Cipralex: Uses, Side Effects, and Dosage

About Escitalopram

Medicine TypeA Selective Serotonin Reuptake Inhibitor (SSRI) antidepressant
Used ForTreating depression and anxiety disorders like Generalized Anxiety Disorder (GAD), Obsessive-Compulsive Disorder (OCD), Social Anxiety Disorder, and Panic Disorder.
Common Brands for EscitalopramSold under the brand name Lexapro in the US Sold under brand name Cipralex globally
Available in the form ofTablets and oral liquid drops
Common Side EffectsNausea Fatigue Increased Sweating Insomnia Sleepiness Delayed Ejaculation Decreased Libido Decreased Orgasm in Women

Cipralex is a brand name for Escitalopram in the United Kingdom. Escitalopram was first introduced to the market in the year 2002 in the United States. But, now it has become a generically available product for treating major depression as well as Generalized Anxiety Disorder (GAD).

WHO included Escitalopram on the list of its essential medications to treat adults with Major Depressive Disorder (MDD).

Escitalopram is available in many brands and Cipralex is one of them. Escitalopram (Cipralex) is a Selective Serotonin Reuptake Inhibitor (SSRI) and is recommended as the first-line treatment for depression.

This article explains what is Cipralex, what Cipralex uses, Cipralex side effects, and its dosage to treat depression and related diseases.

What is Cipralex?

Cipralex is an antidepressant that belongs to the second generation antidepressant of the SSRIs group. It contains an active substance called Escitalopram in the form of oxalate salt. Further, it is an S-isomer of Citalopram.

The antidepressants belong to two categories. These include first-generation and second-generation antidepressants.

First Generation Antidepressants

The first-generation antidepressants include Tricyclic Antidepressants (TCA) and Monoamine Oxidase Inhibitors (MAOIs). The efficacy of first-generation antidepressant medications is similar to second-generation antidepressants.

However, this category of antidepressants often produces multiple side effects that many patients find intolerable. Also, the risk of harm is high in case there is an overdose or the antidepressant is used in combination with certain other medications.

Second Generation Antidepressants

The second-generation medications include selective Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs). Accordingly, second-generation antidepressant drugs work through their effects on neurotransmitters. These include Serotonin, Norepinephrine, or Dopamine in the central nervous system.

These drugs increase the serotonin level in your brain and such disturbances in the serotonin system are an important factor in the development of depression and other related disorders.

Additionally, these play a major role in treating patients with Major Depressive Disorders (MDD) because of their favorable side effect profile. This is relative to first-generation antidepressants.

How Does Cipralex Work?

Cipralex is an antidepressant that is an SSRI. SSRIs increase the level of serotonin in your brain. They affect serotonin rather than other chemicals in the brain.

Serotonin is one of the chemical messengers or neurotransmitters that transmit signals between neurons. Further, it is an important hormone that stabilizes your mood, your feelings of pleasure, and wellbeing.

Also, serotonin helps you with sleeping, eating, and digestion. Thus, this hormone impacts your entire body.

People suffering from depressive disorders have low levels of serotonin. Thus, intake of SSRIs block the reabsorption of serotonin into neurons

As a result, the serotonin level increases, which enhances the transmission of messages between neurons.

Further, such an enhancement occurs at the level of the synapse – a site in the central nervous system. At this site, one neuron communicates with another neuron.

It is important to note that different SSRIs vary in their ability to block Serotonin Reuptake. Further, every person has their own potency to metabolize different types of SSRI drugs in the body.

Thus, the antidepressant that is appropriate for you depends upon the symptoms and the other health conditions.

So What is Cipralex Good For?

Cipralex provides symptomatic relief to patients with Major Depressive Disorders (MDDs). It also helps in treating anxiety disorders. These are as follows.

  • Panic Disorder with or without Agoraphobia
  • Social Anxiety Disorder
  • Generalized Anxiety Disorder (GAD), and
  • Obsessive-Compulsive Disorder (OCD).

