Escitalopram
SSRI, Antidepressant
Escitalopram
Lexapro
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Interactions
Pharmacogenomic + mechanism interactions
Pharmacogenomic guideline recommendationsCPIC and Dutch Pharmacogenetics Working Group clinical guidelines
CPIC rec 8093626 [Strong]: Consider a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19. If citalopram or escitalopram are clinically appropriate, and adequate efficacy is not achieved at standard maintenance dosing, consider titrating to a higher maintenance dose. CPIC pair-level A (CYP2D6, CYP2C19, CYP2B6, SLC6A4, HTR2A and Serotonin Reuptake Inhibitor Antidepressants) [PMID 25974703, 37032427] FDA labeling (Adverse Reactions)
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CPIC rec 8093631 [Strong]: Consider a clinically appropriate antidepressant not predominantly metabolized by CYP2C19. If citalopram or escitalopram are clinically appropriate, consider a lower starting dose, slower titration schedule and 50% reduction of the standard maintenance dose as compared to normal metabolizers. CPIC pair-level A (CYP2D6, CYP2C19, CYP2B6, SLC6A4, HTR2A and Serotonin Reuptake Inhibitor Antidepressants) [PMID 25974703, 37032427] FDA labeling (Adverse Reactions)
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CPIC rec 8093632 [Strong]: Consider a clinically appropriate antidepressant not predominantly metabolized by CYP2C19. If citalopram or escitalopram are clinically appropriate, consider a lower starting dose, slower titration schedule and 50% reduction of the standard maintenance dose as compared to normal metabolizers. CPIC pair-level A (CYP2D6, CYP2C19, CYP2B6, SLC6A4, HTR2A and Serotonin Reuptake Inhibitor Antidepressants) [PMID 25974703, 37032427] FDA labeling (Adverse Reactions)
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CPIC rec 8093628 [Strong]: Initiate therapy with recommended starting dose CPIC pair-level A (CYP2D6, CYP2C19, CYP2B6, SLC6A4, HTR2A and Serotonin Reuptake Inhibitor Antidepressants) [PMID 25974703, 37032427]
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CPIC rec 8093629 [Moderate]: Initiate therapy with recommended starting dose. Consider a slower titration schedule and lower maintenance dose than normal metabolizers. CPIC pair-level A (CYP2D6, CYP2C19, CYP2B6, SLC6A4, HTR2A and Serotonin Reuptake Inhibitor Antidepressants) [PMID 25974703, 37032427]
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CPIC rec 8093630 [Moderate]: Initiate therapy with recommended starting dose. Consider a slower titration schedule and lower maintenance dose than normal metabolizers. CPIC pair-level A (CYP2D6, CYP2C19, CYP2B6, SLC6A4, HTR2A and Serotonin Reuptake Inhibitor Antidepressants) [PMID 25974703, 37032427]
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CPIC rec 8093627 [Optional]: Initiate therapy with recommended starting dose. If patient does not adequately respond to recommended maintenance dosing, consider titrating to a higher maintenance dose or switching to a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19. CPIC pair-level A (CYP2D6, CYP2C19, CYP2B6, SLC6A4, HTR2A and Serotonin Reuptake Inhibitor Antidepressants) [PMID 25974703, 37032427] FDA labeling (Adverse Reactions)
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Clinical relevance: does this interaction matter in practice?trivialcritical
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Outcome (-100 worst, +100 best)
Patient experience
Fluoxetine via Category:Antidepressants exp n/a/5 outcome n/a (n=1) exp 1.0/5 outcome +33.0 (n=1)
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- checking this mechanism here
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Pharmacy
Common uses
Classification(s)
Classes
SSRI, Antidepressant
Pharmacology
Purported mechanism
Selective serotonin reuptake inhibitor
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