Citalopram 20 mg Tablets (Escitalopram Oxalate)

Adult dosage

Safety has not been established for doses exceeding 20mg per day. This drug is administered once daily in the morning or evening, with or without food. 1) Adults (1) Major depressive disorder: The usual dose is 10mg once daily. Depending on the patient's response, the dose may be increased to a maximum of 20mg per day. If increasing the dose of this drug to 20mg, the dose should be increased at intervals of at least 1 week. In general, 2-4 weeks are required for antidepressant effects to become apparent. Even after symptoms have resolved, at least 6 months of drug therapy is required to ensure the therapeutic effect. (2) Panic disorder with or without agoraphobia: It is recommended to administer 5mg per day for 1 week as the initial dose, then increase to 10mg per day. Depending on the patient's response, the dose may be increased to a maximum of 20mg per day. The maximum effect appears after approximately 3 months. The safety and efficacy of long-term administration of this drug for more than 10 weeks in the treatment of panic disorder have not been systematically studied. The physician should periodically reassess each patient to determine the need for continued treatment. (3) Social anxiety disorder: The usual dose is 10mg once daily. In general, 2-4 weeks are required for symptoms to improve. Thereafter, depending on the patient's response, the dose may be reduced to 5mg per day or increased to a maximum of 20mg per day. Social anxiety disorder is a condition with a chronic course, and continued treatment for 12 weeks is recommended to ensure the therapeutic effect. Long-term treatment in patients who responded was studied for 6 months and should be considered on an individual patient basis to prevent relapse. The usefulness of long-term treatment should be reassessed regularly. Social anxiety disorder is a well-defined diagnostic term for a specific disorder and should not be confused with excessive shyness. Drug therapy should be given only when social anxiety disorder significantly interferes with occupational and social activities. Drug therapy has not been compared with cognitive behavioral therapy. Drug therapy is one part of an overall treatment strategy. (4) Generalized anxiety disorder: The initial dose is 10mg once daily. Depending on the patient's response, the dose may be increased to a maximum of 20mg per day after at least 1 week of treatment. A long-term treatment study was conducted in patients who responded to 12 weeks of open-label treatment, with 20mg per day administered for at least 6 months. The physician should regularly reassess the usefulness of long-term treatment with this drug for each patient. (5) Obsessive-compulsive disorder: The usual dose is 10mg once daily. Depending on the patient's response, the dose may be increased to a maximum of 20mg per day. A long-term treatment study was conducted in patients who responded to 16 weeks of open-label treatment, with 10mg or 20mg per day administered for at least 24 weeks. Obsessive-compulsive disorder is a chronic condition; treatment should be continued for a sufficient period to ensure symptom remission. When this drug is used long term, the usefulness and dose for each patient should be reassessed regularly. 2) Patients with renal impairment No dose adjustment is required in patients with mild or moderate renal impairment. Caution should be exercised in patients with severe renal impairment (CLCR < 30㎖/min). 3) Patients with hepatic impairment It is recommended to administer an initial dose of 5mg per day for the first 2 weeks. Depending on the patient's response, the dose may be increased to 10mg per day. 4) Discontinuation of treatment When discontinuing this drug, the dose should be gradually reduced over at least 1-2 weeks to avoid the possibility of withdrawal symptoms. 5) Switching from MAO inhibitors used to treat psychiatric disorders When discontinuing an MAO inhibitor used to treat psychiatric disorders and starting treatment with this drug, an interval of at least 14 days must be observed. Conversely, when starting an MAO inhibitor to treat psychiatric disorders, at least 14 days must have elapsed after discontinuing this drug. 6) Other MAO inhibitors, such as linezolid or methylene blue Patients receiving linezolid or intravenous methylene blue should not start this drug because of the increased risk of serotonin syndrome. In patients who require treatment for a more urgent psychiatric condition, including hospitalization, other interventions should be considered. It may be necessary to urgently administer linezolid or intravenous methylene blue to a patient already receiving this drug. If no alternative to linezolid or intravenous methylene blue is available and the benefits of treatment with linezolid or intravenous methylene blue are judged to outweigh the risk of serotonin syndrome in a particular patient, this drug may be discontinued immediately and linezolid or intravenous methylene blue administered. Patients should be monitored for symptoms of serotonin syndrome for 2 weeks after administration of linezolid or intravenous methylene blue, or until 24 hours after the last dose, whichever comes first. Treatment with this drug may be restarted 24 hours after the last dose of linezolid or intravenous methylene blue. The risk associated with administration of methylene blue by a non-intravenous route (oral tablets or local injection) or intravenous administration of this drug at doses of 1mg/kg or less is unclear. Nevertheless, clinicians should be aware of the possibility of emergency symptoms of serotonin syndrome with these uses.

