Patient/caregiver was educated on precautions to be exercised while taking escitalopram as follows:
- Serotonin is one chemical in the brain, which in permissible amounts, is believed to reduce anxiety and promote happiness and well-being. Very excessive concentrations of serotonin in the brain can lead to serotonin syndrome. Individuals with serotonin syndrome can present with mania, excitement, hallucinations, agitation, insomnia, pounding heartbeat, very rapid heart rate, overactive reflexes, and diarrhea. Escitalopram use, especially along with other antidepressants acting on the same lines, such as, fluoxetine, paroxetine, and sertraline, can significantly increase the serotonin levels in the body and lead to development of serotonin syndrome. Escitalopram use along with a few other antidepressants, such as, phenelzine, selegiline, and tranylcypromine can also significantly increase the serotonin levels in the body and lead to development of serotonin syndrome. Escitalopram use is discouraged along with these medications. Caution must be exercised even when discontinuing on any of the above mentioned antidepressant medications with potential to increase serotonin levels and starting on escitalopram, by observing a window period of atleast 2 weeks, before the transition to escitalopram is made. This helps with complete elimination of these medications from the body, reduce the risk for interaction with escitalopram, and reduce risk for development of serotonin syndrome.
- Individuals with complaint of dehydration, secondary to history of diarrhea, vomiting, or poor fluid intake, can suffer electrolyte disturbances and be more prone to develop arrhythmias with escitalopram. Also, escitalopram carries the risk of increasing diarrhea, thus worsening the fluid deficit and dehydration. Electrolyte disturbances, such as, low potassium and magnesium levels, secondary to diuretic pill intake, can also act as a precipitating factor for cardiac arrhythmias with escitalopram. Observing compliance with recommended supplement intake and/or hydration measures can help prevent development of arrhythmias in these individuals. Also, observe compliance with any periodical lab draws ordered for electrolyte levels and closely follow for development of signs and symptoms of cardiac arrhythmia, such as, episodes of chest pain, rapid heart rate, palpitations, dizziness, and shortness of breath. Report any such findings to your physician immediately, so that, an alternative plan of care could be considered.
- Escitalopram can also induce frequency of urination or polyuria. Individuals with history of poorly controlled diabetes, frequent urinary tract infections, and intake of diuretics can also present with frequent urination. Such individuals taking escitalopram, must be aware of this side-effect, as escitalopram can aggravate the discomfort of polyuria significantly. Severely increased frequency of urination can contribute to loss of body fluid and dehydration. Dehydrated individuals can present with low blood pressure, episodes of confusion, increased risk for falls & accidents, and increased risk for urinary tract infections. Observing compliance with timed voiding recommendations and other hygienic practices can help reduce the discomfort of polyuria. Compliance with daily fluid intake recommendations and rehydration measures can help with preventing dehydration and development of any UTIs.
