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психиатр | 03.ru - медицинские консультации онлайн
- психиатр 10:08 09-02-2006 / Ольга, обратиться
-
В течение пяти месяцев принимала антидепрессант Lyxapro. Потом резко прекратила. Через пару недель начались непроходящие головокружения, впечатление будто тело состоит из двух оболочек, и движение внутренней явно не успевают за движениями внешней. В упаковке оставалось еще три таблетки, решила одну принять. В результате на два дня все как рукой сняло. Это что привыкание? И как же обойтись теперь без этого препарата? Когда это пройдет?
Спасибо.
Ответы
Ответить
Lexapro is used to treat depression and generalized anxiety disorder (excessive worrying that is difficult to control). Lexapro is in a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs). It works by increasing the amount of serotonin, a natural substance in the brain that helps maintain mental balance. Lexapro® information section contains essential Lexapro facts which to help you gain useful information about the benefits of Lexapro. The following information is a summary about Lexapro. It is not intended to replace a doctors instructions.
LEXAPRO INFORMATION
Brand Name: Lexapro®
Generic Name: Lexapro (Escitalopram Oxalate)
is an orally administered selective serotonin reuptake inhibitor (SSRI), and is used for the treatment of major depressive disorder.
See Also:
Other Antidepressants:
Anxiety Information
Depression Information
Buspar
Buspirone
Effexor XR
Fluoxetine
Paxil
Zoloft
HOW DOES LEXAPRO WORK ?
The mechanism of antidepressant action of escitalopram, the S- enantiomer of racemic citalopram, is presumed to be linked to potentiation of serotonergic activity in the central nervous system resulting from its inhibition of CNS neuronal reuptake of serotonin (5- HT). In vitro and in vivo studies in animals suggest that escitalopram is a highly selective serotonin reuptake inhibitor (SSRI) with minimal effects on norepinephrine and dopamine neuronal reuptake. Escitalopram is at least 100 fold more potent than the R- enantiomer with respect to inhibition of 5- HT reuptake and inhibition of 5- HT neuronal firing rate. Consult your physician or pharmacist for further information.
LEXAPRO INGREDIENTS AND COMPOSITION
Escitalopram is the pure S- enantiomer (single isomer) of the racemic bicyclic phthalane derivative citalopram. Escitalopram oxalate is designated S- (+ )- 1- [3- (dimethyl- amino)propyl]- 1- (p- fluorophenyl)- 5- phthalancarbonitrile oxalate.
Lexapro tablets also contain the following inactive ingredients:
talc
croscarmellose sodium
microcrystalline cellulose/ colloidal silicon dioxide
magnesium stearate.
The film coating contains hydroxypropyl methyl cellulose, titanium dioxide, and polyethylene glycol.
LEXAPRO CLINICAL TRIALS AND STUDIES
The efficacy of Lexapro as a treatment for major depressive disorder has been established, in part, on the basis of extrapolation from the established effectiveness of racemic citalopram, of which escitalopram is the active isomer. In addition, the efficacy of escitalopram was shown in an 8- week fixed dose study that compared 10 mg/ day Lexapro and 20 mg/ day Lexapro to placebo and 40 mg/ day citalopram, in outpatients between 18 and 65 years of age who met DSM- IV criteria for major depressive disorder. The 10 mg/ day and 20 mg/ day Lexapro treatment groups showed significantly greater mean improvement compared to placebo on the Montgomery Asberg Depression Rating Scale (MADRS). The 10 mg and 20 mg Lexapro groups were similar in mean improvement on the MADRS score.
Analyses of the relationship between treatment outcome and age, gender, and race did not suggest any differential responsiveness on the basis of these patient characteristics. Longer- term efficacy of escitalopram in major depressive disorder has not been systematically evaluated; however, longer- term efficacy of racemic citalopram in this population has been established. In two longer- term studies, patients meeting DSM- III- R criteria for major depressive disorder who had responded (MADRS 22) or a judgement by an independent review board that discontinuation was due to relapse, was for up to 72 weeks. Patients receiving continued racemic citalopram treatment experienced significantly lower relapse rates over the subsequent 72 weeks compared to those receiving placebo.
HOW TO TAKE LEXAPRO AND LEXAPRO DOSAGE AND ADMINISTRATION
Initial treatment
The recommended dose of Lexapro is 10 mg once daily. Afixed dose trial of Lexapro demonstrated the effectiveness of both 10 mg and 20 mg of Lexapro, but failed to demonstrate a greater benefit of 20 mg over 10 mg. If the dose is increased to 20 mg, this should occur after a minimum of one week.
Lexapro should be administered once daily, in the morning or evening, with or without food.
Maintenance Treatment
It is generally agreed that acute episodes of depression require several months or longer of sustained pharmacological therapy beyond response to the acute episode. Lexapro has not been evaluated in controlled, longer- term trials. However, systematic evaluation of racemic citalopram in two studies has demonstrated a benefit of maintaining treatment following response occurring during 6 to 8 weeks of initial treatment. In both studies, patients were observed for relapse during an observation period of up to 24 weeks. In one study, patients were assigned randomly to placebo or to the same dose of racemic citalopram (20- 60 mg/ day) during maintenance treatment as they had received during the acute stabilization phase, while in the other study, patients were assigned randomly to continuation of racemic citalopram 20 or 40 mg/ day, or placebo, for maintenance treatment. In the latter study, the rates of relapse to depression were similar for the two dose groups. A third longer- term study has demonstrated the efficacy of racemic citalopram in maintaining an antidepressant response in patients with recurrent depression who had responded and continued to be improved during an initial 22- 25 weeks of treatment and were then observed for relapse for a period of up to 72 weeks. Patients should be periodically reassessed to determine the need for maintenance treatment and the appropriate dose for such treatment. Consult your physician or pharmacist for further information.
LEXAPRO SIDE EFFECTS
Lexapro Side Effects - See Here
LEXAPRO PRECAUTIONS
Before taking Lexapro (escitalopram),
tell your doctor or pharmacist if you are allergic to escitalopram, citalopram (Celexa), or any other medications.
do not take escitalopram if you are taking an MAO inhibitor such as phenelzine (Nardil) or tranylcypromine (Parnate) or have stopped taking them in the last 2 weeks.
you should know that escitalopram is very similar to another SSRI, citalopram (Celexa). You should not take these two medications together.
tell your doctor or pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention anticoagulants ('blood thinners') such as warfarin (Coumadin); antihistamines; aspirin and other nonsteroidal anti- inflammatory medications (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn); carbamazepine (Tegretol); cimetidine (Tagamet); ketoconazole (Sporanox); lithium (Eskalith, Lithobid, Lithotabs); medications for anxiety, mental illness, or seizures; metoprolol (Lopressor, Toprol XL); other antidepressants such as desipramine (Norpramin); sedatives; sleeping pills; sumatriptan (Imitrex); and tranquilizers. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
tell your doctor if you have or have ever had, or anyone in your family has or has ever had, depression, bipolar disorder (mood that changes from depressed to abnormally excited), or mania (frenzied, abnormally excited mood), or have thought about or attempted suicide. Also tell your doctor if you have recently had a heart attack and if you have or have ever had seizures or liver, kidney, thyroid, or heart disease.
tell your doctor if you are pregnant, plan to become pregnant, or are breast- feeding. If you become pregnant while taking escitalopram, call your doctor.
if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking escitalopram.
you should know that escitalopram may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you.
remember that alcohol can add to the drowsiness caused by this medication.
you should know that your mental health may change in unexpected ways, especially at the beginning of your treatment and at any time your dose is increased or decreased. These changes may occur at any time if you have depression or other mental illness, whether or not you are taking escitalopram or any other medication. You, your family, or your caregiver should call your doctor right away if you experience any of the following symptoms: new or worsening depression; thinking about harming or killing yourself or planning or trying to do so; extreme worry; agitation; panic attacks; difficulty falling or staying asleep; irritability; aggressive behavior; acting without thinking; severe restlessness; and frenzied abnormal excitement. Be sure that your family or caregiver knows which symptoms may be serious so they can call the doctor when you are unable to seek treatment on your own.
LEXAPRO CONTRAINDICATIONS
Concomitant use in patients taking monoamine oxidase inhibitors (MAOI's) is contraindicated.
Lexapro is contraindicated in patients with a hypersensitivity to escitalopram or citalopram or any of the inactive ingredients in Lexapro.
Because psychoactive drugs may impair judgment, thinking or motor skills, patients should be cautioned about operating hazardous machinery, including automobiles, until they are reasonably certain that Lexapro therapy does not affect their ability to engage in such activities.
