Headmeds fills the medicines information gaps for young people - things you might want to know about meds like will it affect my sex life? Can I still study?  Can I drink?
Headmeds does not give medical advice so this is just general information.
Each medicine has a balance of good and bad effects, and each person gets their own individual effects.
You might want to know just one thing about your medicine, but on each page we have given you the ‘safety headlines’. Please read them as they are important.
We have included lots of information about each medicine - but if you want all the details, please look at the patient information leaflet - which is inside every pack. These leaflets are also at www.medicines.org.uk - where there will be the most up-to-date information.

Safety headlines

• If you have taken more escitalopram than it said on the label, you must see a doctor quickly – even if you do not feel any different.
• Escitalopram can make some people think about hurting themselves or committing suicide. It can happen in the first two weeks of taking it. You must go straight to hospital with your medicine if you have any of these thoughts.
• Escitalopram can also cause other serious side-effects: allergic reactions (difficulty breathing, swelling of your face or throat, itching skin lumps), and other serious symptoms that you can find here. Go to a hospital if you get any of these symptoms, with your medicine.
• Stopping escitalopram suddenly can cause serious side-effects – go to your doctor if you want to stop, or if you are having these effects.
• You might feel sleepy in the first few days after taking escitalopram – do not drive a car, ride a bike or operate machines until you see how this affects you.
• If you take escitalopram while you are pregnant, it may affect the developing baby’s heart. Use good contraception while you are taking escitalopram. It can also cause symptoms in newborn babies if you take it at the end of pregnancy. Talk to your doctor or midwife about this and get their help.
• Escitalopram does not mix well with some other medicines and drugs. Do not take escitalopram if you have taken a monoamine oxidase inhibitor antidepressant (MAOI) like moclobemide, phenelzine, isocarboxazid or tranylcypromine in the last 14 days.

Basic details

The drops contain a small amount of alcohol and will stay fresh for 8 weeks once opened

• The drops contain a small amount of alcohol, but it would not affect your blood alcohol level.
• Once opened, the drops stay fresh for 8 weeks in the bottle in a cool, dry place like a cupboard. After that, you need to get a new bottle and return any unused drops to the pharmacy so that they can throw them away safely. Do not pour them down the sink or toilet.
• Drops can be mixed with water, orange juice or apple juice to make them easier to take.

You can take escitalopram as tablets or drops

• Tablets (5mg, 10mg and 20mg strengths)
• Oral drops (20mg per ml – 5 drops are like one 5mg tablet)

Escitalopram can be used for a number of conditions

• Low mood (depression)
• Anxiety
• Eating disorders such as bulimia nervosa and binge eating disorder
• Panic Disorder
• Generalised Anxiety Disorder
• Obsessive Compulsive Disorder
• Body Dysmorphic Disorder
• Post-traumatic stress disorder
• Social anxiety
• Phobias

Escitalopram can help to adjust the chemicals your brain needs 

For low mood (depression):

The brain is usually good at making sure we have enough of the chemicals we need to function properly.

• Experiments suggest that depression or low mood is more likely to happen when the brain doesn’t have enough of a chemical called serotonin (also called ‘5HT’).
• Medicines like escitalopram are called selective serotonin reuptake inhibitors (SSRIs) because they trick the brain into thinking it needs to produce more serotonin to try and keep the level up.
• This means that the amount of serotonin becomes more normal and the depression and low mood becomes better.

You should take escitalopram once a day

• To get the best effect from escitalopram, take it once a day - every day.
• Make sure that you know your dose. If it is not written on the label, check it with your pharmacist or doctor.
• You can take it every morning, when you have breakfast or brush your teeth.
• If you find that it makes you sleepy, you can take it at night-time instead.
• You can take it before or after food.
• Swallow the tablet with a drink of water - if you chew it, it tastes bitter.

If you forget to take a dose then just take it as soon as possible 

What to do if you miss a dose:

• If you remember later during the day, take it as soon as possible.
• If you forget to take it by bedtime, just start again on the next day.
• Do not take a double dose.

What might happen?

• If you forget to take it for a few days, you may start getting withdrawal symptoms. If you do, see your doctor as soon as possible.

• If you want to stop your tablets, please speak to your doctor first as it is safer if they are stopped slowly over a few weeks rather than stopping suddenly.

You must go to A&E if you take too much 

What to do if you take too much:

• If you have taken more escitalopram than it said on the label, you must get help quickly – even if you do not feel any different.
• Go to A&E. Take your medicine with you, to show to the doctors. Tell them how much you have taken.
• Get a friend or family member to go with you, if you can, just in case you feel ill on the way.

You might get any of the following signs:

• changes in your heartbeat, going fast or unevenly
• feeling sick (nausea) or being sick
• having a fit (seizure/convulsion)
• sweating
• feeling sleepy
• passing out
• feeling shaky (tremor) or dizzy
• changing blood pressure, where you feel dizzy if you stand up
• feeling agitated
• going into a coma

You are also at risk of getting ‘Serotonin syndrome’. This is when you can get a high fever, agitation, confusion, trembling, or weird movements of your muscles. This is rare, but you should watch out for it. Go straight to A&E if you experience these side effects.

It can take 2-4 weeks for escitalopram to start helping 

It takes 2-4 weeks for escitalopram to show its full effect. We do not know why.

• Scientists believe that at first the higher level of serotonin feeds back to the brain that it should make less of it (this means you do not feel any better).
• But after some days of regular treatment, the feedback receptors send fewer messages and the brain gradually releases more serotonin.

Your doctor might start you on a low dose and then increase it slowly over 2-4 weeks to your full dose. They might also reduce your dose, depending on how it affects you.

You might even feel a little more anxious right at the beginning of taking them, but this will get better as the medicine takes effect.

Most people take escitalopram for about 6 months 

You and your doctor should talk about how long you need to take escitalopram.

• You will not get the full effect for 2-4 weeks.
• You should probably take it for at least 6 months after you feel well again - otherwise your symptoms can come back.
• Never stop the tablets suddenly because this may make you more at risk of experiencing your symptoms again and getting withdrawal effects. Ask your doctor or your pharmacist for advice on how to stop medicines safely.

Reference sources

• BNF, 70th edition, London: BMJ Group / Pharmaceutical Press, 285-6
• Cipralex tablets SPC, last updated 02/10/2013
  http://www.medicines.org.uk/emc/medicine/27012 accessed 17/01/2017
• Cipralex drops SPC, last updated 02/10/2013
  http://www.medicines.org.uk/emc/medicine/27010 accessed 17/01/2017
• Cipralex tablets PIL p2-3, last updated 27/09/2013
  http://www.medicines.org.uk/emc/medicine/9365 accessed 17/01/2017
• Neal MC. Medical Pharmacology at a Glance (7^th Edition). Oxford: John Wiley & Sons, 2012. P62
• BNF, 70th edition, London: BMJ Group / Pharmaceutical Press p286
• Neal MC. Medical Pharmacology at a Glance (7^th Edition). Oxford: John Wiley & Sons, 2012.