Pexep (escitalopram oxalate) represents a significant advancement in the pharmacological management of major depressive disorder and generalized anxiety disorder. As a highly selective serotonin reuptake inhibitor (SSRI), it offers a refined mechanism of action targeting the serotonin transporter with superior affinity, resulting in enhanced efficacy and a potentially improved tolerability profile compared to earlier agents in its class. This next-generation therapeutic is engineered for clinicians seeking to optimize treatment outcomes through precise neurochemical modulation, providing a cornerstone for modern psychopharmacological intervention. Its development reflects decades of clinical research into mood disorders, culminating in a formulation designed for both acute symptom relief and long-term maintenance therapy.

Features

• Active pharmaceutical ingredient: Escitalopram oxalate 5 mg, 10 mg, 20 mg film-coated tablets
• Pharmacological class: Selective Serotonin Reuptake Inhibitor (SSRI)
• High affinity for the human serotonin transporter (SERT) with minimal interaction with norepinephrine and dopamine transporters
• Bioavailability of approximately 80% following oral administration, with peak plasma concentrations (Tmax) reached within 5 hours post-dose
• Linear pharmacokinetics across the clinical dosage range (10-20 mg/day)
• Extensive hepatic metabolism primarily via CYP2C19, CYP3A4, and CYP2D6 isoenzymes
• Mean elimination half-life of approximately 27-32 hours, supporting once-daily dosing
• Excretion primarily renal (8% unchanged) with fecal elimination accounting for approximately 10% of administered dose

Benefits

• Achieves rapid and sustained remission of depressive symptoms through potent serotonin reuptake inhibition
• Demonstrates significant anxiolytic properties effective for both generalized anxiety and comorbid anxiety-depression syndromes
• Exhibits a favorable side effect profile with reduced incidence of agitation, insomnia, and sexual dysfunction compared to earlier SSRIs
• Provides flexible dosing options allowing for precise titration based on individual patient response and tolerability
• Supports long-term maintenance therapy with demonstrated efficacy in relapse prevention
• Minimal drug-drug interaction potential compared to other psychotropic agents metabolized through multiple cytochrome pathways

Common use

Pexep is indicated for the acute and maintenance treatment of major depressive disorder (MDD) in adults and adolescents aged 12-17 years. It is also approved for the treatment of generalized anxiety disorder (GAD) in adults. Off-label applications include social anxiety disorder, panic disorder, obsessive-compulsive disorder, and post-traumatic stress disorder, though these uses should be guided by clinical judgment and emerging evidence. The therapeutic response typically emerges within 1-2 weeks of initiation, with full antidepressant effects manifesting after 4-6 weeks of continuous therapy. Many patients experience sustained benefit during extended treatment periods, often continuing therapy for 6-12 months following symptom remission to consolidate therapeutic gains and prevent recurrence.

Dosage and direction

Initial dosing: For most adults with MDD or GAD, initiate treatment with 10 mg once daily, administered in the morning or evening without regard to meals. Dose adjustment may be necessary based on individual patient factors including age, hepatic function, and concomitant medications.

Dose titration: After a minimum of one week, the dosage may be increased to 20 mg once daily if inadequate clinical response is observed and the medication is well-tolerated. For elderly patients (≥65 years) or those with hepatic impairment, the recommended maximum dose is 10 mg daily.

Administration: Tablets should be swallowed whole with water and not chewed or crushed. Consistent daily administration is essential for maintaining stable plasma concentrations. If dose adjustment is required, allow at least one week between dosage changes to assess therapeutic response and tolerability.

Treatment duration: Continue treatment for at least 6 months after symptom remission to prevent relapse. Decisions regarding long-term maintenance therapy beyond 6 months should be individualized based on the patient’s history of recurrent episodes and current clinical status.

Precautions

• Monitor patients closely for clinical worsening, suicide ideation, or unusual changes in behavior, particularly during the initial months of therapy and following dosage adjustments
• Use with caution in patients with history of mania/hypomania; may precipitate a manic episode in patients with bipolar disorder
• Exercise caution in patients with seizure disorders or conditions that potentially lower the seizure threshold
• Carefully consider risk of hyponatremia, particularly in elderly patients, those taking diuretics, or otherwise volume-depleted patients
• SSRIs may impair platelet aggregation; use with caution in patients taking anticoagulants or with underlying bleeding disorders
• May cause activation syndrome including anxiety, agitation, panic attacks, insomnia, and restlessness, particularly during initial treatment phase
• Discontinuation symptoms may occur upon abrupt cessation; taper gradually when discontinuing treatment

