Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.
Abnormal heart rhythm: Escitalopram may cause an abnormal heart rhythm, especially at higher doses. Your doctor may occasionally monitor your heart rate and rhythm with a test called an electrocardiogram. People with a history of a heart rhythm disturbance called QT prolongation should not take this medication. If you have congestive heart failure, have slow heart rhythm, are at risk of low potassium or magnesium levels because of certain illnesses or medications, or are taking certain medications that can affect the heart rhythm (e.g., amiodarone, sotalol), you should discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Bleeding disorders: Other medications from the same class as escitalopram may cause bleeding disorders. Report any unusual bruising or bleeding to your doctor, especially if you are taking medications that affect platelets (special blood cells that help the blood to clot). These medications include ASA, clopidogrel, dipyridamole, nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., ibuprofen or naproxen), and certain antipsychotic medications.
Diabetes: If you have diabetes, your doctor should closely monitor your condition while you are taking escitalopram, as it may affect blood sugar control (either increase or decrease blood sugar levels).
Kidney function: If you have severely reduced kidney function, your doctor should closely monitor your condition while you are taking this medication.
Liver function: If you have reduced liver function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Mania: Escitalopram may cause activation of mania. This means that people who are prone to mania may be more likely to have their mania start up again. If you have a history of mania or bipolar disorder, your doctor should closely monitor your condition while you are taking this medication.
Seizures: If you have a history of seizures, your doctor should closely monitor your condition while you are taking escitalopram. If you develop seizures, stop taking the medication and contact your doctor.
Stopping the medication: Escitalopram should not be stopped abruptly due to the risk of discontinuation symptoms (dizziness, abnormal dreams, numbness, electric shock feelings, agitation, anxiety, difficulty concentrating, headache, tremor, nausea, vomiting, and sweating). A gradual reduction in dose over a period of time is recommended. If you are thinking of stopping the medication, talk to your doctor or pharmacist about how to do this safely.
Suicidal or agitated behaviour: Adults and children taking this medication may feel agitated (restless, anxious, aggressive, emotional, and feeling not like themselves), or they may want to hurt themselves or others. These symptoms may occur within several weeks after a person starts taking this medication or when doses are adjusted. People taking this medication should be closely monitored by their doctor for emotional and behavioural changes.
Pregnancy: The safe use of escitalopram during pregnancy has not been established. It has been reported that babies born to pregnant women who have taken medications similar to escitalopram during the last trimester of pregnancy may be adversely affected. Some babies required longer hospital stays as well as breathing support and tube-feeding.
Also, babies experienced symptoms such as problems with breathing and feeding, seizures (convulsions), muscle stiffness, constant crying, and feeling "jittery." Doctors and pregnant women should carefully consider the benefits and the risks of all treatment options. If you become pregnant while taking this medication, contact your doctor immediately.
Breast-feeding: It is known that the medication citalopram, which is similar to escitalopram, passes into breast milk. If you are a breast-feeding mother and are taking escitalopram, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.
Children and adolescents: The safety and efficacy of this medication for children and adolescents under 18 years of age have not been established. It may cause behavioural and emotional changes, such as suicidal thoughts and behaviour.