英文药名: Cipralex(Escitalopram)

中文药名: 依地普仑片

生产厂家: Lundbeck Inc.

药品简介

依地普仑获瑞典、瑞士、丹麦、比利时、英国、法国、爱尔兰和奥地利等欧洲国家许可，现已在瑞士、瑞典和英国上市，商品名为 Cipralex。
依地普仑是西酞普兰（ Citalopram）的活性S-对映异构体，去除了无抗抑郁活性的 R-对映异构体。临床研究显示了依地普仑的疗效和耐受性好。其推荐剂量为一日10mg，而西酞普兰为一日40mg。此外，许多病人每日服用依地普仑10mg，治疗第1周或第2周后开始显著改善抑郁症状。
依地普仑 10mg在主要疗效上同西酞普兰40mg相似。
依地普仑Escitalopram 是一种新型的选择性5一羟色胺再摄取抑制剂（SSRIs)。选择性5一羟色胺再摄取抑制剂已取代了三环类抗抑郁药物成为抑郁治疗的一线用药，其原因在于它们不仅具有三环类抗抑郁药相似的疗效，同时具有相对较好的耐受性以及过量时较好的安全性。
草酸依地普仑是单纯的SSRIs，其对5一羟色胺再摄制抑制的相对选择性在同类药物中最高，抗抑郁作用优于西酞普兰，起效快．服用剂量小，耐受性好，副反应小，药物相互作用少等优点，可以与其他药物联合应用。与其他SSRIs一样，成为抗重性抑郁的第一线用药。最常见的副反应是恶心、失眠、射精障碍、腹泻、口干、思睡，只有恶心发生率>10％ 。
 
用法用量
成人：草酸依地普伦每日服用一次。开始10 mg／d，如临床适应剂量可增加至20 mg／d，或有需要时增加至30 mg／d。超过65岁的患者，剂量减半，即5-15 mg／d。抗抑郁剂治疗属于对症治疗，必须持续相当长的时间，一般说来对双相障碍性一抑郁障碍需要治疗4-6个月。
若出现失眠或严重的静坐不能，在急性期建议辅助镇静剂治疗。
任何疑问，请遵医嘱！
安全性/耐受性
Wade(2002)报道：草酸依地普仑的副作用通常很少，很轻，且短暂。最常见的副反应有：恶心、多汗、口干、头痛和睡眠时间缩短。通常在治疗开始的第1或第2周时较明显，随着抑郁状态的改善一般都逐渐消失。在稀有个案中曾观察到癫痫发作。在已患有心动过缓的患者中，心动过缓可使治疗更复杂。
与三环类抗抑郁药相比，草酸依地普仑很少引起过度镇静、嗜睡、体质量增加、和直立性低血压、性功能障碍等副反应。尤其无体质量增加及性功能障碍使得依地普仑远比三环类抗抑郁药易于为患者接受。
草酸依地普仑在人怀孕期的安全性尚未确定，动物实验未显示任何致畸形可能的证据。并且，不影响生殖或产期状态。不影响心脏传导系统及血压，这一点对老年患者尤为重要。也不影响血液，肝肾等系统。
药物过量
药物过量时，达6OO mg出现疲乏、无力、嗜睡、头晕、手颤、恶心。最高服用剂量记录约为2,000mg，患者在木僵及呼吸困难状态下入院，但没有心脏中毒的迹象，患者很快康复。
禁用
禁用于已在使用单胺氧化酶抑制剂治疗者，单胺氧化酶抑制剂至少停用14 d后方可使用本品。禁用于对本药品制剂成份有过敏史者。
与单胺氧化酶抑制剂合用时会出现致命的5一羟色胺综合征，因此两药使用间隔应在14 d以上。

Cipralex(Escitalopram)
What is Cipralex (Escitalopram)?
Cipralex (Escitalopram) is an antidepressant in a group of drugs called selective serotonin reuptake inhibitors (SSRIs). It affects chemicals in the brain that may become unbalanced and cause depression or anxiety.Cipralex (Escitalopram) is used to treat anxiety in adults and major depressive disorder in adults and adolescents who are at least 12 years old.Cipralex (Escitalopram) may also be used for purposes other than those listed in this medication guide.

Important information about Cipralex (Escitalopram)
Do not take Cipralex (Escitalopram) together with a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate). You must wait at least 14 days after stopping an MAOI before you can take Cipralex (Escitalopram). After you stop taking Cipralex (Escitalopram), you must wait at least 14 days before you start taking an MAOI.You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment with Cipralex (Escitalopram).Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself. SSRI antidepressants may cause serious or life-threatening lung problems in newborn babies whose mothers take the medication during pregnancy. However, you may have a relapse of depression if you stop taking your antidepressant during pregnancy. If you are planning a pregnancy, or if you become pregnant while taking Cipralex (Escitalopram), do not stop taking the medication without first talking to your doctor.It is dangerous to try and purchase Cipralex (Escitalopram) on the Internet or from vendors outside of the United States. Medications distributed from Internet sales may contain dangerous ingredients, or may not be distributed by a licensed pharmacy. Samples of Cipralex (Escitalopram) purchased on the Internet have been found to contain haloperidol (Haldol), a potent antipsychotic drug with dangerous side effects. For more information, contact the U.S. Food and Drug Administration (FDA) or visit www.fda.gov/buyonlineguideBefore taking Cipralex (Escitalopram)Do not use Cipralex (Escitalopram) if you are using an MAO inhibitor such as isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), rasagiline (Azilect), or selegiline (Eldepryl, Emsam). Serious and sometimes fatal reactions can occur when these medicines are taken with Cipralex (Escitalopram). You must wait at least 14 days after stopping an MAO inhibitor before you can take escitalopram. After you stop taking Cipralex (Escitalopram), you must wait at least 14 days before you start taking an MAOI.Before taking this medicine, tell your doctor if you are allergic to any drugs, or if you have:liver or kidney disease; seizures or epilepsy;bipolar disorder (manic depression); ora history of drug abuse or suicidal thoughts.If you have any of these conditions, you may need a dose adjustment or special tests to safely take Cipralex (Escitalopram).You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Tell your doctor if you have worsening symptoms of depression or suicidal thoughts during the first several weeks of treatment, or whenever your dose is changed.Your family or other caregivers should also be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment with Cipralex (Escitalopram).
FDA pregnancy category C. SSRI antidepressants may cause serious or life-threatening lung problems in newborn babies whose mothers take the medication during pregnancy. However, you may have a relapse of depression if you stop taking your antidepressant during pregnancy. If you are planning a pregnancy, or if you become pregnant while taking Cipralex (Escitalopram), do not stop taking the medication without first talking to your doctor. Escitalopram can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Do not give Cipralex (Escitalopram) to anyone younger than 12 years old without the advice of a doctor.

How should I take Cipralex (Escitalopram)?
Take Cipralex (Escitalopram) exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Your doctor may occasionally change your dose to make sure you get the best results from the medication.Take each dose of Cipralex (Escitalopram) with a full glass of water.Try to take the medicine at the same time each day. Follow the directions on your prescription label.To be sure you get the correct dose of liquid Cipralex (Escitalopram), measure the liquid with a marked measuring spoon or medicine cup, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.It may take 4 weeks or longer before you start feeling better. Do not stop using Cipralex (Escitalopram) without first talking to your doctor. You may have unpleasant side effects if you stop taking this medication suddenly. Store Cipralex (Escitalopram) at room temperature away from moisture and heat.

What happens if I miss a dose?
Take the missed dose as soon as you remember. However, if it is almost time for the next regularly scheduled dose, skip the missed dose and take the next one as directed. Do not take extra medicine to make up the missed dose.

What happens if I overdose?
Seek emergency medical attention if you think you have taken too much of this medication. Overdose symptoms may include nausea, vomiting, tremor, sweating, rapid heartbeat, confusion, dizziness, seizures, and coma.

What should I avoid while taking Cipralex (Escitalopram)?
Talk to your doctor before taking any medicine for pain, arthritis, fever, or swelling. This includes aspirin and NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), diclofenac (Voltaren), indomethacin, piroxicam (Feldene), nabumetone (Relafen), etodolac (Lodine), and others. Taking any of these drugs with escitalopram may cause you to bruise or bleed easily.Avoid drinking alcohol, which can increase some of the side effects of Cipralex (Escitalopram). Cipralex (Escitalopram) can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.Tell your doctor if you regularly use other medicines that make you sleepy (such as cold or allergy medicine, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures or anxiety). They can add to sleepiness caused by Cipralex (Escitalopram).

Side effects of Cipralex (Escitalopram)
Get emergency medical help if you have any of these signs of an allergic reaction: skin rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat.Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.Call your doctor at once if you have any of these serious side effects:very stiff (rigid) muscles, high fever, sweating, fast or uneven heartbeats, tremors, overactive reflexes;nausea, vomiting, diarrhea, loss of appetite, feeling unsteady, loss of coordination; orheadache, trouble concentrating, memory problems, weakness, confusion, hallucinations, fainting, seizure, shallow breathing or breathing that stops.
Less serious Cipralex (Escitalopram) side effects may include:drowsiness, dizziness;sleep problems (insomnia);mild nausea, gas, heartburn, upset stomach, constipation;weight changes;decreased sex drive, impotence, or difficulty having an orgasm; ordry mouth, yawning, ringing in your ears.What other drugs will affect Cipralex (Escitalopram)?Talk to your doctor before taking any medicine for pain, arthritis, fever, or swelling. This includes aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), diclofenac (Voltaren), indomethacin, piroxicam (Feldene), nabumetone (Relafen), etodolac (Lodine), and others. Taking any of these drugs with Cipralex (Escitalopram) may cause you to bruise or bleed easily.Before taking Cipralex (Escitalopram), tell your doctor if you are using any of the following medicines:carbamazepine (Carbatrol, Tegretol); cimetidine (Tagamet);lithium (Lithobid, Eskalith);a blood thinner such as warfarin (Coumadin);any other antidepressants such as amitriptyline (Elavil), citalopram (Celexa), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), imipramine (Tofranil), nortriptyline (Pamelor), paroxetine (Paxil), or sertraline (Zoloft); oralmotriptan (Axert), frovatriptan (Frova), sumatriptan (Imitrex), naratriptan (Amerge), rizatriptan (Maxalt), or zolmitriptan (Zomig).If you are using any of these drugs, you may not be able to use Cipralex (Escitalopram), or you may need dosage adjustments or special tests during treatment.