Escitalopram 10 Mg Film-Coated Tablets
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PACKAGE LEAFLET: INFORMATION FOR THE USER
Escitalopram 5 mg film-coated tablets Escitalopram 10 mg film-coated tablets Escitalopram 20 mg film-coated tablets
Escitalopram (as oxalate)
Read all of this leaflet carefully before you start taking this medicine because it contains important information for you
• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor or pharmacist.
• This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
• If you get any side effects, talk to your doctor or pharmacist or nurse. This includes any possible side effects not listed in this leaflet
What is in this leaflet:
1. What Escitalopram film-coated tablets is and what it is used for
2. What you need to know before you take Escitalopram film-coated Tablets
3. How to take Escitalopram film-coated tablets
4. Possible side effects
5. How to store Escitalopram film-coated tablets
6. Contents of the pack and other information
1. WHAT ESCITALOPRAM
FILM-COATED TABLETS IS AND WHAT IT IS USED FOR
Escitalopram film-coated tablets contain escitalopram and are used to treat depression (major depressive episodes) and anxiety disorders (such as panic disorder with or without agoraphobia, social anxiety disorder, generalised anxiety disorder and obsessive-compulsive disorder).
Escitalopram film-coated tablets belongs to a group of antidepressants called selective serotonin reuptake inhibitors (SSRIs). These medicines act on the serotonin-system in the brain by increasing the serotonin level. Disturbances in the serotonin-system are considered an important factor in the development of depression and related diseases.
2. WHAT YOU NEED TO KNOW
BEFORE YOU TAKE ESCITALOPRAM FILM-COATED TABLETS
Do not take Escitalopram film-coated tablets
• If you are allergic (hypersensitive) to escitalopram or any of the other ingredients of this medicine (listed in section 6)
• If you take other medicines, which belongs to a group, called MAO inhibitors, including selegiline (used in the treatment of Parkinson's disease), moclobemide (used in the treatment of depression) and linezolid (an antibiotic).
• If you are born with or have had an episode of abnormal heart rhythm (seen at ECG; an examination to evaluate how the heart is functioning)
• If you take medicines for heart rhythm problems or that may affect the heart's rhythm (see section 2 “Taking other medicines”)
Warnings and Precautions
Please tell your doctor if you have any other condition or illness, as your doctor may need to take this into consideration. In particular, tell your doctor:
• If you have epilepsy. Treatment with Escitalopram film-coated tablets should be stopped if seizures occur or if there is an increase in the seizure frequency (see also section 4 “Possible side effects").
• If you suffer from impaired liver or kidney function. Your doctor may need to adjust your dosage.
• If you have diabetes. Treatment with Escitalopram film-coated tablets may alter glycaemic control. Insulin and / or oral hypoglycaemic dosage may need to be adjusted.
• If you have a decreased level of sodium in the blood.
• If you have a tendency to easily develop bleedings or bruises.
• If you are receiving electroconvulsive treatment.
• If you have coronary heart disease.
• If you suffer or have suffered from heart problems or have recently had a heart attack
• If you have a low resting heart-rate and/or you know that you may have salt depletion as a result of prolonged severe diarrhoea and vomiting (being sick) or usage of diuretics (water tablets)
• If you experience a fast or irregular heartbeat, fainting, collapse or dizziness on standing up, which may indicate abnormal functioning of the heart rate
• If you have eye problems, such as certain types of glaucoma (increased pressure in the eye)
Please note
Some patients with manic-depressive illness may enter into a manic phase. This is characterized by unusual and rapidly changing ideas, inappropriate happiness and excessive physical activity. If you experience this, contact your doctor.
Symptoms such as restlessness or difficulty in sitting or standing still can also occur during the first weeks of the treatment. Tell your doctor immediately if you experience these symptoms.
Thoughts of suicide and worsening of your depression or anxiety disorder
If you are depressed and / or have anxiety disorders you can sometimes have thoughts of harming or killing yourself. These may be increased when first starting antidepressants, since these medicines all take time to work, usually about two weeks but sometimes longer.
You may be more likely to think like this:
• If you have previously had thoughts about killing or harming yourself.
• If you are a young adult. Information from clinical trials has shown an increased risk of suicidal behaviour in adults aged less than 25 years with psychiatric conditions who were treated with an antidepressant.
If you have thoughts of harming or killing yourself at any time, contact your doctor or go to a hospital straight away.
You may find it helpful to tell a relative or close friend
that you are depressed or have an anxiety disorder, and ask them to read this leaflet. You might ask them to tell you if they think your depression or anxiety is getting worse, or if they are worried about changes in your behaviour.
