SSRI antidepressants including escitalopram may increase the risk of bleeding events. Combined use of aspirin, nonsteroidal anti-inflammatory drugs e. This may include symptoms such as gums that bleed more easily, nose bleed, or gastrointestinal bleeding. Some cases have been life threatening.
To date, there are no known problems associated with long term use of escitalopram. It is a safe and effective medication when used as directed. Escitalopram should not be taken with or within 2 weeks of taking monoamine oxidase inhibitors MAOIs. Escitalopram may increase the effects of other medications that can cause bleeding e. Sleep, energy, or appetite may show some improvement within the first weeks. Improvement in these physical symptoms can be an important early signal that the medication is working.
Depressed mood and lack of interest in activities may need up to weeks to fully improve. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide.
This risk may persist until significant remission occurs. In short-term studies, antidepressants increased the risk of suicidality in children, adolescents, and young adults when compared to placebo. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age Adults age 65 and older taking antidepressants have a decreased risk of suicidality.
Patients, their families, and caregivers should be alert to the emergence of anxiety, restlessness, irritability, aggressiveness and insomnia.
All patients being treated with antidepressants for any indication should watch for and notify their health care provider for worsening symptoms, suicidality and unusual changes in behavior, especially during the first few months of treatment.
Last Updated: January This information is being provided as a community outreach effort of the College of Psychiatric and Neurologic Pharmacists.
This information is for educational and informational purposes only and is not medical advice. This information contains a summary of important points and is not an exhaustive review of information about the medication. Always seek the advice of a physician or other qualified medical professional with any questions you may have regarding medications or medical conditions.
Never delay seeking professional medical advice or disregard medical professional advice as a result of any information provided herein. The College of Psychiatric and Neurologic Pharmacists disclaims any and all liability alleged as a result of the information provided herein.
If you do miss a dose, take it as soon as you remember it unless it is almost time for the next dose. Never double dose your medication. Continue Learning about Antidepressant How does duloxetine interact with other medications? Donna Hill Howes, RN. If you are taking If you are using the oral liquid, shake the bottle well before measuring each dose. Use a marked measuring spoon, oral syringe, or medicine cup to measure each dose.
The average household teaspoon may not hold the right amount of liquid. The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine.
If your dose is different, do not change it unless your doctor tells you to do so. The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Patients believe that this plan should be a required part of the information received when a medication is prescribed and dispensed.
Consumer Medicine Information sheets, which are available for most commonly prescribed medications, contain a section on what to do if a dose is missed. The routine use of these sheets or similar advice may help patients to know what to do when they miss a dose. Why don't consumers know what to do when they miss a dose of their medication?
As health professionals we know that the vast majority of patients occasionally miss a dose of their medication. This unintentional non-compliance, and request for advice after the event, is very common in practice. Given our understanding of the difficulties around compliance with medication regimens, it must be our expectation that many patients will miss doses. Informing them about what to do about a missed dose at the time of prescribing, dispensing and administration would seem to be a logical step towards improved compliance.
Missed doses could be viewed within the framework of patient non-compliance, however the problems which arise often result because health professionals do not give enough information to allow the patient to safely use the medication. Teaching a patient what to do if a dose is missed and providing strategies to minimise the number of missed doses appears a sensible approach. In practice, giving information on what to do if a dose is missed should not be too onerous a task for medical practitioners or pharmacists.
Giving patients a CMI sheet the first time they receive a medication, and using this material in discussion with patients at the time of prescribing and dispensing would prepare them for this eventuality.
The severity of the patient's condition, whether clinically significant breakthrough effects are likely to be observed, and the characteristics of the medication should be considered when deciding the most appropriate strategy following a missed dose.
Vulnerable patients are easily recognisable in any practice and include those on medications of low therapeutic index, b or suffering from conditions which require constant maintenance of therapeutic concentrations for example epilepsy and thromboembolic diseases requiring anticoagulation.
On the other hand, for most people with hypertension or hypercholesterolaemia a single missed dose will be of little consequence. The patients should be informed at the time of prescribing and dispensing, of strategies to minimise missed doses and to redeem the situation when a dose is missed.
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