What are the disadvantages of Escitalopram?

From the Guidelines

Escitalopram has several disadvantages, including an increased risk of gastrointestinal bleeding, hepatotoxicity, hyponatremia, QT prolongation, and sexual effects.

• The risk of gastrointestinal bleeding is higher with concurrent use of antiplatelet or nonsteroidal anti-inflammatory drugs, with an odds ratio of 1.2 to 1.5 1.
• Hepatotoxicity is a potential risk, although the risk is lower with SSRIs like escitalopram, with 0.5% to 3% of patients experiencing asymptomatic mild elevation in transaminase levels 1.
• Hyponatremia is a risk, particularly in older adults, with 0.5% to 12% of patients experiencing this side effect, and an odds ratio of 3.3 (95% CI, 1.3 to 8.6) for SSRIs compared with other drug classes 1.
• QT prolongation is a dose-dependent risk, with a boxed warning not to exceed doses of citalopram (the racemic mixture of escitalopram) > 40 mg per day or > 20 mg per day in adults older than 60 years 1.
• Sexual effects are a common side effect, with a weighted mean incidence across observational studies of 40% (95% CI, 28.3 to 52.6), and escitalopram may have a trend toward increased risk compared to other SSRIs 1.
• Additionally, escitalopram may be associated with an increased risk of suicidality, particularly in adults 18 to 24 years of age, with an odds ratio of 2.30 (95% CI, 1.04 to 5.09) 1.
• Discontinuation syndrome is also a risk when stopping escitalopram, particularly if stopped abruptly, with symptoms including dizziness, fatigue, lethargy, and anxiety 1.

From the FDA Drug Label

The most commonly observed adverse reactions in Escitalopram patients (incidence of approximately 5% or greater and approximately twice the incidence in placebo patients) were nausea, ejaculation disorder (primarily ejaculatory delay), insomnia, fatigue, decreased libido, and anorgasmia Common possible side effects in people who take Escitalopram tablets include: • Nausea • Sleepiness • Weakness • Dizziness • Feeling anxious • Trouble sleeping • Sexual problems • Sweating • Shaking • Not feeling hungry • Dry mouth • Constipation • Infection • Yawning Other side effects in children and adolescents include: • increased thirst • abnormal increase in muscle movement or agitation • nose bleed • difficult urination • heavy menstrual periods • possible slowed growth rate and weight change.

The disadvantages of Escitalopram include:

• Common side effects: nausea, sleepiness, weakness, dizziness, feeling anxious, trouble sleeping, sexual problems, sweating, shaking, and others
• Sexual dysfunction: ejaculation disorder, decreased libido, anorgasmia
• Increased risk of certain problems in newborns if taken late in pregnancy
• Potential for drug interactions with other medications, including triptans, lithium, SSRIs, SNRIs, amphetamines, and antipsychotics
• Risk of withdrawal symptoms if stopped suddenly
• Potential for slowed growth rate and weight change in children and adolescents 2 2

From the Research

Disadvantages of Escitalopram

The following are some of the disadvantages of escitalopram:

• The most common adverse events associated with escitalopram include nausea, insomnia, ejaculation disorder, diarrhoea, dry mouth and somnolence 3
• Sexual dysfunction with escitalopram treatment appeared to occur to a similar or lower extent to that with paroxetine, to a similar or greater extent to that with the SNRI duloxetine, and to a greater extent than that with the aminoketone bupropion 4
• Caution is necessary when escitalopram is coadministered with drugs metabolised by CYP2D6, such as metoprolol, or administered to the elderly or patients with severe hepatic or renal impairment 5
• Escitalopram may induce discontinuation symptoms, although it seems to be well tolerated and induces few or no discontinuation symptoms in some cases 6, 5

Adverse Events

Some of the adverse events associated with escitalopram include:

• Nausea: occurred in > 10% of escitalopram-treated patients 3
• Insomnia 3
• Ejaculation disorder 3
• Diarrhoea 3
• Dry mouth 3
• Somnolence 3
• Sexual dysfunction 4

Special Considerations

Special consideration should be taken when administering escitalopram to certain populations, such as:

• Elderly patients 5
• Patients with severe hepatic or renal impairment 5
• Patients taking drugs metabolised by CYP2D6, such as metoprolol 5