Use in children and adolescents under 18 years of age
Escitalopram film-coated tablets should normally not be used for children and adolescents under 18 years. Also, you should know that patients under 18 have an increased risk of side effects such as suicide attempts, suicidal thoughts and hostility (predominately aggression, oppositional behaviour and anger) when they take this class of medicines. Despite this, your doctor may prescribe Escitalopram film-coated tablets for patients under 18 because he / she decide that this is in their best interest. If your doctor has prescribed Escitalopram film-coated tablets for a patient under 18 and you want to discuss this, please go back to your doctor. You should inform your doctor if any symptoms listed above develop or worsen when patients under 18 are taking Escitalopram film-coated tablets. Also, the long-term safety effects concerning growth, maturation and cognitive and behavioural development of Escitalopram film-coated tablets in this age group have not yet been demonstrated.
Using other medicines
Tell your doctor or pharmacist if you are using, have
recently used any other medicines, including medicines
obtained without prescription.
Tell your doctor if you are taking any of the following medicines:
• “Non-selective monoamine oxidase inhibitors (MAOIs)”, containing phenelzine, iproniazid, isocarboxazid, nialamide, and tranylcypromine as active ingredients. If you have taken any of these medicines you will need to wait 14 days before you start taking Escitalopram film-coated tablets. After stopping Escitalopram film-coated tablets you must allow 7 days before taking any of these medicines.
• “Reversible, selective MAO-A inhibitors”, containing moclobemide (used to treat depression).
• “Irreversible MAO-B inhibitors” containing selegiline (used to treat Parkinson's disease). These increase the risk of side effects.
• The antibiotic linezolid.
• Lithium (used in the treatment of manic-depressive disorder) and tryptophan.
• Imipramine and desipramine (both used to treat depression).
• Sumatriptan and similar medicines (used to treat migraine) and tramadol (used against severe pain). These increase the risk of side effects.
• Cimetidine and omeprazole (used to treat stomach ulcers); fluvoxamine (antidepressant) and ticlopidine (used to reduce the risk of stroke). These may cause increased blood levels of Escitalopram film-coated tablets.
• St. John's Wort (Hypericum perforatum) - a herbal remedy used for depression.
• Acetylsalicylic acid (aspirin) and non-steroidal anti-inflammatory drugs (medicines used for pain relief or to thin the blood, so called anticoagulants).
• Warfarin, dipyridamole and phenprocoumon (medicines used to thin the blood, so called anticoagulants). Your doctor will probably check the coagulation time of your blood when starting and discontinuing Escitalopram film-coated tablets in order to verify that your dose of anticoagulant is still adequate.
• Mefloquin (used to treat Malaria), bupropion (used to treat depression) and tramadol (used to treat severe pain) due to a possible risk of a lowered threshold for seizures.
• Neuroleptics (medicines to treat schizophrenia, psychosis) due to a possible risk of a lowered threshold for seizures, and antidepressants.
• Flecainide, propafenone and metoprolol (used in cardiovascular diseases); clomipramine and nortriptyline (antidepressants) and risperidone, thioridazine and haloperidol (antipsychotics). The dosage of Escitalopram Film-Coated Tablets may need to be adjusted.
DO NOT TAKE Escitalopram film-coated tablets if you
take medicines for heart rhythm problems or medicines that may affect the heart's rhythm, such as Class IA and III antiarrhythmics, antipsychotics (e.g. phenothiazine derivatives, pimozide, haloperidol), tricyclic antidepressants, certain antimicrobial agents (e.g. sparfloxacin, moxifloxacin, erythromycin IV, pentamidine, anti-malarian treatment particularly halofantrine), certain antihistamines (astemizole, mizolastine). If you have any further questions about this you should speak to your doctor.
Escitalopram film-coated tablets with food and drink and alcohol
Escitalopram film-coated tablets can be taken with or without food (see section 3 “How to take Escitalopram film-coated tablets”).
As with many medicines, combining Escitalopram film-coated tablets with alcohol is not advisable, although Escitalopram film-coated tablets is not expected to interact with alcohol.
Pregnancy and breast-feeding and fertility
Inform your doctor if you are pregnant or planning to become pregnant. Do not take Escitalopram film-coated tablets if you are pregnant unless you and your doctor have discussed the risks and benefits involved. If you take Escitalopram film-coated tablets during the last 3 months of your pregnancy you should be aware that the following effects may be seen in your newborn baby: trouble with breathing, bluish skin, fits, body temperature changes, feeding difficulties, vomiting, low blood sugar, stiff or floppy muscles, vivid reflexes, tremor, jitteriness, irritability, lethargy, constant crying, sleepiness and sleeping difficulties. If your newborn baby has any of these symptoms, please contact your doctor immediately.
