Escitalopram 20 Mg Film-Coated Tablets
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PACKAGE LEAFLET: INFORMATION FOR THE PATIENT
CONSILI€NT HEALTH i*
Escitalopram 5 mg film-coated tablets Escitalopram 10 mg film-coated tablets Escitalopram 20 mg film-coated tablets
Escitalopram
Read all of this leaflet carefully before you start taking this medicine because it contains important information for you.
• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor or pharmacist.
• This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
• If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4.
What is in this leaflet
1. What Escitalopram is and what it is used for
2. Before you take Escitalopram
3. How to take Escitalopram
4. Possible side effects
5. How to store Escitalopram
6. Further information
1. What Escitalopram is and what it is used for
Escitalopram contains escitalopram and is used to treat depression (major depressive episodes) and anxiety disorders (such as panic disorder with or without agoraphobia, social anxiety disorder, generalised anxiety disorder and obsessive-compulsive disorder).
Escitalopram belongs to a group of antidepressants called selective serotonin reuptake inhibitors (SSRIs). These medicines act on the serotonin-system in the brain by increasing the serotonin level. Disturbances in the serotonin-system are considered an important factor in the development of depression and related diseases.
It may take a couple of weeks before you start to feel better. Continue to take Escitalopram, even if it takes some time before you feel any improvement in your condition.
You must talk to a doctor if you do not feel better or if you feel worse.
2. What you need to know before you take Escitalopram
Do not take Escitalopram
• if you are allergic to escitalopram or any of the other ingredients of this medicine (listed in section 6),
• if you take other medicines which belong to a group called MAO inhibitors, including selegiline (used in the treatment of Parkinson’s disease), moclobemide (used in the treatment of depression) and linezolid (an antibiotic),
• if you are born with or have had an episode of abnormal heart rhythm (seen at ECG; an examination to evaluate how the heart is functioning),
• if you take medicines for heart rhythm problems or that may affect the heart’s rhythm (see section 2 “Other medicines and Escitalopram”).
Warnings and precautions
Talk to your doctor or pharmacist before taking Escitalopram.
Please tell your doctor if you have any other condition or illness, as your doctor may need to take this into consideration.
In particular, tell your doctor:
• If you have epilepsy. Your doctor will stop treatment with Escitalopram if seizures occur or if there is an increase in the seizure frequency (see also section 4 “Possible side effects”).
• If you suffer from impaired liver or kidney function. Your doctor may need to adjust your dosage.
• If you have diabetes. Treatment with Escitalopram may alter glycaemic control (the level of sugar in the blood). Insulin and/or oral hypoglycaemic dosage may need to be adjusted.
• If you have a decreased level of sodium in the blood.
• If you have a tendency to easily develop bleedings or bruises.
• If you are receiving electroconvulsive treatment (treatment by electroshock).
• If you have coronary heart disease.
• If you suffer or have suffered from heart problems or have recently had a heart attack.
• If you have a low resting heart-rate and/or you know that you may have salt depletion as a result of prolonged severe diarrhoea and vomiting (being sick) or usage of diuretics (water tablets).
• If you experience a fast or irregular heartbeat, fainting, collapse or dizziness on standing up, which may indicate abnormal functioning of the heart rate.
• If you have angle-closure glaucoma or history of glaucoma (increased pressure in the eye).
Please note
Some patients with manic-depressive illness may enter into a manic phase. This is characterized by unusual and rapidly changing ideas, inappropriate happiness and excessive physical activity. If you experience this, contact your doctor.
Symptoms such as restlessness or difficulty to sit or stand still can also occur during the first weeks of the treatment. Tell your doctor immediately if you experience these symptoms.
Thoughts of suicide and worsening of your depression or anxiety disorder
If you suffer from depression or anxiety disorder, you can sometimes have thoughts of harming yourself or killing yourself. These thoughts can occur more frequently at the time of the initiation of taking antidepressants, since a certain period of time is necessary before the medicines start to be effective.
You may be more likely to think like this:
• if you have previously had thoughts about killing or harming yourself
• if you are a young adult. Data from clinical trials indicate an enhanced risk of the suicidal behaviour in adults aged less than 25 years with psychiatric diseases who were treated with an antidepressant.
