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Concomitant Medications Since escitalopram is the active isomer of racemic citalopram Celexa , the two agents should not be coadministered. Patients should be advised to inform their physician if they are taking, or plan to take, any prescription or over-the-counter drugs, as there is a potential for interactions. Continuing The Therapy Prescribed While patients may notice improvement with Lexapro therapy in 1 to 4 weeks, they should be advised to continue therapy as directed.

Interference With Psychomotor Performance Because psychoactive drugs may impair judgment, thinking, or motor skills, patients should be cautioned about operating hazardous machinery, including automobiles, until they are reasonably certain that Lexapro therapy does not affect their ability to engage in such activities. Alcohol Patients should be told that, although Lexapro has not been shown in experiments with normal subjects to increase the mental and motor skill impairments caused by alcohol, the concomitant use of Lexapro and alcohol in depressed patients is not advised.

Pregnancy And Breast Feeding Patients should be advised to notify their physician if they become pregnant or intend to become pregnant during therapy. Need For Comprehensive Treatment Program Lexapro is indicated as an integral part of a total treatment program for MDD that may include other measures psychological, educational, social for patients with this syndrome.

Drug treatment may not be indicated for all adolescents with this syndrome. Safety and effectiveness of Lexapro in MDD has not been established in pediatric patients less than 12 years of age. Appropriate educational placement is essential and psychosocial intervention is often helpful. A no-effect dose for this finding was not established. The relevance of these findings to humans is unknown. However, coadministration of escitalopram 20 mg and ritonavir mg , a potent inhibitor of CYP3A4, did not significantly affect the pharmacokinetics of escitalopram.

Because escitalopram is metabolized by multiple enzyme systems, inhibition of a single enzyme may not appreciably decrease escitalopram clearance. In addition, steady state levels of racemic citalopram were not significantly different in poor metabolizers and extensive CYP2D6 metabolizers after multiple-dose administration of citalopram, suggesting that coadministration, with escitalopram, of a drug that inhibits CYP2D6, is unlikely to have clinically significant effects on escitalopram metabolism.

However, there are limited in vivo data suggesting a modest CYP2D6 inhibitory effect for escitalopram, i. The clinical significance of this finding is unknown. Nevertheless, caution is indicated in the coadministration of escitalopram and drugs metabolized by CYP2D6. Increased metoprolol plasma levels have been associated with decreased cardioselectivity. Coadministration of Lexapro and metoprolol had no clinically significant effects on blood pressure or heart rate. Slight maternal toxicity clinical signs and decreased body weight gain and food consumption was seen at this dose.

This dose was also associated with maternal toxicity clinical signs, decreased body weight gain. Thus, teratogenic effects of racemic citalopram were observed at a maternally toxic dose in the rat and were not observed in the rabbit.

When female rats were treated with racemic citalopram 4. The no-effect dose was A no-effect dose was not determined in that study. There are no adequate and well-controlled studies in pregnant women; therefore, escitalopram should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Pregnancy-Nonteratogenic Effects Neonates exposed to Lexapro and other SSRIs or serotonin and norepinephrine reuptake inhibitors SNRIs , late in the third trimester have developed complications requiring prolonged hospitalization, respiratory support, and tube feeding.

Such complications can arise immediately upon delivery. Reported clinical findings have included respiratory distress, cyanosis, apnea, seizures, temperature instability, feeding difficulty, vomiting, hypoglycemia, hypotonia, hypertonia, hyperreflexia, tremor, jitteriness, irritability, and constant crying. It should be noted that, in some cases, the clinical picture is consistent with serotonin syndrome [see Warnings and Precautions 5. PPHN occurs in 1 - 2 per 1, live births in the general population and is associated with substantial neonatal morbidity and mortality.

Other studies do not show a significant statistical association. Physicians should also note the results of a prospective longitudinal study of pregnant women with a history of major depression, who were either on antidepressants or had received antidepressants less than 12 weeks prior to their last menstrual period, and were in remission.

Women who discontinued antidepressant medication during pregnancy showed a significant increase in relapse of their major depression compared to those women who remained on antidepressant medication throughout pregnancy. When treating a pregnant woman with Lexapro, the physician should carefully consider both the potential risks of taking an SSRl, along with the established benefits of treating depression with an antidepressant. This decision can only be made on a case by case basis [see Dosage and Administration 2.

Labor and Delivery The effect of Lexapro on labor and delivery in humans is unknown. Nursing Mothers Escitalopram is excreted in human breast milk. Limited data from women taking mg escitalopram showed that exclusively breast-fed infants receive approximately 3. There were two reports of infants experiencing excessive somnolence, decreased feeding, and weight loss in association with breastfeeding from a racemic citalopram-treated mother; in one case, the infant was reported to recover completely upon discontinuation of racemic citalopram by its mother and, in the second case, no follow-up information was available.

Caution should be exercised and breastfeeding infants should be observed for adverse reactions when Lexapro is administered to a nursing woman.

Pediatric Use The safety and effectiveness of Lexapro have been established in adolescents 12 to 17 years of age for the treatment of major depressive disorder [see Clinical Studies Although maintenance efficacy in adolescent patients with major depressive disorder has not been systematically evaluated, maintenance efficacy can be extrapolated from adult data along with comparisons of escitalopram pharmacokinetic parameters in adults and adolescent patients.

The safety and effectiveness of Lexapro have not been established in pediatric younger than 12 years of age patients with major depressive disorder. Patients should be monitored for the emergence of serotonin syndrome or NMS-like signs and symptoms. If concomitant treatment of Lexapro with a 5-hydroxytryptamine receptor agonist triptan is clinically warranted, careful observation of the patient is advised, particularly during treatment initiation and dose increases. The concomitant use of Lexapro with serotonin precursors such as tryptophan is not recommended.

Treatment with Lexapro and any concomitant serotonergic or antidopaminergic agents, including antipsychotics, should be discontinued immediately if the above events occur and supportive symptomatic treatment should be initiated. Discontinuation of Treatment with Lexapro During marketing of Lexapro and other SSRIs and SNRIs serotonin and norepinephrine reuptake inhibitors , there have been spontaneous reports of adverse events occurring upon discontinuation of these drugs, particularly when abrupt, including the following: While these events are generally self-limiting, there have been reports of serious discontinuation symptoms.

Patients should be monitored for these symptoms when discontinuing treatment with Lexapro. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered.

Subsequently, the physician may continue decreasing the dose but at a more gradual rate see Dosage and Administration. Seizures Although anticonvulsant effects of racemic citalopram have been observed in animal studies, Lexapro has not been systematically evaluated in patients with a seizure disorder.

These patients were excluded from clinical studies during the product's premarketing testing. Due to server maintenance we are not accepting new questions at this moment. I was on 10mg Paxil doing well but experieince rapid heart beat episodes which was. I take Keppra mg twice a day, lexapro at night and multivitamins. Keep working with your doctor to find a drug or combination that works for you.

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