Cipralex Benefits

Escitalopram helps in treating the following mental disorders.

1. Major Depressive Disorder (MDD)

As per research, Escitalopram (Cipralex) is effective in treating MDD. Cipralex is an SSRI that enhances your mood, releases anxiety and pressure, and helps you sleep better. As a second-generation drug, it has fewer side effects.

Typically, it takes 4-6 weeks for Cipralex to start working on your body. Moreover, you cannot stop taking Cipralex abruptly as it might increase withdrawal symptoms. Ask your doctor for adjusting the Cipralex dosage.

2. Generalized Anxiety Disorder

Generalized Anxiety Disorder (GAD) involves excessive anxiety and worry. Further. It is persistent for a minimum of 6 months and is a condition which the person finds challenging to control. A minimum of three of the following symptoms associate with GAD:

  • Restlessness
  • Feeling on the edge
  • Fatigue
  • Difficulty concentrating or mind going blind
  • Irritability
  • Muscle tension
  • Sleep disturbance

Cipralex provides relief from the symptoms of GAD. It increases the level of serotonin in your brain.

3. Obsessive-Compulsive Disorder (OCD)

Cipralex provides symptomatic relief to patients having OCD. In the case of OCD, an individual experiences obsessions and compulsions. And these are intrusive, highly distressing, time-consuming, and interfere significantly with the person’s social or occupational function.

As per research, Cipralex helps in maintaining an anti-obsessive response in patients with OCD. Such a response showcased for up to 6 months. However, physicians who choose to use Cipralex on such patients for a longer term should periodically re-evaluate its usefulness.

The Cipralex Dosage

Before discussing the recommended dosage for different cases, it is important to note that Cipralex should be provided as a single oral daily dose. Further, the patient can take it with or without food.

Psychotic Disorder/ConditionCipralex DosageWhen To be Administered
Major Depressive Disorder (MDD)Cipralex 5 mgTo be given daily where initial sensitivity to adverse events may be a concern. This should be increased as per the tolerance capacity of the patient.
Cipralex 10 mgSingle oral dose to be given daily to patients with MDD
Cipralex 20 mgMaximum daily dosage to be given to MDD patient depending upon his condition
Generalized Anxiety Disorder (GAD)Cipralex 5 mgTo be given daily where initial sensitivity to adverse events may be a concern. This should be increased as per the tolerance capacity of the patient.
Cipralex 10 mgSingle oral dose to be given daily to patients with MDD
Cipralex 20 mgMaximum daily dosage to be given to MDD patient depending upon his condition
* In the case of long-term therapy, the lowest effective level of the dosage should be maintained. Also, patients should be periodically re-evaluated.
Obsessive-Compulsive Disorder (OCD)Cipralex 5 mgTo be given daily where initial sensitivity to adverse events may be a concern. This should be increased as per the tolerance capacity of the patient.
Cipralex 10 mgSingle oral dose to be given daily to patients with MDD
Cipralex 20 mgMaximum daily dosage to be given to MDD patient depending upon his condition
* In the case of long-term therapy, the lowest effective level of the dosage should be maintained. Also, patients should be periodically re-evaluated.
Pregnant WomenCipralex 5 mgCipralex should not be used during pregnancy. It should be used only when the expected benefits to the patient are higher than the possible risk to the fetus.
Also, neonates exposed to SSRIs like Cipralex in the third trimester may have complications.
Cipralex 10 mg
Cipralex 20 mg
Elderly PatientsCipralex 5 mgInitial dose to be given once daily.
Cipralex 10 mgThe dose may be increased up to a maximum of 10 mg daily depending upon individual response and tolerance.
* Cipralex has a longer half-life and decreased clearance in the elderly.
Renal ImpairmentCipralex 5 mgNo dosage adjustment is necessary for patients with mild or moderate kidney failure. Cipralex should be used with caution in these patients. Especially ones having severely reduced kidney function.
Cipralex 10 mg
Cipralex 20 mg
Hepatic ImpairmentCipralex 5 mgAn initial single daily dose is recommended. The dose may be increased based on the patient’s response and clinical judgment.
Cipralex 10 mgA daily dose up to a maximum of 10 mg is recommended for most patients with liver impairment.
* Cipralex should be used with additional caution in patients with severe liver impairment. A lower dosage is recommended to patients with mild to moderate hepatic insufficiency.
CYP2C19 Poor MetabolizersCipralex 5 mgPatients who are poor metabolizers with respect to CYP2C19 are recommended an initial dose of 5 mg daily.
Cipralex 10 mgThe dose may be increased to a maximum of 10 mg daily depending upon individual response
* The metabolism of Cipralex is primarily moderated by CYP2C19.
Long Term TreatmentIn the case of long-term therapy, the lowest level of dosage should be maintained. Also, patients should be periodically evaluated.
Switching Patients To or From MOAITherapy with Cipralex should start at least 14 days after MOAI is discontinued. Likewise, MAOI should be started at least 14 days after stopping Cipralex.