If you have thoughts of killing or harming yourself at any time, inform your physician without delay or seek for medical care in the closest medical facility.
You will perhaps consider useful to inform your close friends or relatives that you suffer from depressions or anxious disorders and to ask them to read the present Package Leaflet.
You could ask them to tell you, if they believe that your depression or anxiety is getting worse, or if they are worried about changes in your behaviour.
Children and adolescents under 18 years of age
Escitalopram should normally not be used for children and adolescents under 18 years. Also, you should know that patients under 18 have an increased risk of side effects such as suicide attempts, suicidal thoughts and hostility (predominately aggression, oppositional behaviour and anger) when they take this class of medicines. Despite this, your doctor may prescribe Escitalopram for patients under 18 because he/she decides that this is in their best interest. If your doctor has prescribed Escitalopram for a patient under 18 and you want to discuss this, please go back to your doctor. You should inform your doctor if any symptoms listed above develop or worsen when patients under 18 are taking Escitalopram. Also, the long term safety effects concerning growth, maturation and cognitive and behavioural development of Escitalopram in this age group have not yet been demonstrated.
Other medicines and Escitalopram
Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines.
DO NOT TAKE Escitalopram if you take medicines for heart rhythm problems or medicines that may affect the heart’s rhythm, such as Class IA and III antiarrhythmics, antipsychotics (e.g. phenothiazine derivatives, pimozide, haloperidol), tricyclic antidepressants, certain antimicrobial agents (e.g. sparfloxacin, moxifloxacin, erythromycin IV, pentamidine, anti-malarian treatment particularly halofantrine), certain antihistamines (astemizole, mizolastine). If you have any further questions about this you should speak to your doctor.
Tell your doctor if you are taking any of the following medicines:
• ”Non-selective monoamine oxidase inhibitors (MAOIs)” (used to treat depression), containing phenelzine, iproniazid, isocarboxazid, nialamide, and tranylcypromine as active ingredients. If you have taken any of these medicines you will need to wait 14 days before you start taking Escitalopram. After stopping Escitalopram you must allow 7 days before taking any of these medicines.
• “Reversible, selective MAO-A inhibitors”, containing moclobemide (used to treat depression).
• “Irreversible MAO-B inhibitors”, containing selegiline (used to treat Parkinson’s disease). These increase the risk of side effects.
• The antibiotic linezolid.
• Lithium (used in the treatment of manic-depressive disorder) and tryptophan (used to treat depression).
• Imipramine and desipramine (both used to treat depression).
• Sumatriptan and similar medicines (used to treat migraine) and tramadol (used against severe pain). These increase the risk of side effects.
• Cimetidine, lansoprazole and omeprazole (used to treat stomach ulcers), fluvoxamine (antidepressant) and ticlopidine (used to reduce the risk of stroke). These may cause increased blood levels of escitalopram.
• St. John’s Wort (Hypericum Perforatum) - a herbal remedy used for depression.
• Acetylsalicylic acid and non-steroidal anti-inflammatory drugs (medicines used for pain relief or to thin the blood, so called anti-coagulant). These may increase bleeding tendency.
• Warfarin, dipyridamole, and phenprocoumon (medicines used to thin the blood, so called anticoagulant). Your doctor will probably check the coagulation time of your blood when starting and discontinuing Escitalopram in order to verify that your dose of anti-coagulant is still adequate.
• Mefloquin (used to treat Malaria), bupropion (used to treat depression) and tramadol (used to treat severe pain) due to a possible risk of a lowered threshold for seizures.
• Neuroleptics (medicines to treat schizophrenia, psychosis) and antidepressants (tricyclic antidepressants and SSRIs) due to a possible risk of a lowered threshold for seizures.
• Flecainide, propafenone, and metoprolol (used in cardio-vascular diseases), clomipramine, and nortriptyline (antidepressants) and risperidone, thioridazine, and haloperidol (antipsychotics). The dosage of Escitalopram may need to be adjusted.