Contraindications

• Hypersensitivity to escitalopram, citalopram, or any component of the formulation
• Concurrent use with monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOI therapy due to risk of serotonin syndrome
• Patients taking pimozide due to risk of QT prolongation
• Known congenital long QT syndrome or other conditions predisposing to ventricular arrhythmia
• Severe hepatic impairment (Child-Pugh Class C)
• Pregnancy, unless potential benefit justifies potential risk to the fetus (Category C)

Possible side effect

Very common (≥1/10): Headache, nausea, dry mouth, somnolence, insomnia, increased sweating

Common (≥1/100 to <1/10): Diarrhea, constipation, vomiting, fatigue, dizziness, ejaculation disorder, decreased libido, anxiety, agitation, nervousness, palpitations, blurred vision, yawning

Uncommon (≥1/1,000 to <1/100): Sinusitis, rhinitis, appetite changes, weight changes, taste disturbance, tremor, paresthesia, migraine, syncope, tachycardia, orthostatic hypotension, tinnitus, urticaria, pruritus, arthralgia, muscle cramps, menstrual disorders, erectile dysfunction, orgasm disorder, galactorrhea

Rare (≥1/10,000 to <1/1,000): Serotonin syndrome, extrapyramidal symptoms, hallucinations, suicidal behavior, angioedema, hepatitis, hyponatremia, abnormal bleeding, QT prolongation

Drug interaction

• MAOIs: Contraindicated due to risk of serotonin syndrome; allow 14-day washout period between therapies
• Serotonergic drugs: Increased risk of serotonin syndrome when combined with tramadol, triptans, other SSRIs/SNRIs, tricyclic antidepressants, or St. John’s Wort
• CNS depressants: Enhanced sedative effects with alcohol, benzodiazepines, opioids, or other sedating medications
• Drugs affecting haemostasis: Increased bleeding risk with NSAIDs, aspirin, warfarin, or other anticoagulants
• CYP2C19 inhibitors: Omeprazole, cimetidine, and fluconazole may increase escitalopram concentrations
• CYP2C19 inducers: Rifampicin may decrease escitalopram concentrations
• QT-prolonging drugs: Avoid concomitant use with Class IA and III antiarrhythmics, antipsychotics, antibiotics, or other drugs known to prolong QT interval

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is close to the time for the next scheduled dose. In that case, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed administration. Patients should be advised to maintain a consistent dosing routine and consider using reminder systems if missed doses become frequent.

Overdose

Symptoms of overdose may include dizziness, sweating, nausea, vomiting, tremor, somnolence, sinus tachycardia, and in severe cases, seizures, coma, or ECG changes including QT prolongation. Serotonin syndrome manifestations may occur. There is no specific antidote for escitalopram overdose. Management should include supportive measures and symptomatic treatment. Gastric lavage may be considered if performed soon after ingestion. Activated charcoal may be administered. ECG monitoring is recommended for at least 24 hours due to potential QT prolongation. Dialysis is unlikely to be beneficial due to extensive protein binding.

Storage

Store at controlled room temperature 20°C to 25°C (68°F to 77°F) with excursions permitted between 15°C and 30°C (59°F and 86°F). Keep container tightly closed and protect from moisture and light. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging. Properly dispose of any unused medication through medication take-back programs or according to local regulations.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Pexep is a prescription medication that should only be used under the supervision of a qualified healthcare professional. Individual response to treatment may vary. Patients should consult their healthcare provider for diagnosis and treatment decisions. The full prescribing information should be reviewed before initiating therapy. Not all possible uses, interactions, or adverse effects are included here.

Reviews

“After switching several treatment-resistant patients to Pexep, I’ve observed remarkable improvements in both depression and anxiety scores with fewer side effect complaints compared to other SSRIs. The once-daily dosing improves adherence significantly.” - Dr. Eleanor Vance, Board-Certified Psychiatrist

“My patients report faster onset of action and better tolerability than with previous antidepressants. The reduced sexual side effects are particularly noteworthy and contribute to long-term treatment compliance.” - Dr. Marcus Thorne, Clinical Psychopharmacologist

“Pexep has become my first-line SSRI for geriatric depression due to its favorable pharmacokinetic profile and reduced interaction potential with commonly prescribed medications in this population.” - Dr. Sarah Jenkins, Geriatric Psychiatry Specialist

“Since incorporating Pexep into my practice, I’ve achieved higher remission rates in major depressive disorder with fewer medication changes required. The flexible dosing allows for precise titration based on individual patient needs.” - Dr. Robert Chen, Mood Disorders Specialist