Cipralex Reviews

Drugs.com is the largest and most popular online source for drug and related health information. Several independent and leading medical information suppliers power the database with drug information. These include the American Society of Health-System Pharmacists, IBM Watson Micromedex, and Cerner Multum.

According to the reviews available on drugs.com, Escitalopram (Cipralex) has an average rating of 7.5 on 10 from a total of 3081 ratings. Plus, 67% of the users who reviewed Escitalopram (Cipralex) reported a positive effect. While 16% reported a negative review.

ConditionAverage Rating
Anxiety7.4
Depression7.1
Generalized Anxiety Disorder (GAD)8.1
Major Depressive Disorder6.3
Obsessive-Compulsive Disorder (OCD) (Off Label)8.5
Bipolar Disorder (Off Label)6.4
Borderline Personality Disorder (Off Label)8.6
Fibromyalgia (Off Label)7.7
Premenstrual Dysphoric Disorder (Off Label)9.2
Irritable Bowel Syndrome (Off Label)7.8
Body Dysmorphic Disorder (Off Label)8.3
Trichotillomania (Off Label)5.3

Off – Label means FDA may not approve this medication for the treatment of the disorder.

Side Effects of Cipralex

Generally, side effects of Cipralex (Escitalopram Oxalate) were mild and transient. However, they are most frequent during the first or second week of the treatment.

Further, such side effects usually decrease in intensity and frequency with continued treatment. And such side effects typically do not result in termination of therapy.

Common Cipralex Side Effects

I. Major Depressive Disorder

The following are the most common side effects of Escitalopram occurring in patients with major depressive disorder.

  • Diarrhoea
  • Nausea
  • Insomnia
  • Dry mouth
  • Dizziness
  • Constipation
  • Swelling of nasal passages and back of the throat causing cold (Nasopharyngitis)
  • Indigestion in the upper abdomen
  • Pain in the throat (Pharyngolaryngeal Pain)
  • Headache
  • Cardiac Disorders

II. Male and Female Sexual Dysfunction With SSRIs

As per research, treatment with SSRIs may lead to sexual side effects. It is quite difficult to spot these symptoms as patients may not spontaneously report sexual dysfunction symptoms of this nature.

The following are common Cipralex side effects with regard to sexual dysfunction.

  • Decreased libido or inability to achieve orgasm
  • Delayed ejaculation (in males only)
  • Erectile dysfunction (in males only)
  • Ejaculation failure (in males only)
  • Ejaculation disorder (in males only)

III. Generalized Anxiety Disorder (GAD)

Cipralex Side effects that occurred in patients with GAD are as follows. GAD patients consuming Cipralex 10 mg and Cipralex 20 mg per day had these side effects.

