Drugs On Review

Archive for the ‘Antidepressant’ Category

What is Lexapro?

Lexapro is a trade name used by Forest Pharmaceuticals for escitalopram, an SSRI antidepressant. It is used for treating major depression and generalized anxiety disorder. Lexapro has been demonstrated as effective in relieving depression in adults and adolescents aged between 12 and 17. Like many other SSRIs it has been used off-label for the treatment of premature ejaculation in males. Other off-label uses include the treatment of fibromyalgia, obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder, autism, migraines and Tourette syndrome.

Like all SSRIs, Lexapro acts by blocking the reuptake of serotonin in the synaptic gap, thus making more serotonin available to activate serotonin receptors. Lexapro has high selectivity of serotonin reuptake inhibition.

What does Lexapro look like?

Lexapro is sold as a round white tablet in strengths of 5, 10 and 20 mg. The tablets are imprinted with FL 5, FL 10 and FL 20 respectively.

Lexapro dosing and administration

The standard starting dose of Lexapro for depression or generalized anxiety disorder is 10 mg once a day. If this is not effective your doctor may increase the dosage incrementally until the desired effect is achieved. Typically, Lexapro treatment will continue for a period of several months or more. Patients with liver disorders should not take more than 10 mg per day.

Common adverse effects from Lexapro

Lexapro may have all the side effects usually associated with SSRIs. These include insomnia, constricted pupils, dry mouth, sleepiness, vertigo, sweating, constipation, fatigue and dyspepsia. There may be a number of sexual side effects including decreased libido and delayed ejaculation or failure to ejaculate. These are usually reversible after cessation of Lexapro treatment. There is an increased incidence of suicidal ideation. The use of Lexapro for depression is known to result in weight gain.

Lexapro warnings and precautions

Before taking Lexapro you should tell your doctor if you have bipolar disorder or a family history of bipolar disorder, recent heart problems, diabetes, epilepsy or any liver disease.

Interactions with Lexapro

St John’s wort may potentiate Lexapro as much as 50%. Like all SSRIs, Lexapro may interact with a wide range of drugs and you should tell you doctor about any other medications you are using. The use of alcohol should be avoided while you are taking Lexapro.

Lexapro and migraine

Lexapro may be used of-label for the prevention of migraines. It has been observed to be of particular use in patients who have more than two migraines per week and who also suffer from depression or anxiety.

Lexapro withdrawal

Withdrawal symptoms may occur in patients who cease taking Lexapro abruptly. These symptoms may include irritability, vertigo, anxiety, confusion, headache, insomnia and fatigue. When ceasing treatment the dosage should be tapered down over a number of weeks to avoid withdrawal symptoms.

What if I take an accidental overdose of Lexapro?

If you suspect that you or another person may have taken an overdose of Lexapro you should seek medical attention immediately. Symptoms of overdose may include drowsiness, nausea, vomiting, low blood pressure, tachycardia, coma or seizures. There is no specific antidote for Lexapro so treatment for overdose will be symptomatic and may include assistance with breathing and hydration through an infusion.

What is Paxil?

Paxil is a trade name for paroxetine, an SSRI antidepressant used in the treatment of obsessive-compulsive disorder, panic disorder, generalized anxiety disorder and major depression in adults. It has been regarded as a replacement for the earlier generation of tricyclic antidepressants, being as effective and having fewer side effects.

Like all SSRIs, Paxil prevents the reuptake or reabsorption of serotonin in the synaptic gap. This results in a higher concentration of serotonin available to receptors in the gap and thus more transmission. This has the primary effect of mood elevation, which relieves the symptoms of depression or anxiety.

What does Paxil look like?

Paxil comes in a wide variety of pills, mostly round or oval in various colors with the strength in milligrams imprinted.

Paxil dosing and administration

The standard starting dose for Paxil is 20 mg taken in one dose in the morning. In cases of panic disorder or for the elderly or patients with compromised liver or kidneys, the starting dose is 10 mg once daily. If symptoms are not relieved, your doctor may increase the dosage. The maximum recommended dosage of Paxil is 50 mg. This is the dosage used for major depression, anxiety disorder, post-traumatic stress disorder. A dosage of 60 mg may be used in cases of social anxiety disorder or obsessive-compulsive disorder. Paxil may take as much as a month before beneficial effects are noticed. Paxil is usually taken in a single dose in the morning. However, if this causes drowsiness, you may be better off taking it before sleeping. It is important to take the drug at the same time each day to maintain a steady concentration in the blood. Paxil may be taken with our without food. When ceasing Paxil treatment, the dosage should be reduced gradually over several weeks to avoid withdrawal symptoms.

Common adverse effects from Paxil

The most common side effects of Paxil are nausea, insomnia, drowsiness, weakness, dry mouth, headache, constipation, decreased libido, heavy sweating, vertigo, diarrhea and tremor. Less common side effects include anorexia, nervousness, erectile dysfunction, agitation, anxiety, yawning, painful menstrual cramps and indigestion. Less frequent but more serious side effects include suicidal ideation, anxiety or panic attacks, hostility, excessive risk-taking, mood swings, serotonin syndrome, palpitations, insomnia, and allergic reactions. There have been reports of decreased fertility in men taking SSRIs. This effect appears to be reversible.