Make sure your midwife and/or doctor know you are on Escitalopram film-coated tablets. When taken during pregnancy, particularly in the last 3 months of pregnancy, medicines like Escitalopram film-coated tablets may increase the risk of a serious condition in babies, called persistent pulmonary hypertension of the newborn (PPHN), making the baby breathe faster and appear bluish. These symptoms usually begin during the first 24 hours after the baby is born. If this happens to your baby you should contact your midwife and/or doctor immediately.
If used during pregnancy Escitalopram film-coated tablets should never be stopped abruptly.
Do not take Escitalopram film-coated tablets if you are breast-feeding unless you and your doctor have discussed the risks and benefits involved.
Citalopram, a medicine like escitalopram, has been shown to reduce the quality of sperm in animal studies. Theoretically, this could affect fertility, but impact on human fertility has not been observed as yet.
Ask your doctor or pharmacist for advise before taking any medicine.
If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.
Driving and using machines
You are advised not to drive a car or operate machinery until you know how Escitalopram film-coated tablets affects you.
3. HOW TO TAKE ESCITALOPRAM FILM-COATED TABLETS
Always take this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure.
Adults
Depression
The normally recommended dose of Escitalopram film-coated tablets is 10 mg taken as one daily dose. The dose may be increased by your doctor to a maximum of 20 mg per day.
Panic disorder
The starting dose of Escitalopram film-coated tablets is 5 mg as one daily dose for the first week before increasing the dose to 10 mg per day. The dose may be further increased by your doctor to a maximum of 20 mg per day.
Social anxiety disorder
The normally recommended dose of Escitalopram film-coated tablets is 10 mg taken as one daily dose. Your doctor can either decrease your dose to 5 mg per day or increase the dose to a maximum of 20 mg per day, depending on how you respond to the medicine.
Generalised anxiety disorder The normally recommended dose of Escitalopram film-coated tablets is 10 mg taken as one daily dose. The dose may be increased by your doctor to a maximum of 20 mg per day.
Obsessive-compulsive disorder The normally recommended dose of Escitalopram film-coated tablets is 10 mg taken as one daily dose. The dose may be increased by your doctor to a maximum of 20 mg per day.
Elderly patients (above 65 years of age)
The recommended starting dose of Escitalopram film-coated tablets is 5 mg taken as one daily dose. The dose may be increased by your doctor to 10 mg per day.
Denmark
Estonia
Ireland
Latvia
Lithuania
Portugal
Spain
Bulgaria
Finland
Italy
Netherland
Sweden
Slovakia
L
Children and adolescents (below 18 years of age) Escitalopram film-coated tablets should not normally be given to children and adolescents. For further information please see section 2 “Before you take Escitalopram film-coated tablets”.
You can take Escitalopram film-coated tablets with or without food. Swallow the tablet with some water. Do not chew them, as the taste is bitter.
If necessary, you can divide the tablets by firstly placing the tablet on a flat surface with the score facing upwards. The tablets may then be broken by pressing down on each end of the tablet, using both forefingers as shown in the drawing.
Only 10 mg and 20 mg tablets can be divided into equal halves.
Duration of treatment
It may take a couple of weeks before you start to feel better. Continue to take Escitalopram film-coated tablets even if it takes some time before you feel any improvement in your condition.
Do not change the dose of your medicine without talking to your doctor first.
Continue to take Escitalopram film-coated tablets for as long as your doctor recommends. If you stop your treatment too soon, your symptoms may return. It is recommended that treatment should be continued for at least 6 months after you feel well again.
If you take more Escitalopram film-coated tablets than you should
If you take more than the prescribed dose of Escitalopram film-coated tablets, contact your doctor or nearest hospital emergency department immediately. Do this even if there are no signs of discomfort. Some of the signs of an overdose could be dizziness, tremor, agitation, convulsion, coma, nausea, vomiting, change in heart rhythm, decreased blood pressure and change in body fluid / salt balance. Take the Escitalopram Film-Coated Tablets box / container with you when you go to the doctor or hospital.
If you forget to take Escitalopram film-coated tablets
Do not take a double dose to make up for forgotten doses. If you do forget to take a dose, and you remember before you go to bed, take it straight away. Carry on as usual the next day. If you only remember during the night, or the next day, leave out the missed dose and carry on as usual.
If you stop taking Escitalopram film-coated tablets
Do not stop taking Escitalopram film-coated tablets until your doctor tells you to do so. When you have completed your course of treatment, it is generally advised that the dose of Escitalopram film-coated tablets is gradually reduced over a number of weeks.
When you stop taking Escitalopram film-coated tablets, especially if it is abruptly, you may feel discontinuation symptoms. These are common when treatment with Escitalopram film-coated tablets is stopped. The risk is higher, when Escitalopram film-coated tablets has been used for a long time or in high doses or when the dose is reduced too quickly. Most people find that the symptoms are mild and go away on their own within two weeks. However, in some patients they may be severe in intensity or they may be prolonged (2-3 months or more). If you get severe discontinuation symptoms when you stop taking Escitalopram film-coated tablets, please contact your doctor. He or she may ask you to start taking your tablets again and come off them more slowly.
Discontinuation symptoms include: Feeling dizzy (unsteady or off-balance), feelings like pins and needles, burning sensations and (less commonly) electric shock sensations, including in the head, sleep disturbances (vivid dreams, nightmares, inability to sleep), feeling anxious, headaches, feeling sick (nausea), sweating (including night sweats), feeling restless or agitated, tremor (shakiness), feeling confused or disorientated, feeling emotional or irritable, diarrhoea (loose stools), visual disturbances, fluttering or pounding heartbeat (palpitations).
If you have any further questions on the use of this medicine, ask your doctor or pharmacist or nurse.
4. POSSIBLE SIDE EFFECTS
Like all medicines, this medicine can cause side effects, although not everybody gets them.
The side effects usually disappear after a few weeks of treatment. Please be aware that many of the effects may also be symptoms of your illness and therefore will improve when you start to get better.
See your doctor if you get any of the following side effects during treatment:
Uncommon: affects 1 to 10 users in 1,000 • Unusual bleeds, including gastrointestinal bleeds
Rare: affects 1 to 10 users in 10,000
• If you experience swelling of skin, tongue, lips, or face, or have difficulties breathing or swallowing (allergic reaction), contact your doctor or go to a hospital straight away.
• If you have a high fever, agitation, confusion, trembling and abrupt contractions of muscles these may be signs of a rare condition called serotonin syndrome. If you feel like this contact your doctor.
If you experience the following adverse events you should
contact your doctor or go to the hospital straight away:
• Difficulties urinating
• Fast, irregular heartbeat, fainting which could be symptoms of a life-threatening condition known as Torsades de Pointes.
• Seizures (fits), see also section Take special care with Escitalopram Film-Coated Tablets
• Yellowing of the skin and the white in the eyes are signs of liver function impairment / hepatitis
In addition to above the following side effects have
been reported:
Very common: affects more than 1 user in 10
• Feeling sick (nausea)
• Headache
Common: affects 1 to 10 users in 100
• Blocked or runny nose (sinusitis)
• Decreased or increased appetite
• Anxiety, restlessness, abnormal dreams, difficulties falling asleep, feeling sleepy, dizziness, yawning, tremors, prickling of the skin
• Diarrhoea, constipation, vomiting, dry mouth
• Increased sweating
• Pain in muscle and joints (arthralgia and myalgia)
• Sexual disturbances (delayed ejaculation, problems with erection, decreased sexual drive and women may experience difficulties achieving orgasm)
• Fatigue, fever
• Increased weight
Uncommon: affects 1 to 10 users in 1,000
• Nettle rash (urticaria), rash, itching (pruritus)
• Grinding one's teeth, agitation, nervousness, panic attack, confusion state
• Disturbed sleep, taste disturbance, fainting (syncope)
• Enlarged pupils (mydriasis), visual disturbance, ringing in the ears (tinnitus)
• Loss of hair
• Vaginal bleeding
• Decreased weight
• Fast heart beat
• Swelling of the arms or legs
• Nosebleeds
Rare: affects 1 to 10 users in 10,000
• Aggression, depersonalisation, hallucination
• Slow heart beat
Some patients have reported (not known: frequency can
not be estimated from the available data):
• Thoughts of harming yourself or thoughts of killing yourself, see also section “Take special care with Escitalopram Film-Coated Tablets”
• Decreased levels of sodium in the blood (the symptoms are feeling sick and unwell with weak muscles or confused)
• Alteration of the heart rhythm (called “pronlongation of QT interval”, seen on ECG, electrical activity of the heart).