This medication may increase the risk of suicidal thoughts or behaviors in children, adolescents, and young adults with major depressive disorder or other psychiatric disorders, so it must be used with caution. This medication should not be administered to patients who have hypersensitivity to its ingredients or are taking certain medications (e.g., MAO inhibitors, pimozide). Patients with closed-angle glaucoma or a history of glaucoma should be cautious due to the potential risk of increased intraocular pressure with this medication. Early administration may lead to mental adverse reactions such as anxiety, restlessness, and insomnia, although these symptoms generally decrease over time. This medication can affect heart rhythm, so patients with prolonged QT interval or those taking related medications should be cautious. During treatment, abnormal behavioral changes such as suicidal tendencies, aggression, or anger must be closely monitored, and family members or caregivers should also carefully observe the patient. This medication may cause withdrawal symptoms such as dizziness, anxiety, and sleep disturbances upon sudden discontinuation; therefore, the dosage should be gradually reduced under medical supervision. During pregnancy, especially in the late stages, it may affect the newborn, so pregnant women should carefully consider the necessity and risks before administration. If breastfeeding, it is recommended to discontinue nursing or avoid taking this medication as it may be transmitted through breast milk. There is a serious risk of serotonin syndrome when taken with other serotonin-acting medications, so caution is required when combining treatments. Caution is also needed when driving or operating machinery, and patients should assess their own condition before proceeding. Overdosage of this medication can lead to abnormalities in the central nervous system, gastrointestinal tract, and cardiovascular system; thus, immediate medical attention is necessary. It is advisable not to use this medication in children and adolescents as safety and efficacy have not been established. Elderly patients should start at a lower initial dose and limit the maximum dose. The risk of bleeding may increase during treatment, so caution is necessary for patients with bleeding tendencies or those taking anticoagulants.

Thrombocytopenia, anaphylactic reaction, inappropriate antidiuretic hormone secretion, hyperprolactinemia, decreased appetite, increased appetite, weight gain, weight loss, hyponatremia, loss of appetite, anxiety, restlessness, abnormal dreams, decreased libido, sexual dysfunction, teeth grinding, agitation, nervous irritability, panic attacks, confusion, aggression, depersonalization, hallucination, mania, suicidal thoughts, suicidal behavior, insomnia, drowsiness, dizziness, perceptual disturbances, tremors, taste disturbance, sleep disorders, fainting, serotonin syndrome, movement disorder, motor dysfunction, seizures, psychomotor agitation, inability to sit still, mydriasis, visual impairment, tinnitus, tachycardia, bradycardia, QT interval prolongation on ECG, polymorphic ventricular tachycardia, ventricular arrhythmia, orthostatic hypotension, sinusitis, yawning, nosebleed, nausea, diarrhea, constipation, vomiting, dry mouth, gastrointestinal bleeding, hepatitis, abnormal liver function tests, increased sweating, urticaria, hair loss, rash, itching, petechiae, angioedema, arthralgia, myalgia, rhabdomyolysis, urinary retention, sexual dysfunction, erectile dysfunction, uterine bleeding, menorrhagia, galactorrhea, postpartum hemorrhage, fatigue, fever, edema, headache, dry mouth, abdominal pain, dyspepsia, enteritis, sensory disturbances, cough, asthma, dyspnea, fracture, palpitations, hypertension, paralysis, extrapyramidal disorder, migraine, chest pain, frequent urination, tremor, dry mouth, heartburn, sedation, anxiety, visual hallucinations, emotional instability, hypersensitivity, visual impairment, dizziness, sleep disorder, anxiety, nausea, tremors, confusion, sweating, headache, diarrhea, headache, frequent urination

This medication is sensitive to light and should be stored in a container that does not permit light to enter. Additionally, it should be kept at room temperature, avoiding extremes of high or low temperatures, ideally between 1°C to 30°C.

Appearance

White oval film-coated tablet

Package unit

30 tablets/bottle, 100 tablets/bottle