• Medicines that decrease blood levels of potassium or magnesium as these conditions increase the risk of life-threatening heart rhythm disorder.
Escitalopram with food and alcohol
Escitalopram may be taken with or without food (see section 3 “How to take Escitalopram”).
As with many medicines, combining Escitalopram with alcohol is not advisable, although escitalopram has been shown not to interact with alcohol.
Pregnancy, breast-feeding and fertility
If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.
Do not take Escitalopram if you are pregnant unless you and your doctor have discussed the risks and benefits involved.
If you take Escitalopram during the last 3 months of your pregnancy you should be aware that the following effects may be seen in your newborn baby: trouble with breathing, bluish skin, fits, body temperature changes, feeding difficulties, vomiting, low blood sugar, stiff or floppy muscles, vivid reflexes, tremor, jitteriness, irritability, lethargy, constant crying, sleepiness and sleeping difficulties. If your newborn baby has any of these symptoms, please contact your doctor immediately.
Make sure your midwife and/or doctor know you are on Escitalopram. When taken during pregnancy, particularly in the last 3 months of pregnancy, medicines like Escitalopram may increase the risk of a serious condition in babies, called persistent pulmonary hypertension of the newborn (PPHN), making the baby breathe faster and appear bluish.
These symptoms usually begin during the first 24 hours after the baby is born. If this happens to your baby you should contact your midwife and/or doctor immediately.
If used during pregnancy Escitalopram should never be stopped abruptly.
It is expected that escitalopram will be excreted into breast milk.
Do not take Escitalopram if you are breast-feeding unless you and your doctor have discussed the risks and benefits involved.
Citalopram, a medicine like escitalopram, has been shown to reduce the quality of sperm in animal studies. Theoretically, this could affect fertility, but impact on human fertility has not been observed as yet.
Driving and using machines
Do not drive a car or operate machinery until you know how Escitalopram affects you.
Escitalopram contains lactose
If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicinal product.
3. How to take Escitalopram
Always take this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure.
Adults
Depression
The normally recommended dose of Escitalopram is 10 mg taken as one daily dose. The dose may be increased by your doctor to a maximum of 20 mg per day.
Panic disorder
The starting dose of Escitalopram is 5 mg as one daily dose for the first week before increasing the dose to 10 mg per day. The dose may be further increased by your doctor to a maximum of 20 mg per day.
Social anxiety disorder
The normally recommended dose of Escitalopram is 10 mg taken as one daily dose. Your doctor can either decrease your dose to 5 mg per day or increase the dose to a maximum of 20 mg per day, depending on how you respond to the medicine.
Generalised anxiety disorder
The normally recommended dose of Escitalopram is 10 mg taken as one daily dose. The dose may be increased by your doctor to a maximum of 20 mg per day.
Obsessive-compulsive disorder
The normally recommended dose of Escitalopram is 10 mg taken as one daily dose. The dose may be increased by your doctor to a maximum of 20 mg per day.
Elderly patients (above 65 years of age)
The recommended starting dose of Escitalopram is 5 mg taken as one daily dose. The dose may be increased by your doctor to 10 mg per day.
Use in children and adolescents (below 18 years of age)
Escitalopram should not normally be given to children and adolescents. For further information please see section 2 “What you need to know before you take Escitalopram”.
Route and method of administration
You can take Escitalopram with or without food. Swallow the tablet with some water. Do not chew them, as the taste is bitter.
10 mg and 20 mg tablet: The tablet can be divided into equal doses.
Duration of treatment
It may take a couple of weeks before you start to feel better. Continue to take Escitalopram even if it takes some time before you feel any improvement in your condition.
Do not change the dose of your medicine without talking to your doctor first.
Continue to take Escitalopram for as long as your doctor recommends. If you stop your treatment too soon, your symptoms may return. It is recommended that treatment should be continued for at least 6 months after you feel well again.
If you take more Escitalopram than you should
If you take more than the prescribed dose of Escitalopram, contact your doctor or nearest hospital emergency department immediately. Do this even if there are no signs of discomfort. Some of the signs of an overdose could be dizziness, tremor, agitation, convulsion, coma, nausea, vomiting, change in heart rhythm, decreased blood pressure and change in body fluid/salt balance. Take the Escitalopram box with you when you go to the doctor or hospital.