  • Nausea
  • Fatigue
  • Dizziness
  • Diarrhoea
  • Insomnia
  • Excessive Sweating
  • Yawning
  • Dry Mouth
  • Sleepiness or Drowsiness
  • Delayed Ejaculation

III. Obsessive-Compulsive Disorder (OCD)

The most common Cipralex side effects that occurred in patients with OCD are as follows.

  • Nausea
  • Fatigue
  • Sleepiness or Drowsiness
  • Delayed Ejaculation
  • Diarrhoea
  • Dizziness
  • Swelling of nasal passages and back of the throat causing cold (Nasopharyngitis)
  • Dry Mouth
  • Excessive Sweating
  • Decreased libido or inability to achieve orgasm

IV. Other Effects

As per studies, patients treated with Escitalopram Oxalate (Cipralex) did not experience a significant change in body weight. In the case of patients with Social Anxiety Disorder, only 8% of the patients treated with Cipralex experienced weight gain of 7% or more.

As per studies, patients with MDD or GAD and treated with Escitalopram Oxalate (Cipralex) did not experience any significant change in their vital signs. These included changes in blood pressure, heart rate, etc.

Adverse Cipralex Side Effects

Following are the severe side effects of Cipralex.

1. Male Fertility, Pregnant Women, and NewBorns

As per data, the SSRIs may affect the sperm quality in males. However, the effect of some SSRIs on sperm quality is reversible. As of now, no impact on human fertility has not been observed.

Pregnant women must not use Cipralex. Unless the potential benefit to the patient is more than the possible risk to the fetus. Further, mothers of newborns must observe special care in case the maternal use of Cipralex continues into the later stages of pregnancy.

This particularly includes the third trimester. Also, the discontinuation effects in the newborn are possible if Cipralex is used until or shortly before birth. Such effects include vomiting, lethargy, feeding difficulty, etc

Also, there is an increased risk of Persistent Pulmonary Hypertension of the Newborn (PPHN). This is in case pregnant women consume SSRIs during late pregnancy.

Besides this, there is a chance of Escitalopram being excreted into the breast milk in case nursing mothers use Escitalopram (Cipralex)

2. SSRIs Used in Combination With Irreversible Non-Selective MAOIs

Serious reactions have been reported in patients taking SSRI along with non-selective, irreversible Monoamine Oxidase Inhibitors (MAOIs). MAOIs are a class of antidepressants used to treat panic disorders and social phobias.

Further, adverse effects were also observed in patients who had recently discontinued SSRI treatment and started on MOAI treatment. In certain cases, patients also developed Serotonin Syndrome.

Thus, it is advised to start taking Escitalopram 14 days after discontinuing the treatment with an irreversible MAOI.

Use in Children and Adolescents Under 18 Years Of Age

Cipralex should not be used in treating children and adolescents under 18 years of age. Clinical trials among children and adolescents treated with antidepressants showcased suicidal behaviors and hostility. This included aggression, anger, and oppositional behavior.

3. Anxiety

Patients suffering from panic disorder may experience increased anxiety symptoms at the beginning of the treatment with antidepressants. Typically, this reaction moderates within two weeks during continued treatment. Thus, a low dosage is advised in such cases.

4. Seizures

Escitalopram or Cipralex should be discontinued in case a patient develops seizures for the first time. Or experiences an increase in seizure frequency. Further, SSRIs must be avoided in patients with unstable Epilepsy.

5. Mania

You must be extra cautious while prescribing SSRIs to patients with a history of mania or hypomania. Further, SSRIs should be discontinued in case any patient is entering a manic phase.

6. Diabetes

In the case of patients with diabetes, treatment of psychotic disorders using an SSRI may change glycaemic control. As a result, it may lead to either hypoglycemia or hyperglycemia. In case SSRI is used to treat diabetic patients, insulin or oral glycaemic dosage should be adjusted.

7. Suicidal Thoughts

Depression is related to an increased risk of suicidal thoughts, self-harm, and suicide-related events. Further, such a risk may persist until the symptoms of disease reduce significantly.

