Nexito (Escitalopram): Medication Classification
Nexito is a selective serotonin reuptake inhibitor (SSRI), specifically the S-enantiomer of citalopram, classified as a second-generation antidepressant used primarily for treating major depressive disorder and anxiety disorders. 1
Pharmacological Class and Mechanism
Escitalopram belongs to the SSRI class of second-generation antidepressants, which work by selectively inhibiting the presynaptic reuptake of serotonin in the brain, thereby increasing serotonin availability at the synaptic cleft 1
It is the most selective serotonin transporter inhibitor currently available, demonstrating highly selective and potent, dose-dependent inhibition of the human serotonin transporter 2, 3
The medication works through a multistep process: blocking serotonin reuptake leads to downregulation of inhibitory serotonin autoreceptors over time, which eventually heightens serotonergic neuronal firing rate and increases serotonin release 1
Clinical Indications
Primary approved uses include:
Major depressive disorder (MDD) - effective for treating depressive symptoms with moderate to high quality evidence 1, 3
Anxiety disorders - including generalized anxiety disorder, social anxiety disorder, separation anxiety disorder, and panic disorder 1, 4
Dysthymia - chronic depressive disorder characterized by depressed mood on most days for at least 2 years 1
Distinguishing Characteristics
Escitalopram is the S-enantiomer of the racemic drug citalopram, making it approximately twice as potent as the racemate 2, 5
It demonstrates faster onset of antidepressant action compared to citalopram, with statistically significant improvements in depression and anxiety symptoms after 1 week of treatment versus 4-6 weeks for citalopram 5
The drug has low protein binding (56%) and is unlikely to cause interactions with highly protein-bound drugs 6
Elimination half-life is 27-33 hours, consistent with once-daily dosing, with steady-state concentrations achieved within 7-10 days 6
Safety Profile
Escitalopram is generally well tolerated with mild to moderate and transient adverse events, including nausea, diarrhea, dizziness, dry mouth, headache, somnolence, insomnia, and sexual dysfunction 1, 3
It has a low propensity for drug interactions due to negligible inhibitory effects on CYP isoenzymes and P-glycoprotein 6
Critical warning: Never combine with other SSRIs (such as sertraline or citalopram) due to high risk of serotonin syndrome, a potentially life-threatening condition 7