From the Guidelines
Escitalopram has several disadvantages, including potential for QT prolongation, sexual effects, and discontinuation syndrome.
Disadvantages of Escitalopram
- QT Prolongation: Escitalopram may cause QT prolongation, which can lead to serious cardiac arrhythmias, particularly when used at high doses or in combination with other medications that prolong the QT interval 1.
- Sexual Effects: Escitalopram has been associated with a high incidence of sexual effects, including decreased libido and difficulty achieving orgasm, with a weighted mean incidence of 40% across observational studies 1.
- Discontinuation Syndrome: Escitalopram, like other SSRIs, can cause a discontinuation syndrome characterized by dizziness, fatigue, and irritability when stopped abruptly or tapered too quickly 1.
- Interactions with Other Medications: Escitalopram may interact with other medications, including monoamine oxidase inhibitors (MAOIs), which can increase the risk of serotonin syndrome 1.
- Risk of Suicidality: Escitalopram, like other antidepressants, may increase the risk of suicidality, particularly in younger adults, although the evidence is not conclusive 1.
Important Considerations
When prescribing escitalopram, it is essential to:
- Start with a low dose and gradually increase as needed and tolerated 1.
- Monitor patients for signs of QT prolongation, particularly those with pre-existing cardiac conditions 1.
- Inform patients about the potential for sexual effects and discontinuation syndrome 1.
- Be aware of potential interactions with other medications and adjust the treatment plan accordingly 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: