escitalopram
oxalate
Lexapro
Nursing Considerations
• Use escitalopram cautiously in patients
with history of mania or seizures, patients
with severe renal impairment, and those
with diseases or conditions that produce
altered metabolism or hemodynamic
responses.
•Monitor patient—especially elderly
patient—for hypoosmolarity of serum and
urine and for hyponatremia (headache,
trouble contentrating, impaired memory,
weakness, unsteadiness) because they may
may indicate escitalopram-induced syndrome
of inappropriate ADH secretion.
•Watch for signs of misuse or abuse, such
as development of tolerance, increasing
dosage without approval, and drug-seeking
behavior; drug’s potential for physical
and psychological dependence is
unknown.
•Monitor patient for bleeding, especially if
patient is also taking aspirin, an NSAID, or
an anticoagulant. Bleeding can range from
ecchymoses, hemtomas, epitaxis and
petechiae to life-threatening hemorrhages.
• Expect prescriber to reassess patient periodically
to determine the continued need
for therapy and evaluate dosage.
• If patient (particularly a child or an adolescent)
takes escitalopram for depression,
watch closely for suicidal tendencies, especially
when therapy starts or dosage
changes, because depression may worsen
temporarily.
• If escitalopram will be stopped, expect to
taper dosage to avoid serious adverse reactions.
PATIENT TEACHING
• Inform patient that alcohol use isn’t recommended
during escitalopram therapy
because it may decrease his ability to think
clearly and perform motor skills.
• Advise patient to avoid hazardous activities
until drug’s CNS effects are known.
• Instruct patient that drug shouldn’t be
taken with citalopram hydrobromide
because of potentially additive effects.
• Tell patient that improvement may not be
noticed for 1 to 4 weeks after therapy
begins. Emphasize the importance of continuing
therapy as prescribed.
• If patient (particularly a child or an adolescent)
takes drug for depression, urge
caregivers to watch closely for suicidal tendencies,
especially when therapy starts or
dosage changes.
•Warn patient not to stop taking drug
abruptly. Explain that gradual tapering
helps to avoid withdrawal symptoms.
• Urge patient to inform prescriber of any
OTC drugs he takes because of potential
for interactions.
• Review signs and symptoms of hyponatremia,
and instruct patient to report them
to prescriber.
•Warn patient that escitalopram increases
bleeding risk if taken with aspirin, an
NSAID, or an anticoagulants and that
bleeding events could range from mild to
severe. Tell patient to seek emergency care
for serious or prolonged bleeding.
