ZELAX 20/MG FC CAP 30/FC TAB

Indications

Approved Uses

Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) (age ranges depend on local labeling; commonly MDD in adults and adolescents ≥12 years, and GAD in adults).

Dosage & Administration

Initial Dose

10 mg once daily.

Maintenance Dose

10-20 mg once daily.

Maximum Dose

20 mg once daily.

Dose Adjustment Notes

Elderly and hepatic impairment: generally use 10 mg once daily (and avoid exceeding 10 mg/day in many labels due to QT risk). Renal impairment: no adjustment for mild-moderate impairment; use caution in severe renal impairment (e.g., CrCl <20 mL/min).

Safety & Warnings

Contraindications

Contraindicated with MAOIs (including within 14 days of stopping an MAOI; and allow 14 days after stopping escitalopram before starting an MAOI), with pimozide, and in patients with hypersensitivity to escitalopram/citalopram; avoid/contraindicated with linezolid or IV methylene blue unless no alternatives and with close monitoring.

Warnings & Precautions

Monitor for suicidality/clinical worsening (especially early and after dose changes); avoid/monitor for serotonin syndrome with serotonergic drugs; QT prolongation risk (caution with congenital long QT, electrolyte abnormalities, and QT-prolonging drugs); hyponatremia risk (elderly/diuretics); screen for bipolar disorder (mania risk); increased bleeding risk with NSAIDs/anticoagulants; taper to avoid discontinuation; caution in seizure disorders.

Drug Interactions

Interaction Severity

MAJOR/Contraindicated: MAOIs (including linezolid and IV methylene blue) due to serotonin syndrome risk; pimozide due to QT prolongation. MODERATE: other serotonergic agents (e.g., triptans, tramadol, lithium, fentanyl, St John’s wort) → serotonin syndrome risk; QT-prolonging drugs → additive QT risk; NSAIDs/antiplatelets/anticoagulants → increased bleeding risk; strong CYP2C19 inhibitors (e.g., omeprazole, fluconazole) → increased escitalopram exposure/QT risk. MINOR: alcohol (additive CNS effects).

Special Populations

Breastfeeding

Caution

Elderly

Recommended dose is 10mg once daily; maximum dose is 10mg once daily due to increased risk of QT prolongation and hyponatremia in elderly patients

Liver Impairment

Hepatic impairment: recommended maximum 10 mg once daily (especially in moderate-to-severe impairment).

Storage & Patient Advice

Patient Counseling

Take once daily at the same time; with or without food. Expect gradual benefit (often several weeks); do not stop abruptly-taper with prescriber. Seek help urgently for suicidal thoughts, severe agitation, fever/tremor (serotonin syndrome), or manic symptoms. Avoid/limit alcohol; use caution driving until effects known. Report unusual bleeding/bruising and symptoms of hyponatremia (confusion, headache, weakness). Check with a clinician before combining with other serotonergic drugs or MAOIs. Store below 30°C.

Monitoring Requirements

No routine labs for all patients, but monitor clinically for worsening depression/suicidality (especially early and after dose changes), serotonin syndrome, and mania/hypomania; consider serum sodium in at-risk patients (e.g., elderly/diuretics) and ECG/QT risk assessment in patients with cardiac risk factors or when using QT-prolonging drugs.

Pharmacology

Mechanism of Action

Selective serotonin reuptake inhibitor (SSRI) that inhibits the serotonin transporter (SERT), increasing synaptic serotonin in the CNS.

Metabolism

Hepatic metabolism primarily via CYP2C19 and CYP3A4, with contribution from CYP2D6; metabolites (e.g., desmethyl- and didesmethyl-escitalopram) are less active.

Product Information

Available Dosage Forms

Film-coated tablet (this product: 20 mg film-coated tablet/caplet, oral use).

Psych Class

Antidepressant-SSRI

Controlled Substance

No

Reviewed by Al Mujtama Pharmacy Medical Review Team. Last reviewed 20-06-2026