EscitalopramReturn to Escitalopram overview
After a couple of weeks my sleeping patterns regulated to how they had been before I began the medication
Whilst taking escitalopram some people may think about hurting themselves or have suicidal thoughts. This can happen to anyone, including people who are under 25.
These thoughts may happen or get worse in the first few weeks of taking the medicine until the depression starts to improve. Always tell a friend or a family member if you feel this way.
If you have ever had thoughts about hurting yourself or had suicidal thoughts before starting the medicine, you may be more likely to feel this again when you start the medicine. Tell your doctor so that everyone can watch for this happening.
You must go straight to hospital with your medicine if you have any of these thoughts. You must tell the doctor that you are taking escitalopram. There are other things you can take instead.
Escitalopram has fewer side effects than many other medicines used for depression, but if they happen they can be serious
Stop taking escitalopram and go to a doctor or hospital straight away if you get any of the following symptoms:
- Difficulty breathing
- Swelling of your face, lips, tongue or throat so that you cannot swallow or breathe
- Really bad itching of the skin (with raised lumps)
- Difficulty going for a pee (urinating)
- Yellowing of the skin and the whites of the eyes
- Fast, uneven heartbeat and fainting - this could mean a life-threatening condition called ‘torsades de pointes’
Go to a doctor or hospital straight away, but do not stop your escitalopram, if you get any of the following symptoms:
- You start having fits (seizures) for the first time, or if fits that you have had in the past happen more often
- Your behaviour changes because you feel very happy or over excited
- Any unusual bleeding, including bleeding from your gut coming out in your poo
- You get a high temperature/fever, agitation, confusion, trembling or weird muscle movements. These may be signs of a rare condition called ‘serotonin syndrome’
- Tiredness, confusion and muscle twitching. You may have a low blood level of sodium
- Restlessness, or difficulty sitting or standing still
- Dizziness, feeling sick or being sick
Young people under 25 taking escitalopram can get serious side-effects
- Young people under 25 have an increased risk of trying to trying to take their own lives, thinking about taking their own lives, and hostility (mostly aggression, oppositional behaviour and anger) when they take escitalopram.
- This is why it is not licensed for people under 18 years. If you are under 18, make sure that you and your doctor have talked about what to do if you get these side effects.
- You and your doctor may decide together that the benefits are greater than the risks for you.
- If you are taking escitalopram and have not talked about this with your doctor, go back to them and talk it through. You might also want to talk to your parents or carers about it.
Some side-effects that do appear should get better after a few days. If they do not, you should go back to your doctor. If you get any side effects not listed here please look at the patient leaflet in the medicine pack
Some side-effects of escitalopram may – strangely - seem like other mental health symptoms. Some side-effects here are also the opposites of each other. The balance of chemicals in the brain is very fragile, and hard to control! If they do not get better after a few days on the tablets, go back to the doctor.
Do not stop taking the tablets until you talk to your doctor, or you may get withdrawal symptoms as well.
Very common side effects (could affect more than 1 in 10 people)
- Feeling sick
Common side effects (could affect up to 1 in 10 people)
- Strange dreams, difficulty going to sleep
- Feeling very tired or sleepy
- Unusual yawning
- Feeling anxious or restless
- Tingling or numbness in the hands or feet
- Shaking (tremor)
- Skin feeling prickly
- Weight gain
- Changes in appetite
- Diarrhoea or constipation
- Being sick
- Dry mouth
- Fever and increased sweating
- Pain in muscles and joints
- Blocked or runny nose (sinusitis)
- Lower sex drive, difficulty coming on during sex, difficulty getting an erection
There are other side-effects that you can get when taking this medicine – we have only included the most common ones here.
- Please look at the leaflet inside your medicine box, or ask a doctor or pharmacist, if you want to know if you are getting a side-effect from your medicine.
- If you do get a side-effect, please think about reporting it via the Yellow Card Scheme
Tell your doctor or pharmacist before you take escitalopram if you have any of these conditions
You need to talk to your doctor or pharmacist if you have, or have ever had:
- Liver disease
- Kidney disease
- Diabetes (you may need an adjustment of your antidiabetic therapy)
- Epilepsy or a history of seizures or fits
- A bleeding problem, or bleeding in the stomach or gut
- Mania or panic disorder
- Low blood levels of sodium
- ECT (electroconvulsive therapy)
- Problems with your eyes, such as narrow angle glaucoma (increased pressure in the eye)
- Heart problems, or a heart attack
- A low resting heart-rate and/or you know that you may have lost salt from your body as a result of long-lasting diarrhoea (loose poo) and vomiting (being sick) or using diuretics (water tablets)
- A fast or irregular heartbeat, fainting, collapsing or dizziness when you stand up
Escitalopram does not mix well with some other medicines and drugs. Do not take escitalopram if you have taken a monoamine oxidase inhibitor antidepressant (MAOI) like moclobemide, phenelzine, isocarboxazid or tranylcypromine in the last 14 days.
