Volume : 09, Issue : 12, December – 2022
Title:
02.FACTS ABOUT OFF-LABEL CLINICAL USES OF ESCITALOPRAM
Authors :
Fahad S. Alharthi, Muslah A. Alanazi, Sultan J. Alotaibi, Salah A. Alrashid, Yousof M. Almutairi, Ahmad M AlAyed, Ahmad A. Althabaiti, Abdullrahman N. Abudalli, Shaddi R. Alshammari, Abduallh M. Almutairi, Amjad A. Almotawa, Hassan S. alagedi, Yousef T. Almutairi3, Awad M. Alsahfi
Abstract :
Escitalopram is a drug originally approved treatment of major depressive disorders (MDD). In the pharmacotherapy of obsessive compulsive disorders (OCD), general anxiety disorder (GAD) and post-traumatic stress disorder (PSTD), escitalopram may be considered a first-line treatment due to its good tolerability and lack of withdrawal symptoms. However, aside approved uses of escitalopram, the drug has found clinically-evidence-based uses for which it was not originally recognized. The objective of this review was to evaluate the unapproved uses of escitalopram in medicine. Electronic searches for relevant literature were undertaken in Google scholar, MEDLINE, EMBASE, PubMed, and Science Direct. Literatures and studies were considered in which escitalopram uses, facts about clinical uses of escitalopram, off-label uses, and limitations of the off-label uses were discussed. Eating disorders, pain management, premature ejaculation, autism spectrum disorders, cancer, hot flashes and premenstrual syndrome were identified as some of the off-label uses of escitalopram. For eating disorders; major depressive disorder, anxiety disorder, and obsessive compulsive disorder associated with abnormal eating patterns are all serious mental illnesses that often occur together, therefore escitalopram is used to alleviate the symptoms and conditions such as obesity resulting from this disorders. Escitalopram may alleviate pain through a number of different processes. Neuropathy pain can be alleviated by antidepressants because of their ability to block sodium channels. Patients with persistent erectile dysfunction (PE) whose condition is managed with daily escitalopram medication have reportedly seen changes in semen parameters. Some studies mentioned that escitalopram use gave relief from hot flashes and other menopausal symptoms within one week. Hepatocellular carcinoma (HCC) and autism were identified as other diseases managed with escitalopram. Lack of sufficient data to support use, and proliferated chances for adverse events were included as the drawbacks of off-label uses of escitalopram. However, certain factors such as fewer availability of approved treatments for the illness are considered in the off-label uses of escitalopram. Although escitalopram expands therapy possibilities for some individuals who had none before, it’s crucial to remember that it does have some adverse effects that may lessen the quality of life for those who take it. Depression is a comorbidity for many of the off-label disorders. Therefore, in many circumstances, the antidepressant may just alleviate symptoms while more therapy is required to address the underlying cause of the depression. Evidence on off-label antidepressant usage must be generated and provided to clinicians in order to improve prescribing practices.
Cite This Article:
Please cite this article in press Fahad S. Alharthi et al, Facts About Off-Label Clinical Uses Of Escitalopram.., Indo Am. J. P. Sci, 2022; 09(12).
Number of Downloads : 10
References:
2. Baldwin DS, Asakura S, Koyama T, Hayano T, Hagino A, Reines E, et al. Efficacy of escitalopram in the treatment of social anxiety disorder: A meta-analysis versus placebo. Eur Neuropsychopharmacol. 2016 Jun;26(6):1062–9.
3. Bareggi SR, Mundo E, Dell’Osso B, Altamura AC. The use of escitalopram beyond major depression: pharmacological aspects, efficacy and tolerability in anxiety disorders. Expert Opin Drug Metab Toxicol. 2007 Oct;3(5):741–53.
4. Landy K, Rosani A, Estevez R. Escitalopram [Internet]. StatPearls Publishing; 2022 [cited 2022 Jan 12]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557734/
5. Sánchez C, Bergqvist PBF, Brennum LT, Gupta S, Hogg S, Larsen A, et al. Escitalopram, the S-(+)-enantiomer of citalopram, is a selective serotonin reuptake inhibitor with potent effects in animal models predictive of antidepressant and anxiolytic activities. Psychopharmacology (Berl). 2003 Jun;167(4):353–62.
6. Skånland SS, Cieślar-Pobuda A. Off-label uses of drugs for depression. Eur J Pharmacol. 2019 Dec;865:172732.
7. Amodeo G, Cuomo A, Bolognesi S, Goracci A, Trusso MA, Piccinni A, et al. Pharmacotherapeutic strategies for treating binge eating disorder. Evidence from clinical trials and implications for clinical practice. Expert Opin Pharmacother. 2019 Apr 13;20(6):679–90.
8. Marvanova M, Gramith K. Role of antidepressants in the treatment of adults with anorexia nervosa. Ment Health Clin. 2018 May 1;8(3):127–37.
9. Gibson D, Workman C, Mehler PS. Medical Complications of Anorexia Nervosa and Bulimia Nervosa. Psychiatr Clin North Am. 2019 Jun;42(2):263–74.
10. Guerdjikova AI, McElroy SL, Kotwal R, Welge JA, Nelson E, Lake K, et al. High-dose escitalopram in the treatment of binge-eating disorder with obesity: a placebo-controlled monotherapy trial. Hum Psychopharmacol Clin Exp. 2008 Jan;23(1):1–11.
11. Latagliata EC, Patrono E, Puglisi-Allegra S, Ventura R. Food seeking in spite of harmful consequences is under prefrontal cortical noradrenergic control. BMC Neurosci. 2010 Dec;11(1):15.
12. Monteleone P, Tortorella A, Castaldo E, Maj M. Association of a functional serotonin transporter gene polymorphism with binge eating disorder. Am J Med Genet B Neuropsychiatr Genet. 2006 Jan 5;141B(1):7–9.
13. Vander Wal JS, Gang CH, Griffing GT, Gadde KM. Escitalopram for Treatment of Night Eating Syndrome: A 12-Week, Randomized, Placebo-Controlled Trial. J Clin Psychopharmacol. 2012 Jun;32(3):341–5.
14. Flament MF, Bissada H, Spettigue W. Evidence-based pharmacotherapy of eating disorders. Int J Neuropsychopharmacol. 2012 Mar;15(02):189–207.
15. Crow S. Treatment of Binge Eating Disorder. Curr Treat Options Psychiatry. 2014 Dec;1(4):307–14.
16. Richards BL, Whittle SL, Buchbinder R. Antidepressants for pain management in rheumatoid arthritis. Cochrane Musculoskeletal Group, editor. Cochrane Database Syst Rev [Internet]. 2011 Nov 9 [cited 2022 Dec 1]; Available from: https://doi.wiley.com/10.1002/14651858.CD008920.pub2
17. Krishnadas R, Krishnadas R, Cavanagh J. Sustained remission of rheumatoid arthritis with a specific serotonin reuptake inhibitor antidepressant: a case report and review of the literature. J Med Case Reports. 2011 Mar 19;5:112.
18. Dick IE, Brochu RM, Purohit Y, Kaczorowski GJ, Martin WJ, Priest BT. Sodium Channel Blockade May Contribute to the Analgesic Efficacy of Antidepressants. J Pain. 2007 Apr;8(4):315–24.
19. Zuliani V, Rivara M, Fantini M, Costantino G. Sodium channel blockers for neuropathic pain. Expert Opin Ther Pat. 2010 Jun;20(6):755–79.
20. Saleh R, Majzoub A, Abu El-Hamd M. An update on the treatment of premature ejaculation: A systematic review. Arab J Urol. 2021 Jul 3;19(3):281–302.
21. Zaazaa A, Selim O, Hosny Awad H, Soltan G, Ghanem H. Safety and efficacy of escitalopram in the treatment of premature ejaculation: a double-blind, placebo-controlled, fixed-dose, randomized study. Hum Androl. 2012 Mar;2(1):16–8.
22. Arafa M, Shamloul R. A randomized study examining the effect of 3 SSRI on premature ejaculation using a validated questionnaire. Ther Clin Risk Manag. 2007 Aug;3(4):527–31.
23. Koyuncu H, Serefoglu EC, Yencilek E, Atalay H, Akbas NB, Sarıca K. Escitalopram treatment for premature ejaculation has a negative effect on semen parameters. Int J Impot Res. 2011 Nov;23(6):257–61.
24. LaCroix AZ, Freeman EW, Larson J, Carpenter JS, Joffe H, Reed SD, et al. Effects of escitalopram on menopause-specific quality of life and pain in healthy menopausal women with hot flashes: A randomized controlled trial. Maturitas. 2012 Dec;73(4):361–8.
25. Freeman EW. Efficacy of Escitalopram for Hot Flashes in Healthy Menopausal Women: A Randomized Controlled Trial. JAMA. 2011 Jan 19;305(3):267.
26. Defronzo Dobkin R, Menza M, Allen LA, Marin H, Bienfait KL, Tiu J, et al. Escitalopram reduces hot flashes in nondepressed menopausal women: A pilot study. Ann Clin Psychiatry Off J Am Acad Clin Psychiatr. 2009;21(2):70–6.
27. Mori C, Imai A. Relief of hot flashes with escitalopram in non-depressed menopausal women in Japan: Results of a retrospective analysis. Health (N Y). 2012;04(10):893–6.
28. Bishop JR, Najjar F, Rubin LH, Guter SJ, Owley T, Mosconi MW, et al. Escitalopram pharmacogenetics: CYP2C19 relationships with dosing and clinical outcomes in autism spectrum disorder. Pharmacogenet Genomics. 2015 Nov;25(11):548–54.
29. Chen LJ, Hsu TC, Chan HL, Lin CF, Huang JY, Stewart R, et al. Protective Effect of Escitalopram on Hepatocellular Carcinoma by Inducing Autophagy. Int J Mol Sci. 2022 Aug 17;23(16):9247.
30. Wong J, Motulsky A, Abrahamowicz M, Eguale T, Buckeridge DL, Tamblyn R. Off-label indications for antidepressants in primary care: descriptive study of prescriptions from an indication based electronic prescribing system. BMJ. 2017 Feb 21;j603.
31. Dresser R, Frader J. Off-Label Prescribing: A Call for Heightened Professional and Government Oversight. J Law Med Ethics. 2009;37(3):476–86.
32. O’Malley PG. What does off-label prescribing really mean? Arch Intern Med. 2012 May 28;172(10):759–60.
33. Cascade E, Kalali AH, Kennedy SH. Real-World Data on SSRI Antidepressant Side Effects. Psychiatry Edgmont Pa Townsh. 2009 Feb;6(2):16–8.
34. Hu XH, Bull SA, Hunkeler EM, Ming E, Lee JY, Fireman B, et al. Incidence and duration of side effects and those rated as bothersome with selective serotonin reuptake inhibitor treatment for depression: patient report versus physician estimate. J Clin Psychiatry. 2004 Jul;65(7):959–65.
35. Carvalho AF, Sharma MS, Brunoni AR, Vieta E, Fava GA. The Safety, Tolerability and Risks Associated with the Use of Newer Generation Antidepressant Drugs: A Critical Review of the Literature. Psychother Psychosom. 2016;85(5):270–88.
36. Dall M, Schaffalitzky de Muckadell OB, Lassen AT, Hansen JM, Hallas J. An association between selective serotonin reuptake inhibitor use and serious upper gastrointestinal bleeding. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2009 Dec;7(12):1314–21.
37. Anglin R, Yuan Y, Moayyedi P, Tse F, Armstrong D, Leontiadis GI. Risk of upper gastrointestinal bleeding with selective serotonin reuptake inhibitors with or without concurrent nonsteroidal anti-inflammatory use: a systematic review and meta-analysis. Am J Gastroenterol. 2014 Jun;109(6):811–9.
38. Wittich CM, Burkle CM, Lanier WL. Ten common questions (and their answers) about off-label drug use. Mayo Clin Proc. 2012 Oct;87(10):982–90.
39. Eguale T, Buckeridge DL, Verma A, Winslade NE, Benedetti A, Hanley JA, et al. Association of Off-label Drug Use and Adverse Drug Events in an Adult Population. JAMA Intern Med. 2016 Jan;176(1):55–63.
40. Wong J, Motulsky A, Eguale T, Buckeridge DL, Abrahamowicz M, Tamblyn R. Treatment Indications for Antidepressants Prescribed in Primary Care in Quebec, Canada, 2006-2015. JAMA. 2016 May 24;315(20):2230.
41. Chen DT, Wynia MK, Moloney RM, Alexander GC. U.S. physician knowledge of the FDA-approved indications and evidence base for commonly prescribed drugs: results of a national survey. Pharmacoepidemiol Drug Saf. 2009 Nov;18(11):1094–100.
42. Ghinea N, Lipworth W, Kerridge I. x? Ther Innov Regul Sci. 2015 May;49(3):359–63.
43. Stafford RS. Regulating off-label drug use–rethinking the role of the FDA. N Engl J Med. 2008 Apr 3;358(14):1427–9.
44. Sbarbaro JA. Can we influence prescribing patterns? Clin Infect Dis Off Publ Infect Dis Soc Am. 2001 Sep 15;33 Suppl 3:S240-244.
45. Wilson S, Nutt D, Alford C, Argyropoulos S, Baldwin D, Bateson A, et al. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders. J Psychopharmacol (Oxf). 2010 Nov;24(11):1577–601.
46. American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012 Apr;60(4):616–31.
47. Largent EA, Miller FG, Pearson SD. Going off-label without venturing off-course: evidence and ethical off-label prescribing. Arch Intern Med. 2009 Oct 26;169(19):1745–7.
48. O’Brien PL, Cummings N, Mark TL. Off-Label Prescribing of Psychotropic Medication, 2005–2013: An Examination of Potential Influences. Psychiatr Serv. 2017 Jun;68(6):549–58.