From the Guidelines
Cipralex (escitalopram) is a recommended treatment option for patients with acute major depression, due to its favorable adverse effect profile and cost, as suggested by the American College of Physicians 1.
Key Considerations for Cipralex Use
- The typical starting dose of Cipralex is 10mg once daily, which may be increased to 20mg daily if needed after at least one week.
- Treatment usually continues for at least 6 months after symptom improvement to prevent relapse, and often longer for recurrent depression, as recommended by the American College of Physicians 1.
- Common side effects of Cipralex include nausea, insomnia, sexual dysfunction, headache, and increased sweating, which often improve with continued use.
- Cipralex works by increasing serotonin levels in the brain by blocking its reuptake, which helps regulate mood, emotion, and anxiety.
- The medication typically takes 2-4 weeks to show significant therapeutic effects, though some patients may notice improvements sooner.
Important Safety Precautions
- Abrupt discontinuation of Cipralex should be avoided; instead, the dose should be gradually tapered over at least 1-2 weeks to minimize withdrawal symptoms.
- Cipralex should not be combined with monoamine oxidase inhibitors (MAOIs) and caution is needed when using it with other medications that affect serotonin levels to avoid serotonin syndrome, as noted in the clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders 1.
- Cipralex may have a lower propensity for drug interactions compared to other SSRIs, as it has the least effect on CYP450 isoenzymes, making it a safer option for patients taking multiple medications 1.
From the FDA Drug Label
Escitalopram tablets contains escitalopram oxalate, an orally administered selective serotonin reuptake inhibitor (SSRI). Escitalopram is the pure S-enantiomer (single isomer) of the racemic bicyclic phthalane derivative citalopram The FDA drug label does not answer the question about Cipralex.
From the Research
Overview of Cipralex
- Cipralex, also known as escitalopram, is a selective serotonin reuptake inhibitor (SSRI) used for the treatment of major depressive disorder (MDD) and anxiety disorder 2, 3, 4, 5, 6.
- It exerts a highly selective, potent, and dose-dependent inhibitory effect on the human serotonin transport, enhancing the activity of serotonin in the central nervous system 2, 3.
Efficacy of Cipralex
- Escitalopram has been shown to be effective in the treatment of MDD, with studies demonstrating its superiority to placebo and comparability to other SSRIs and serotonin-noradrenaline reuptake inhibitors (SNRIs) 2, 3, 6.
- It has also been found to be effective in the treatment of generalized anxiety disorder (GAD), with significant improvements in anxiety symptoms compared to placebo 4.
- Long-term administration of escitalopram has been shown to have a preventive effect on MDD relapse and recurrence 2, 3.
Tolerability and Safety of Cipralex
- Escitalopram has been found to have a predictable tolerability profile, with generally mild to moderate and transient adverse events 3, 5.
- The most common adverse event associated with escitalopram is nausea, with an incidence of ≥10% and ≥5 percentage points greater than with placebo during short-term treatment 5.
- Escitalopram has been found to have a lower risk of discontinuation symptoms compared to paroxetine, and a similar risk of suicidal behavior compared to placebo 5.
Comparison to Other Treatments
- Escitalopram has been found to be at least as effective as other SSRIs, such as citalopram, fluoxetine, paroxetine, and sertraline, and SNRIs, such as venlafaxine, in the treatment of MDD 2, 3, 6.
- It has also been found to be cost-effective compared to other SSRIs and venlafaxine extended release 3, 6.