• Dizziness when you stand up due to low blood pressure (orthostatic hypotension)
• Abnormal liver function test (increased amounts of liver enzymes in the blood)
• Movement disorders (involuntary movements of the muscles)
• Painful erections (priapism)
• Bleeding disorders including skin and mucous bleeding (ecchymosis) and low level of blood platelets (thrombycytopenia)
• Sudden swelling of skin or mucosa (angioedemas)
• Increase in the amount of urine excreted (inappropriate ADH secretion)
• Flow of milk in women that are not nursing
• Mania
• An increased risk of bone fractures has been observed in patients taking this type of medicines
In addition, a number of side effects are known to occur with drugs that work in a similar way to Escitalopram Film-Coated Tablets (the active ingredient of Escitalopram Film-Coated Tablets). These are:
• Motor restlessness (akathisia)
• Anorexia
Reporting of side effects
If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. By reporting side effects you can help provide more information on the safety of this medicine.
For UK- You can also report side effects directly via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard.
For Ireland- You can also report side effects directly via
HPRA Pharmacovigilance
Earlsfort Terrace, IRL - Dublin 2
Tel: +353 1 6764971, Fax: +353 1 6762517
Website: www.hpra.ie. e-mail: medsafety@hpra.ie
5. HOW TO STORE ESCITALOPRAM FILM-COATED TABLETS
Keep this medicine out of the sight and reach of children. Do not use this medicine after the expiry date, which is stated on the blister, label or carton after EXP.
The expiry date refers to the last day of the month.
Do not store above 30°C.
Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.
6. CONTENTS OF THE PACK AND L OTHER INFORMATION_
What Escitalopram film-coated tablets contains
The active substance is escitalopram.
Each Escitalopram 5mg film-coated tablet contains 5 mg escitalopram (as oxalate).
Each Escitalopram 10mg film-coated tablet contains 10 mg escitalopram (as oxalate).
Each Escitalopram 20mg film-coated tablet contains 20 mg escitalopram (as oxalate).
The other ingredients are:
Core: cellulose, microcrystalline (PH 101) (E460), croscarmellose sodium (E468), hypromellose E5 (E464), talc (E553b), colloidal anhydrous silica (E551), magnesium stearate (E572)
Coating:
hypromellose E-15 (E464), titanium dioxide (E171), macrogol 400
What Escitalopram film-coated tablets looks like and contents of the pack
Escitalopram film-coated tablets is presented as film-coated tablets. The tablets are described below.
5 mg:
White to off-white, round, biconvex, film coated tablets plain on both side.
10 mg:
White to off-white, oval, biconvex film coated tablets with inscription '1' and '0' on either side of score line on one side and plain on other side.
20 mg:
White to off-white, oval, biconvex, film coated tablets with score line on one side and plain on other side.
The 10 mg and 20 mg tablets can be divided into equal halves.
Escitalopram film-coated tablets is available in the following pack sizes:
Blister(s) in outer carton:
5mg, 10mg and 20 mg: 14, 28, 56 and 98 tablets HDPE bottle packs of 100 tablets.
Not all pack sizes may be marketed.
Marketing Authorisation Holder
Accord Healthcare Limited
Sage House, 319, Pinner Road, North Harrow,
Middlesex, HA1 4HF, United Kingdom
Manufacturer
ACCORD HEALTHCARE LIMITED,
Sage House, 319, Pinner Road, North Harrow,
Middlesex HA1 4Hf, United Kingdom
Pharmacare Premium Ltd.,
HHF 003, Hal Far Industrial Estate, Birzebbugia,
BBG 3000, Malta.
This medicinal product is authorised in the Member States of the eEa under the following names:
Austria Escitalopram Accord 5 mg / 10mg / 20mg
filmtabletten
Czech Republic Escitalopram Accord 5 mg / 10mg / 20mg potahovane tablety Escitalopram Accord Healthcare Escitalopram Accord 5 mg / 10 mg /20 mg Escitalopram 5 mg/10mg/20mg film-coated tablets
Escitalopram Accord 5 mg / 10 mg / 20 mg apvalkotas tabletes
Escitalopram Accord 5 mg / 10 mg / 20 mg plevele dengtos tabletes Escitalopram Accord
Escitalopram Accord 5 mg / 10mg / 20mg comprimidos recubiertos con pelfcula Escitalopram Accord 10 mg ^MnMMpaHM TabneTKM
Escitalopram Accord 10/20 mg Tabletti, kalvopaallysteinen Escitalopram Accord Escitalopram Accord 5 mg/10 mg /20 mg Filmomhulde tabletten Escitalopram Accord 5 mg /10 mg /20 mg Filmdragerade tabletter Escitalopram Accord 10 mg /20 mg filmom obalene tablety United Kingdom Escitalopram 5 mg/10 mg /20 mg Film-coated tablets