Patients should be told that, although citalopram has not been shown in experiments with normal subjects to increase the mental and motor skill impairments caused by alcohol, the concomitant use of Lexapro and alcohol in depressed patients is not advised. Consult your physician or pharmacist for further information.
LEXAPRO EXPERIENCES AND RESULTS
The efficacy of Lexapro in the treatment of major depressive disorder was established, in part, on the basis of extrapolation from the established effectiveness of racemic citalopram, of which escitalopram is the active isomer. In addition, the efficacy of escitalopram was shown in an 8- week controlled trial of outpatients whose diagnoses corresponded most closely to the DSM- IV category of major depressive disorder.
The efficacy of Lexapro in hospitalized patients with major depressive disorders has not been adequately studied. While the longer- term efficacy of Lexapro has not been systematically evaluated, the efficacy of racemic citalopram, of which escitalopram is the active isomer, in maintaining a response following 6 to 8 weeks of acute treatment in patients with major depressive disorder was demonstrated in two placebo- controlled trials, in which patients were observed for relapse for up to 24 weeks. The efficacy of racemic citalopram in maintaining a response in patients with recurrent major depressive disorder who had responded and continued to be improved during an initial 22- 25 weeks of treatment and were then followed for a period of up to 72 weeks was demonstrated in a third placebo- controlled trial. Nevertheless, the physician who elects to use Lexapro for extended periods should periodically reevaluate the long- term usefulness of the drug for the individual patient.
TAKING LEXAPRO DURING PREGNANCY OR BREAST- FEEDING
There are no adequate and well- controlled studies in pregnant women; therefore, escitalopram should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
Lexapro, like many other drugs, is excreted in human breast milk. There have been two reports of infants experiencing excessive somnolence, decreased feeding, and weight loss in association with breast feeding from a Lexapro- treated mother; in one case, the infant was reported to recover completely upon discontinuation of citalopram by its mother and, in the second case, no follow up information was available. The decision whether to continue or discontinue either nursing or Lexapro therapy should take into account the risks of citalopram exposure for the infant and the benefits of Lexapro treatment for the mother. Consult your physician or pharmacist for further information.
LEXAPRO MISSED DOSE AND OVERDOSE
Lexapro Missed Dose :
Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.
Lexapro Overdose :
There have been three reports of Lexapro overdose involving doses of up to 600 mg. All three patients recovered and no symptoms associated with the overdoses were reported. In clinical trials of racemic citalopram, there were no reports of fatal citalopram overdose involving overdoses of up to 2000 mg. During the postmarketing evaluation of citalopram, like other SSRIs, a fatal outcome in a patient who has taken an overdose of citalopram has been rarely reported. Postmarketing reports of drug overdoses involving citalopram have included 12 fatalities, 10 in combination with other drugs and/ or alcohol and 2 with citalopram alone (3920 mg and 2800 mg), as well as non- fatal overdoses of up to 6000 mg. Symptoms most often accompanying citalopram overdose, alone or in combination with other drugs and/ or alcohol, included dizziness, sweating, nausea, vomiting, tremor, somnolence, sinus tachycardia, and convulsions. In more rare cases, observed symptoms included amnesia, confusion, coma, hyperventilation, cyanosis, rhabdomyolysis, and ECG changes (including QTc prolongation, nodal rhythm, ventricular arrhythmia, and one possible case of Torsades de pointes).
Overdose Management
Establish and maintain an airway to ensure adequate ventilation and oxygenation. Gastric evacuation by lavage and use of activated charcoal should be considered. Careful observation and cardiac and vital sign monitoring are recommended, along with general symptomatic and supportive care. Due to the large volume of distribution of escitalopram, forced diuresis, dialysis, hemoperfusion, and exchange transfusion are unlikely to be of benefit. There are no specific antidotes for Lexapro.
In managing overdosage, consider the possibility of multiple drug involvement. The physician should consider contacting a poison control center for additional information on the treatment of any overdose.
LEXAPRO STORAGE
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.
COMMON LEXAPRO MISSPELLINGS
Lexapro (branded tablet form Escitalopram) is sometimes misspelled. The most frequent examples are Leksapro, Lexapo, Lexapro, Lexaro, Lixapro, Lyxapro, Lexopro, Lexapra, Lexapr, Leapro, Leksopro, Lexapro, Lexabro and Mexapro. Full correct name of this prescription drug is "Lexapro".