If you forget to take Escitalopram
Do not take a double dose to make up for a forgotten dose. If you do forget to take a dose, and you remember about it the same day, take it straight away. Carry on as usual the next day. Do not take the missed dose during the night, or the next day, leave the missed dose out and carry on as usual.
If you stop taking Escitalopram
Do not stop taking Escitalopram until your doctor tells you to do so. When you have completed your course of treatment, it is generally advised that the dose of Escitalopram is gradually reduced over a number of weeks.
When you stop taking Escitalopram, especially if it is abruptly, you may feel discontinuation symptoms. These are common when treatment with Escitalopram is stopped. The risk is higher, when Escitalopram has been used for a long time or in high doses or when the dose is reduced too quickly. Most people find that the symptoms are mild and go away on their own within two weeks. However, in some patients they may be severe in intensity or they may be prolonged (2-3 months or more). If you get severe discontinuation symptoms when you stop taking Escitalopram, please contact your doctor. He or she may ask you to start taking your tablets again and come off them more slowly.
Discontinuation symptoms include: Feeling dizzy (unsteady or off-balance), feelings like pins and needles, burning sensations and (less commonly) electric shock sensations, including in the head, sleep disturbances (vivid dreams, nightmares, inability to sleep), feeling anxious, headaches, feeling sick (nausea), sweating (including night sweats), feeling restless or agitated, tremor (shakiness), feeling confused or disorientated, feeling emotional or irritable, diarrhoea (loose stools), visual disturbances, fluttering or pounding heartbeat (palpitations).
If you have any further questions on the use of this medicine, ask your doctor or pharmacist.
4. Possible side effects
Like all medicines, this medicine can cause side effects, although not everybody gets them.
The side effects usually disappear after a few weeks of treatment.
Please be aware that many of the effects may also be symptoms of your illness and therefore will improve when you start to get better.
If you experience any of the following symptoms you should contact your doctor or go to the hospital straight away:
Uncommon (may affect up to 1 in 100 people):
• Unusual bleeds, including gastrointestinal bleeds.
Rare (may affect up to 1 in 1,000 people):
• Swelling of skin, tongue, lips, or face, or have difficulties breathing or swallowing (allergic reaction).
• High fever, kinetic unrest (agitation), confusion, trembling and abrupt contractions of muscles these may be signs of a rare condition called serotonin syndrome.
Not known (frequency cannot be estimated from the available data):
• Difficulties urinating.
• Seizures (fits), see also section Warnings and precautions.
• Yellowing of the skin and the white in the eyes are signs of liver function impairment/hepatitis.
• Fast, irregular heart beat, fainting which could be symptoms of a life-threatening condition known as Torsades de Pointes.
• Thoughts of harming yourself or killing yourself, see also section “Warnings and precautions”.