Sexual side effects of Paxil

Like other SSRI antidepressants, Paxil may cause a range of sexual problems. These include decreased libido, inability to ejaculate or delayed ejaculation, orgasm problems, erectile dysfunction and priapism. Ejaculation problems occur in up to 28 percent of males taking Paxil. Priapism is the rarest of these side effects but if an erection persists for more than four hours, emergency medical attention should be sought.

Paxil warnings and precautions

Before taking Paxil you should tell your doctor if you have or have had bipolar disorder (or a family history of bipolar disorder), suicidal ideas, a recent heart attack or unstable heart disease, diabetes, glaucoma, epilepsy, liver or kidney problems or any allergies. Care should be taken over the differential diagnosis of depression and bipolar disorder because these may often appear similar. Paxil is not recommended for patients with bipolar disorder. Paxil should not be taken with other medications affecting the serotonin system because of the risk of serotonin syndrome. Paxil has been reported to occasionally cause bleeding in the gastrointestinal tract. This risk is higher in patients also taking aspirin or NSAIDs.

Interactions with Paxil

Paxil is known to interact with alcohol, aspirin, atomoxetine, arrhythmia medications, seizure medications, cimetidine, fentanyl, linezolid, lithium, other antidepressants, monoamine oxidase inhibitors, NSAIDs, phenothiazines, pimozide, procyclidine, resperidone, other SSRI or SNRI antidepressants, St John’s wort, Tamoxifen, theophylline, tramadol, tricyclic antidepressants, triptans, tryptophan and warfarin.

What is Wellbutrin?

Wellbutrin is GlaxoSmithKline’s brand name for bupropion, a non-tricyclic antidepressant. It is an aminoketone and is believed toinhibit reuptake of norepinephrine and dopamine. It binds selectively to dopamine and is also a nicotinic acetylcholine receptor antagonist

Wellbutrin acts by selectively inhibiting the reuptake of norepinephrine and dopamine.

What does Wellbutrin look like?

Wellbutrin is sold as a round pill in a wide range of colors, each representing a different strength. The strength of Wellbutrin pills ranges from 75 to 300 mg. All pills are imprinted with “Wellbutrin” and the strength in milligrams. There are also several slow release versions of the drug.

Wellbutrin dosing and administration

In treating depression, the standard starting dose of Wellbutrin is 100 mg twice daily increasing after several days to 100 mg three times daily. Because Wellbutrin carries a risk of seizure, no individual dose should be more than 150 mg. No more than 450 mg total should be taken in any 24 hours period. Because it may take up to four weeks for the drug to reach peak levels, any titration of the dose will be done very gradually. Wellbutrin may be taken with or without food. If possible you should avoid taking the final dose of the day close to your bedtime because one possible side effect of this drug is insomnia. Wellbutrin should be taken at the same time each day to maintain a stable blood plasma concentration.

Common adverse effects from Wellbutrin

The most common side effects of Wellbutrin are agitation, dry mouth, constipation, headaches, nausea or vomiting, vertigo, sweating, tremors, insomnia, anorexia, vision disturbances, tachycardia, confusion, aggression, cardiac arrhythmia and hearing disturbances. Less common are menstrual problems, hypertension, palpitations, increased appetite, dyspepsia, decrease in libido, erectile dysfunction, taste disturbances, hypotension and fainting. Serious side effects of Wellbutrin which should be reported to your doctor immediately include seizures, suicidal ideation, anxiety or panic attacks, risk-taking behavior, restlessness, mood swings, hallucinations or allergic reactions. In very rare cases Wellbutrin may cause hair loss, acne, ulcers, chest congestion, high or low blood glucose levels, memory loss and redness of the skin.

Wellbutrin and sexual side effects

Wellbutrin may diminish libido in up to 3.1 percent of patients but may also be responsible for an increase in sex drive. Erectile dysfunction and the inability to ejaculate have also been reported.

Wellbutrin warnings and precautions

Because of the risk of seizure at the beginning of therapy it is important that the dosage of Wellbutrin be begun at a low level and gradually increased to a therapeutically effective level. It is also important to discuss any history of heart, liver, kidney or bipolar disorder with your doctor before beginning Wellbutrin therapy. It is also important for the doctor to make a careful differential diagnosis of depression as bipolar disorder may sometimes present with very similar symptoms to depression. Any family history of bipolar disorder should also be taken into account. Like all antidepressants, Wellbutrin may be responsible for suicidal ideation or behavior and other behavioral disturbances including anxiety, agitation, aggression, hyperactivity and hallucinations.

Interactions with Wellbutrin

Wellbutrin is known to interact with alcohol, other antidepressants, antipsychotics, amantadine, all beta blockers, arrhythmia drugs, Plavix, cyclophosphamide, doxorubicin, efavirenz, monoamine oxidase inhibitors, nelfinavir, nicotine therapy, orphenadrine, ritonavir, lopinavir, steroids, theophylline, thiotepa and ticlopidine.

Wellbutrin and pregnancy

Wellbutrin has been shown to increase the risk of birth defects and low fetal weight in rabbits. However depression may also have a negative effect in pregnancy and the risk of Wellbutrin side effects must be weighed against this.