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Drug Overdoses during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
An overdose of escitalopram (280 mg) at 31 weeks pregnancy presented as acute serotonergic intoxication. At 5 hours post-ingestion, the patient was treated with activated charcoal. She experienced regular uterine contractions, signaling a possible premature delivery. The patient was given intravenous nicardipine and an intramuscular corticosteroid in addition to activated charcoal. After 24 hours, contractions subsided. Spontaneous vaginal delivery at 37 weeks resulted in a normal infant who was extremely agitated. Irritability and nervousness continued for several days (Tixier, 2008), but it seems unlikely that escitalopram persisted for 5 weeks given the half-life of 27–33 hours and six days for terminal clearance.
pushing children into suicide with happy pills
Published in Peter C. Gøtzsche, Richard Smith, Drummond Rennie, Deadly Medicines and Organised Crime, 2019
Peter C. Gøtzsche, Richard Smith, Drummond Rennie
The documents include details of a huge programme of phase IV studies (seeding trials it seems) and describe that investigator grants would cover the costs of ‘Thought Leader Initiated Phase IV studies with Lexapro’. The outcome of all these studies seemed to have been determined beforehand, even before the studies started, as key messages were listed for each study: Escitalopram has the lowest potential for drug interactionsEscitalopram has an excellent dosing profileEscitalopram represents a new more selective and/or potent generation of SSRIsEscitalopram is an effective first-line treatment for depressionEscitalopram has a favourable side-effect profileEscitalopram has improved side-effect, drug interaction and safety profiles resulting from the removal of the inactive moiety, the R-enantiomerEscitalopram is a refinement of citalopram in terms of antidepressant effect and tolerability.
Information on level of drugs into breastmilk
Published in Wendy Jones, Breastfeeding and Medication, 2018
Escitalopram is the S-enantiomer of citalopram. Its mechanism of action is similar but it is claimed to have a faster onset of action. Rampono et al. (2006) studied eight mothers taking escitalopram for post-natal depression. Results showed that the total relative infant dose for escitalopram plus its demethyl metabolite was 5.3%. All of the infants in the study met normal developmental milestones and no adverse effects were seen. The side-effect profile may be expected to be lower than that of citalopram as the dose is smaller reflecting use of the active enantiomer. Relative infant dose is quoted as 5.28% (Hale 2017 online access).
SSRI withdrawal syndrome in children and adolescents: a narrative literature review
Published in Expert Opinion on Drug Safety, 2023
Yasser Saeed Khan, Mohamed Adil Shah Khoodoruth, Yahia Albobali, Peter M. Haddad
A book chapter by Hernández-Otero and colleagues reviewed the scientific evidence for the use of antidepressants in children and adolescents [34]. It reported that downward titration at the time of discontinuation is not needed in the case of fluoxetine due to its long half-life. For Sertraline, it proposed a gradual reduction of dose to avoid withdrawal symptoms. It concluded that some patients could tolerate a reduction of 50% of the total dose over 3 days and the remaining 50% dose reduction over the subsequent 3 days. The recommendation is not much different for citalopram except that no progressive reduction is necessary however, a gradual reduction in the rate similar to what is reported for Sertraline is advisable. In relation to Escitalopram, the authors advise that it is wise to carry out a gradual titration to avoid withdrawal syndrome.
An overview of the pharmacotherapeutics for dystonia: advances over the past decade
Published in Expert Opinion on Pharmacotherapy, 2022
O. Abu-hadid, J. Jimenez-Shahed
The serotonergic system is postulated to play a role in the pathogenesis of dystonia, based on known connections between the dorsal raphe nuclei and the basal ganglia [80]. Escitalopram is a highly selective SSRI that increases the synaptic availability of serotonin with minimal influence on the dopaminergic and noradrenergic systems [81]. A DB-RCT with a cross over design evaluated eight patients with CD who received escitalopram and compared the binding potential of striatal D2 and D3 receptors, dopamine transporter, and extrastriatal serotonin transporter [82]. The study only shows a trend for a higher serotonin transporter occupancy in patients who received escitalopram and had a perceived improvement in their dystonia [82]. Another DB-RCT, with a cross over design, studied the effect of escitalopram on patients with CD, already on botulinum toxin, and associated dystonic tremor/jerks [83]. The study shows no additional improvement on dystonia measures as well as in the dystonic tremors/jerks that were resistant to botulinum toxin [83].
Routinely accessible parameters of mineralocorticoid receptor function, depression subtypes and response prediction: a post-hoc analysis from the early medication change trial in major depressive disorder
Published in The World Journal of Biological Psychiatry, 2022
Jan Engelmann, Harald Murck, Stefanie Wagner, Lea Zillich, Fabian Streit, David P. Herzog, Dieter F. Braus, Andre Tadic, Klaus Lieb, Marianne B. Műller
If necessary, antidepressant medication before study entry was washed out. During the first two weeks of treatment, all patients received escitalopram (up to 20 mg per day). From day 15 onwards, patients were treated according to study protocol. Concurrent medication for general medical conditions was not changed. Associated symptoms (e.g. insomnia) or adverse drug reactions (e.g. agitation or anxiety) were allowed to be treated with short-acting hypnotics (zolpidem or zopiclone), low potency antipsychotic drug (e.g. pipamperone), histamine-receptor antagonist like promethazine in standard doses as well as benzodiazepines in a dose-equivalent up to 1.5 mg lorazepam per day. Concurrent medication, specifically cardiac concurrent medication (ACE inhibitors, angiotensin-II-receptor-antagonists, beta-blockers, and diuretics), was monitored in weekly intervals and included in the analysis. Patients treated with mineralocorticoid receptor antagonists or renin-inhibitors (N = 2) were excluded from analyses due to the direct influence on the RAAS.