In addition to above the following side effects have been reported:
Very common (may affect more than 1 in 10 people):
• Feeling sick
• Headache
Common (may affect up to 1 in 10 people):
• Blocked or runny nose (sinusitis)
• Decreased or increased appetite
• Anxiety, restlessness, abnormal dreams, difficulties falling asleep, feeling sleepy, dizziness, yawning, tremors, prickling of the skin
• Diarrhoea, constipation, vomiting, dry mouth
• Increased sweating
• Pain in muscle and joints (arthralgia and myalgia)
• Sexual disturbances (delayed ejaculation, problems with erection, decreased sexual drive and women may experience difficulties achieving orgasm)
• Fatigue, fever
• Increased weight
Uncommon (may affect up to 1 in 100 people):
• Nettle rash (urticaria), rash, itching (pruritus)
• Grinding one’s teeth, kinetic unrest (agitation), nervousness, panic attack, confusion state
• Disturbed sleep, taste disturbance, fainting (syncope)
• Enlarged pupils (mydriasis), visual disturbance, ringing in the ears (tinnitus)
• Loss of hair
• Excessive menstrual bleeding
• Irregular menstrual period
• Decreased weight
• Fast heart beat
• Swelling of the arms or legs
• Nosebleeds
Rare (may affect up to 1 in 1,000 people):
• Aggression, depersonalisation, hallucination
• Slow heart beat
Not known (frequency can not be estimated from available data):
• Decreased levels of sodium in the blood (the symptoms are feeling sick and unwell with weak muscles or confused)
• Dizziness when you stand up due to low blood pressure (orthostatic hypotension)
• Abnormal liver function test (increased amounts of liver enzymes in the blood)
• Movement disorders (involuntary movements of the muscles)
• Painful erections (priapism)
• Signs of increased bleeding e.g. from skin and mucous membranes (ecchymosis) and low level of blood platelets (thrombocytopenia)
• Sudden swelling of skin or mucosa (angioedemas)
• Increase in the amount of urine excreted (inappropriate ADH secretion)
• Flow of milk in men and in women that are not nursing
• Mania
• Alteration of the heart rhythm (called “prolongation of QT interval”, seen on ECG, electrical activity of the heart)
In addition, a number of side effects are known to occur with drugs that work in a similar way to escitalopram. These are:
• Motor restlessness (inability to stay in the rest (akathisia))
• Loss of appetite
An increased risk of bone fractures has been observed in patients taking this type of medicines.
Reporting of side effects
If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via Yellow Card Scheme Website: www.mhra.gov.uk/yellowcard
By reporting side effects you can help provide more information on the safety of this medicine.
5. How to store Escitalopram
Keep this medicine out of the sight and reach of children.
Do not use this medicine after the expiry date which is stated on the packaging. The expiry date refers to the last day of that month.
Store in the original package in order to protect from moisture.
Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.
6. Further information
What Escitalopram contains
• The active active substance is escitalopram.
Each film-coated tablet contains 5 mg escitalopram corresponding to 6.390 mg escitalopram oxalate. Each film-coated tablet contains 10 mg escitalopram corresponding to 12.780 mg escitalopram oxalate. Each film-coated tablet contains 20 mg escitalopram corresponding to 25.560 mg escitalopram oxalate.
• The other ingredients are lactose monohydrate, crospovidone, povidone K30, microcrystalline cellulose, pregelatinised maize starch and magnesium stearate in the tablet core and hypromellose 6cP (E464), titanium dioxide (E171), lactose monohydrate, macrogol 3000, triacetin and black ink (shellac (E904), black iron oxide (E172), propylene glycol (E1520)) in the film-coating (see section 2).
What Escitalopram looks like and contents of the pack
5 mg film-coated tablets: white, round, biconvex film-coated tablets with bevelled edges and diameter 5.5 mm, imprinted with “5” in black colour on one side of the tablet.
10 mg film-coated tablets: white, oval, biconvex film-coated tablets, scored on one side with dimensions 9 x 6 mm, imprinted with “10” in black colour on each side of the tablet. The tablet can be divided into equal doses.
20 mg film-coated tablets: white, oval, biconvex film-coated tablets, scored on one side with dimensions 12 x 7.5 mm, imprinted with “20” in black colour on each side of the tablet. The tablet can be divided into equal doses.
Escitalopram film-coated tablets are available in cartons of 14, 20, 28, 30, 50, 56, 60, 90 and 100 tablets in blisters (OPA/Alu/PVC-Alu).
Not all pack sizes may be marketed.
Marketing Authorisation Holder
KRKA, d.d., Novo mesto, Smarjeska cesta 6, 8501 Novo mesto, Slovenia.
Manufacturer(s)
KRKA, d.d., Novo mesto, Smarjeska cesta 6, 8501 Novo mesto, Slovenia.
TAD Pharma GmbH, Heinz-Lohmann-StraBe 5, 27472 Cuxhaven, Germany.
KRKA - FARMA d.o.o., DPC Jastrebarsko, Cvetkovic bb, 10450 Jastrebarsko, Croatia.
Distributor
Consilient Health (UK) Ltd., 500 Chiswick High Road, London, W4 5RG.
This leaflet was last revised in 04/2014.
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