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Escitalopram is an SSRI antidepressant and anti-anxiety medicine that compounding pharmacies prepare as oral capsules and oral liquids.
Escitalopram is the S-enantiomer of citalopram. It is a selective serotonin reuptake inhibitor: it blocks the serotonin transporter on nerve endings so more serotonin stays available in the synapse, which is presumed to underlie its antidepressant action. Manufactured products include Lexapro film-coated tablets (Allergan), whose oral solution is listed as not currently marketed, plus generic tablets and oral solutions. Lexapro is FDA-approved for major depressive disorder in adults and children 12 and older and for generalized anxiety disorder in adults and children 7 and older. A prescriber may order escitalopram compounded when a patient needs a strength below or between the manufactured tablets for slow titration or tapering, a capsule or liquid free of a specific dye, flavor or filler, or a liquid when the generic solution is unavailable. Compounded preparations are not FDA-approved and require a prescription.
Lexapro carries a boxed warning: antidepressants increased the risk of suicidal thoughts and behaviors in children, adolescents and young adults in short-term studies, so everyone taking it should be watched closely for worsening mood or new suicidal thoughts, and it is not approved for children under 7. Escitalopram should not be taken with an MAO inhibitor (including linezolid) or within 14 days of one, with pimozide, or by anyone allergic to escitalopram or citalopram. Combining it with other serotonergic drugs such as triptans, tramadol, lithium or St. John's wort raises the risk of serotonin syndrome. Aspirin, NSAIDs, warfarin and other blood thinners add to its bleeding risk. Stopping suddenly can cause dizziness and electric-shock sensations, so doses are usually tapered. In pregnancy, SSRIs are linked to postpartum bleeding and newborn adaptation problems; LactMed states that needing escitalopram is not a reason to stop breastfeeding, with infants watched for drowsiness, poor feeding or poor weight gain. Common side effects are nausea, sleep changes and sexual problems. If side effects are severe or do not go away, talk to your prescriber or pharmacist.
Escitalopram inhibits CNS neuronal serotonin reuptake with minimal affinity for other receptors; its demethylated metabolites are at least 7 and 27 times less potent and do not contribute meaningfully. Oral absorption is unaffected by food; tablet and solution are bioequivalent; peak plasma levels occur at about 5 hours; absolute bioavailability of citalopram is about 80 percent; plasma protein binding is about 56 percent. Metabolism is hepatic via CYP3A4 and CYP2C19 to S-desmethylcitalopram and S-didesmethylcitalopram; terminal half-life is about 27 to 32 hours, with steady state in about one week; renal clearance is a minor route. Labeled indications (Lexapro, Allergan): MDD in patients 12 and older and GAD in patients 7 and older. Prescribers have ordered escitalopram off-label for social anxiety disorder, OCD, panic disorder, PTSD, premenstrual dysphoric disorder and menopausal vasomotor symptoms (StatPearls). Dosing, titration and taper are per prescriber. Monitoring: suicidality and clinical worsening, especially early in treatment and after dose changes; serotonin syndrome with concomitant serotonergic agents; INR with warfarin; sodium in older adults; weight and growth in pediatric patients; ECG and electrolytes where QT risk exists (StatPearls). Escitalopram is not a controlled substance.
Compounded at Bayview
Patient guides for the preparations we make most often. Each one is compounded to order and requires a prescription.
We do not have a patient page for this ingredient yet. That does not mean we cannot make it. Bayview compounds this ingredient to a prescriber's order, and our full compounding formulary lists every preparation we make. Viewing the formulary requires a prescriber account.
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Every preparation in our formulary that contains this ingredient. Strength, base and dose form are set by the prescription.
Other salt forms of this molecule, and ingredients commonly compounded alongside it.
This page describes an active pharmaceutical ingredient, not a finished drug product. Bayview Pharmacy compounds preparations containing it only on a prescriber's order for an individual patient.
Compounded preparations are not FDA-approved, and the FDA has not evaluated them for safety, effectiveness, or manufacturing quality. Nothing on this page is a claim that any preparation is effective for any condition.
A valid prescription is required. Availability depends on Bayview's licensure in your state. This page is general information, not medical advice. Discuss your situation with a licensed healthcare provider.
Our pharmacists work with prescribers to build preparations around a patient's dose, form and tolerances. Ask us what is possible with this ingredient.