Do not take escitalopram with the herbal product St. John’s Wort
Tell your doctor or pharmacist if you are taking any other medicines: a few drugs may not go well with escitalopram whilst some dose adjustments may be required to ensure you get the best from the escitalopram with as few side effects as possible.
Be careful if you are also using street drugs
- Cannabis can give you a fast heartbeat with escitalopram.
- Methadone can make drowsiness worse with escitalopram. The escitalopram could increase the concentration of methadone in your body.
- Escitalopram could raise the level of cocaine in your body, giving you a bigger reaction.
- Taking escitalopram with cocaine or ecstasy or amphetamines could bring on serotonin syndrome. You could get a high temperature/fever, agitation, confusion, trembling or weird muscle movements. You need to go to hospital if this happens. Tell the doctor that you are taking escitalopram.
Stopping the medication causes the balance of chemicals in the brain to alter
Once you start taking a SSRI, the brain adjusts to having a new level of serotonin around. If you stop taking the SSRI all at once, the balance starts to change again. You could get some symptoms from the change.
Stopping this medicine quickly, or reducing the dose too much at once, may cause uncomfortable symptoms called withdrawal symptoms
These do not mean you are addicted to the medicine - just that your brain has become used to it to control the serotonin levels.
Withdrawal symptoms usually start a few days after stopping the medicine. You can stop taking it safely with your doctor’s help.
- You will probably get uncomfortable withdrawal symptoms if you stop escitalopram suddenly. It is better to agree stopping with a doctor who will reduce you gradually.
- These do not mean you are addicted to the medicine - just that your brain has become used to it to control the serotonin levels.
Some of the symptoms you might get include:
- dizziness or headaches
- numbness, ‘pins and needles’ or tingling in hands or feet
- sleep disturbances (vivid dreams, nightmares, not being able to sleep)
- burning or ‘electric shock’ feelings in the head, neck and back (spine)
- feeling anxious, confused or disorientated
- feeling or being sick, or having loose poo (diarrhoea)
- sweating (including night sweats) or shaking
- feeling restless or agitated, or feeling emotional or irritable
- flu-like symptoms
- ringing in your ears (tinnitus)
- problems with your eyes
- fluttering/pounding heartbeat (palpitations)
Go and speak to your doctor if you have missed a few doses or have decided to stop taking your medication. If you slowly reduce your medication, withdrawal symptoms are less likely to occur.
Withdrawal symptoms should stop within 2 weeks. If they do not, or they are stopping you getting on with your life, you might need the help of a doctor.
If you agree with your doctor to stop the medicine, you will carry on with a lower dose for one to two weeks. This will help reduce your chance of getting withdrawal symptoms.
Search www.medicines.org.uk to find patient information leaflets and prescribing information on escitalopram. The drops are Cipralex brand only. The SmPC lists all the inactive ingredients in the product so you can check against any allergies. If you are still unsure about this then speak to your pharmacist.
- British National Formulary (BNF) and British National Formulary for children. Download the BNF/BNFC app (blue background) on to your mobile device. No longer available for public access via the web
- Taylor D, Barnes T, Young A. Maudsley Prescribing Guidelines in Psychiatry, 13th edition. Oxford: John Wiley & Sons, May 2018. ISBN: 978-1-119-44260-8
- Royal Pharmaceutical Society. Medicines Ethics and Practice (42nd edition). London: RPS, 2018. Standards for pharmacists to work to. It is not a free publication
- World Anti Doping Agency WADA Prohibited List https://www.wada-ama.org/en/resources/science-medicine/prohibited-list-documents
- Choiceandmedication; an independent source of information on many mental health conditions and their medicines with easy to read fact sheets www.choiceandmedication.org Personal subscriptions to download the app available for £1 per month (with proportionate discounts for longer periods) but your local mental health Trust may subscribe and provide information sheets for free.
- Best Use of Medicines in Pregnancy (BUMPS). Information sheets on drugs in pregnancy http://www.medicinesinpregnancy.org/
- Drugs and Lactation Database (LactMed). Information on drugs in breastfeeding https://toxnet.nlm.nih.gov/newtoxnet/lactmed.htm