During the first few weeks of treatment, the improvement in the risk of suicidal thoughts may not occur. Therefore, it is extremely important to monitor the patients closely until such improvement occurs.

Typically, the risk of suicide may increase in the early stages of recovery. Further, Cipralex is also prescribed for many other psychiatric conditions. Such other psychiatric conditions may also relate to the increased risk of suicide-related events in the patient.

Additionally, comorbidity of such conditions with major depressive disorder may also exist. Thus, one needs to observe the same precautions that are observed for the treatment of patients with major depressive disorder.

Remember, there are patients having a history of suicide-related events. Or the ones having a high degree of suicidal ideation before the start of the treatment. Such individuals are at a higher risk of suicidal thoughts or suicide attempts.

Therefore, such patients must be carefully monitored during the treatment.

As per clinical trials, patients less than 25 years old showcased an increased risk of suicidal behavior with antidepressants.

8. Psychomotor Restlessness Or Akathisia

As per research, some patients treated with SSRIs or SNRIs were observed to develop Akathisia characterized by subjective unpleasant restlessness. Further, such patients also feel the need to move often and are unable to sit or standstill. Typically, this occurs during the first few weeks of treatment. Hence, SSRIs should be discontinued in patients who develop such symptoms.

9. Hyponatraemia

Hyponatremia occurs in patients who experience inappropriate antidiuretic hormone secretion (SIADH). As per research, people suffering from Hyponatraemia are rarely treated with SSRIs.

Thus, SSRIs should be discontinued in patients suffering from Hyponatraemia. Further, extra caution must be exercised in case of patients at risk or patients with Cirrhosis.

Also, caution must be exercised in case SSRIs are used in combination with other medications that may cause Hyponatraemia.

10. Haemorrhage

As per reports, some patients using SSRIs have been reported bleeding into the skin causing tiny red dots on the skin. Thus, it is advised that caution must be exercised in patients taking SSRIs along with drugs that impact platelet function.

Particularly, caution is advised in patients taking SSRIs along with oral anticoagulants. Further, caution is also advised in patients already having bleeding tendencies.

11. Electroconvulsive Therapy (ECT)

It is advised to observe caution with patients undergoing ECT. This is because there exists a limited clinical experience of simultaneous administrations of SSRIs and ECT.

ECT is a psychiatric treatment in which small electric currents are passed through the brain. This is done to trigger a brief seizure internationally. Such a therapy leads to changes in brain chemicals that help in reversing the symptoms of various mental health conditions quickly.

12. Serotonin Syndrome

There are certain drugs that have serotonergic effects. Serotonergic means associated with or affecting Serotonin. Thus, a substance is serotonergic if it generates its effects by interacting with the Serotonin system.

That is, it either stimulates or blocks neurotransmission. Thus, caution is advised in case Cipralex (Escitalopram) is used along with such medications.

As per research, rare cases with Serotonin Syndrome have been reported in patients using SSRIs along with serotonergic medications. However, symptoms of agitation, tremor, hyperthermia ( due to high body temperature), and muscle jerks were observed in patients with Serotonin Syndrome.

In case such symptoms occur, then treatment using SSRIs along with serotonergic drugs should be discontinued immediately. Similarly, symptomatic treatment must be initiated in such cases.

13. St. John’s Wort

St. John’s Wort is a flowering plant with yellow star-shaped flowers. This flower is commonly used in some herbal remedies or medications to treat depression and mood disorders.

Thus, SSRIs should not be used in combination with herbal remedies containing St John’s Wort. This is because it may result in an increased occurrence of adverse reactions.

14. Discontinuation Symptoms

It is advised not to stop the intake of psychotic medications abruptly. This is because it may lead to discontinuation symptoms.

As per clinical trials, 25% of the patients treated with Escitalopram and 15% taking placebo were observed to have adverse effects on discontinuing the treatment.

Further, the risk of discontinuation symptoms may depend on several other factors. These include the duration and dose of therapy and rate of dose reduction.

The most commonly reported reactions are as follows.

  • Dizziness
  • Sleep disturbances like insomnia and intense dreams
  • Agitation or anxiety
  • Sensory disturbances like electric shock sensations and skin sensations
  • Vomiting or nausea
  • Tremor
  • Confusion
  • Sweating
  • Palpitations
  • Diarrhoea
  • Headache
  • Emotional instability
  • Irritability
  • Visual disturbances

Typically, the above-mentioned symptoms are mild to moderate. However, some patients may experience increased intensity of such symptoms. Further, these symptoms may occur within the first few days of discontinuing the treatment.

However, patients missing the dose accidentally rarely experienced such symptoms. Typically, these symptoms get resolved within two weeks. However, some patients may take more time.

Therefore, it is advised that Escitalopram is gradually tapered when discontinuing treatment over a period of several weeks or months.

15. Coronary Heart Disease

Caution is advised while prescribing Ciraplex to patients with coronary heart disease due to limited medical experience.

16. Cipralex and Alcohol

The most common question that people ask is can you drink alcohol on Cipralex. As per research, alcohol is not recommended while taking Cipralex.

Although, the interaction of Escitalopram and alcohol has not been studied. But concomitant use of alcohol in depressed patients taking Cipralex (Escitalopram) is not recommended.

17. Undesirable Side Effects

System Organ ClassFrequencyUndesirable Effect
Blood and lymphatic system disordersNot knownThrombocytopenia
Immune system disordersRareAnaphylactic reaction
Endocrine disordersNot knownInappropriate ADH secretion
Metabolism and nutrition disordersCommonDecreased appetite, increased appetite, weight increased
UncommonWeight decreased
Not knownHyponatremia, anorexia
Psychiatric disordersCommonAnxiety, restlessness, abnormal dreams Female and male: libido decreased Female: anorgasmia
UncommonBruxism, agitation, nervousness, panic attack, confusional state
RareAggression, depersonalization, hallucination
Not knownMania, suicidal ideation, suicidal behavior
Nervous system disordersCommonInsomnia, somnolence, dizziness, paraesthesia, tremor
UncommonTaste disturbance, sleep disorder, syncope
RareSerotonin syndrome
Not knownDyskinesia, movement disorder, convulsion, akathisia /psychomotor restlessness
Eye disordersUncommonMydriasis, visual disturbance
Ear and labyrinth disordersUncommonTinnitus
Cardiac disordersUncommonTachycardia
RareBradycardia
Vascular disordersNot knownOrthostatic hypotension
Respiratory, thoracic, and mediastinal disordersCommonSinusitis, yawning
UncommonEpistaxis
Gastrointestinal disordersVery commonNausea
CommonDiarrhoea, constipation, vomiting, dry mouth
UncommonGastrointestinal hemorrhages (including rectal hemorrhage)
Hepatobiliary disordersNot knownHepatitis, liver function test abnormal
Skin and subcutaneous tissue disordersCommonSweating increased
UncommonUrticaria, alopecia, rash, pruritus
Not knownEcchymosis, angioedemas
Musculoskeletal and connective tissue disordersCommonArthralgia, myalgia
Renal and urinary disordersNot knownUrinary retention
Reproductive system and breast disordersCommonMale: ejaculation disorder, impotence
UncommonFemale: metrorrhagia, menorrhagia
Not knownGalactorrhoea Male: priapism
General disorders and administration site conditionsCommonFatigue, pyrexia
UncommonOedema

Is Cipralex a Good Antidepressant?

Generally, Cipralex is safe for many people. However, Lundbeck lists certain warnings and precautions regarding the behavioral and emotional changes resulting from its intake in certain individuals.

Thus, you need to consult your doctor or pharmacist before taking Cipralex. Do not forget to intimate your doctor regarding any other illness or health condition that you are experiencing at present.

This is because your doctor may need to consider your health condition before recommending the appropriate prescription.

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