In this drug factsheet:
What side effects are possible with this medication?
Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.
The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.
The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.
Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.
- changes in heart rate
- congested or runny nose
- difficulty sleeping
- dry mouth
- increased sweating
- change of appetite
- prickling sensation on the skin
- sexual dysfunction including:
- decreased libido (sex drive)
- erectile dysfunction (difficulty getting or keeping an erection)
- inability to have an orgasm
- stomach upset
Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
- abnormal dreams
- bruising or unusual bleeding from the skin or other areas
- difficulty concentrating
- difficulty controlling blood sugar levels
- electric shock sensation
- emotional indifference
- glaucoma (eye pain, vision changes)
- inability to urinate
- involuntary movements of the body or face
- low blood sodium (confusion, seizures, drowsiness, dryness of mouth, increased thirst, lack of energy)
- overactive behaviors or thoughts
- severe agitation or restlessness
- symptoms of liver damage, e.g.:
- abdominal pain
- dark urine
- clay-coloured stools
- loss of appetite
- nausea and vomiting
- yellow skin or eyes
- vomiting blood or presence of blood in the stool
Stop taking the medication and seek immediate medical attention if any of the following occur:
- bleeding (vomiting blood or passing blood in stools)
- seizure or convulsions
- serotonin syndrome or neuroleptic malignant syndrome – signs include:
- overactive reflexes
- poor coordination
- talking or acting with excitement you cannot control
- trembling or shaking
- symptoms of a serious allergic reaction such as swelling of the face or throat, hives, or difficulty breathing
- thoughts of suicide or hurting yourself
Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.
Are there any other precautions or warnings for this medication?
Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.
HEALTH CANADA ADVISORY
May 8, 2012
Health Canada has issued new restrictions concerning the use of Cipralex® (escitalopram). To read the full Health Canada Advisory, visit Health Canada's web site at www.hc-sc.gc.ca.
Abnormal heart rhythm: Escitalopram may cause an abnormal heart rhythm, especially at higher doses. Your doctor may occasionally monitor your heart rate and rhythm with a test called an electrocardiogram. People with a history of a heart rhythm disturbance called QT prolongation should not take this medication. If you have congestive heart failure, have slow heart rhythm, are at risk of low potassium or magnesium levels because of certain illnesses or medications, or are taking certain medications that can affect the heart rhythm (e.g., amiodarone, sotalol), you should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Bleeding disorders: Other medications from the same class as escitalopram may cause bleeding disorders. Report any unusual bruising or bleeding to your doctor, especially if you are taking medications that affect platelets (special blood cells that help the blood to clot). These medications include ASA, clopidogrel, dipyridamole, nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., ibuprofen or naproxen), and certain antipsychotic medications.
Bone fractures: Escitalopram can increase risk of bone fractures and loss of mineral density. If you have osteoporosis or a history of fractures, discuss with your doctor how this medication may affect your medical condition, and whether any special monitoring is needed.
Diabetes: If you have diabetes, your doctor should closely monitor your condition while you are taking escitalopram, as it may affect blood sugar control (either increase or decrease blood sugar levels).
Glaucoma: If you have glaucoma, discuss with your doctor how this medication may affect your medical condition, and whether any special monitoring is needed.
Kidney function: If you have severely reduced kidney function, your doctor should closely monitor your condition while you are taking this medication.
Liver function: If you have reduced liver function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Mania: Escitalopram may cause activation of mania. This means that people who are prone to mania may be more likely to have their mania start up again. If you have a history of mania or bipolar disorder, your doctor should closely monitor your condition while you are taking this medication.
Seizures: If you have a history of seizures, your doctor should closely monitor your condition while you are taking escitalopram. If you develop seizures, stop taking the medication and contact your doctor.
Stopping the medication: Escitalopram should not be stopped abruptly due to the risk of discontinuation symptoms (dizziness, abnormal dreams, numbness, electric shock feelings, agitation, anxiety, difficulty concentrating, headache, tremor, nausea, vomiting, and sweating). A gradual reduction in dose over a period of time is recommended. If you are thinking of stopping the medication, talk to your doctor or pharmacist about how to do this safely.
Suicidal or agitated behaviour: Adults and children taking this medication may feel agitated (restless, anxious, aggressive, emotional, and feeling not like themselves), or they may want to hurt themselves or others. These symptoms may occur within several weeks after a person starts taking this medication or when doses are adjusted. People taking this medication should be closely monitored by their doctor for emotional and behavioural changes.
Pregnancy: The safe use of escitalopram during pregnancy has not been established. It has been reported that babies born to pregnant women who have taken medications similar to escitalopram during the last trimester of pregnancy may be adversely affected. Some babies required longer hospital stays as well as breathing support and tube-feeding.
Also, babies experienced symptoms such as problems with breathing and feeding, seizures (convulsions), muscle stiffness, constant crying, and feeling "jittery." Doctors and pregnant women should carefully consider the benefits and the risks of all treatment options. If you become pregnant while taking this medication, contact your doctor immediately.
Breast-feeding: It is known that the medication citalopram, which is similar to escitalopram, passes into breast milk. If you are a breast-feeding mother and are taking escitalopram, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.
Children and adolescents: This medication may cause behavioural and emotional changes, such as suicidal thoughts and behaviour, in people below the age of 18 and should not be used by people in this age group.
What other drugs could interact with this medication?
There may be an interaction between escitalopram and any of the following:
- MAO inhibitors (e.g., selegiline, moclobemide, phenelzine, tranylcypromine)
- medications that affect platelets (e.g., ASA, nonsteroidal anti-inflammatory drugs [NSAIDs], tricyclic antidepressants, some antipsychotic drugs such as chlorpromazine)
- other SSRI medications (e.g., citalopram, fluoxetine, sertraline)
- St. John's wort
- triptans (e.g., naratriptan, sumatriptan, zolmitriptan)
If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:
- stop taking one of the medications,
- change one of the medications to another,
- change how you are taking one or both of the medications, or
- leave everything as is.
An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.
Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.