April 11, 2016, http://www.ncbi.nlm.nih.gov/pubmed/15107719
  14. “Combined Effects of Acamprosate and Escitalopram on Ethanol Consumption in Mice,” May 17, 2016, http://www-ncbi-nlm-nih-gov.liboff.ohsu.edu/pubmed/27184383
  15. “High-dose escitalopram in the treatment of binge-eating disorder with obesity: a placebo-controlled monotherapy trial,” January 2008, http://www.ncbi.nlm.nih.gov/pubmed/18058852
  16. “Antidepressant Escitalopram Helps Heart Problems Caused By Stress,” May 22, 2013, http://www.medicalnewstoday.com/articles/260898.php
  17. “Characteristics of Escitalopram Discontinuation Syndrome: A Preliminary Study,” May 2016, http://www-ncbi-nlm-nih-gov.liboff.ohsu.edu/pubmed/27171568