Nexito (Escitalopram Oxalate)
Also sold as: Nexito, Lexapro, Citoles, S-Citopram
Pregnancy
Cat C
Lactation
Caution
Schedule
H
Forms
Tablet 5/10/20mg +1
Indications
- Major depressive disorder
- Generalized anxiety disorder
- Panic disorder
- OCD
- Social anxiety disorder
- PTSD
Adult Dosing
Depression/anxiety
10 mg PO OD; can titrate to 20 mg after 1-2 weeks
Max 20 mg/day
Elderly / hepatic impairment
Max 10 mg/day
Pediatric Dosing
Monitor for suicidality especially in first month
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| CrCl > 20 | No adjustment |
| CrCl < 20 | Use cautiously |
Hepatic Adjustment
Max 10 mg/day in mild-moderate impairment
Pregnancy & Lactation
Pregnancy: Category C
3rd trimester: neonatal withdrawal, PPHN risk. Discuss benefits vs risks
Lactation: Caution
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| MAOIs | CONTRAINDICATED — serotonin syndrome (avoid 14 days after MAOI) | Major |
| QT-prolonging drugs (azithromycin, ondansetron) | Additive QT prolongation | Major |
| NSAIDs, aspirin, anticoagulants | Increased bleeding risk | Major |
| Tramadol, triptans | Serotonin syndrome risk | Major |
| Other SSRIs, SNRIs | Serotonin syndrome | Major |
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Side Effects
Common
- Nausea (early)
- Insomnia
- Sexual dysfunction
- Sweating
- Dry mouth
- Headache
Serious / Discontinue If
- Suicidal ideation (especially first month, <25 years)
- Serotonin syndrome
- QT prolongation (esp >20 mg)
- Hyponatremia (SIADH, especially elderly)
- Bleeding risk
- Withdrawal syndrome on abrupt stop
Contraindications
- MAOI use within 14 days
- Concomitant pimozide
- Hypersensitivity
- Congenital long QT
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Nexito 10 | Sun Pharma | 10 tab ₹95 |
| Citoles 10 | Cipla | 10 tab ₹85 |
| S-Citopram 10 | Lupin | 10 tab ₹78 |
Monitoring Required
- Mood, suicidality (especially first 4-8 weeks), Na+ in elderly, ECG if risk factors
Patient Counseling Points
- Effect takes 4-6 weeks
- Do not stop abruptly — taper over 2-4 weeks
- Avoid alcohol
- Report worsening mood or thoughts of self-harm immediately
- May affect sexual function
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References
- BNF
- Lexicomp Drug Information
- Indian National Formulary
- Specialty society guidelines (RSSDI/CSI/IAP)