Last update July 5, 2022

Escitalopram Oxalate

Very Low Risk

Safe. Compatible. Minimal risk for breastfeeding and infant.

SSRI antidepressant with actions and uses similar to those of fluoxetine. S-Enantiomer of Citalopram that shares similar pharmacokinetics with Citalopram Oral administration once daily.

It is excreted in breast milk in small amounts (Weisskopf 2020 y 2017, Delaney 2018, Hackett 2006, Rampono 2006, Castberg 2006) .

Serum levels of infants from breastfeeding mothers who were treated have been shown to be undetectable or very low. (Delaney 2018, Rampono 2006)

Overall, short or long-term harmful effect has not been reported among breastfed infants (Hackett 2006, Gentile 2006, Rampono 2006, Castberg 2006). Isolated cases of irritability, sleepiness (Kronenfeld 2018), neonatal necrotizing enterocolitis (Potts 2007) or convulsión (Neuman 2014) after intrauterine exposure and/or polytherapy have appeared in medical literature contrasting with harmlessness reported by others.

Galactorrhea, associated or not to hyperprolactinemia, may appear. (McGrane 2019, Pathania 2018, Suthar 2018, Kaba 2017, Shim 2009, Gulsun 2007)

Several medical societies, experts and expert consensus, consider the use of this medication safe or probably safe during breastfeeding. (Hale, Lactmed, Uguz 2021, Weisskopf 2020, Davanzo 2014 y 2011, Rowe 2013, Bellantuono 2013 y 2012, Berle 2011, Amir 2011)

Safer known alternatives may be preferable, especially during the neonatal period and in cases of prematurity. (Orsolini 2015, Sriraman 2015, Patil 2011)

Women suffering from depression during pregnancy need more breastfeeding support due to their increased risk of breastfeeding problems and early weaning. (Grzeskowiak 2018, Leggett 2017, Gorman 2012)


See below the information of this related product:

  • Maternal Depression (Possibly safe. Probably compatible. Mild risk possible. Follow up recommended. Read the Comment.)

Alternatives

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Escitalopram Oxalate is also known as


Escitalopram Oxalate in other languages or writings:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 80 %
Molecular weight 414 daltons
Protein Binding 56 %
VD 12 - 26 l/Kg
pKa 9.8 -
Tmax 4 - 5 hours
30 hours
M/P ratio 1.7 - 2.5 -
Theoretical Dose 0.004 - 0.01 mg/Kg/d
Relative Dose 1.7 - 9 %

References

  1. Hale TW. Medications & Mothers' Milk. 1991- . Springer Publishing Company. Available from https://www.halesmeds.com Consulted on March 17, 2022 Full text (link to original source)
  2. LactMed. Drugs and Lactation Database (LactMed). Internet. Bethesda (MD): National Library of Medicine (US); 2006-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501922/ 2006 - Consulted on March 15, 2022 Full text (link to original source)
  3. Uguz F. A New Safety Scoring System for the Use of Psychotropic Drugs During Lactation. Am J Ther. 2021 Jan-Feb 01;28(1):e118-e126. Abstract
  4. Weisskopf E, Guidi M, Fischer CJ, Bickle Graz M, Beaufils E, Nguyen KA, Morisod Harari M, Rouiller S, Rothenburger S, Gaucherand P, Kassai-Koupai B, Borradori Tolsa C, Epiney M, Tolsa JF, Vial Y, Hascoët JM, Claris O, Eap CB, Panchaud A, Csajka C. A population pharmacokinetic model for escitalopram and its major metabolite in depressive patients during the perinatal period: Prediction of infant drug exposure through breast milk. Br J Clin Pharmacol. 2020 Aug;86(8):1642-1653. Abstract
  5. McGrane IR, Morefield CM, Aytes KL. Probable Galactorrhea Associated with Sequential Trials of Escitalopram and Duloxetine in an Adolescent Female. J Child Adolesc Psychopharmacol. 2019 Dec;29(10):788-789. Abstract
  6. Suthar N, Pareek V, Nebhinani N, Suman DK. Galactorrhea with antidepressants: A case series. Indian J Psychiatry. 2018 Jan-Mar;60(1):145-146. Abstract
  7. Pathania M, Goel B, Dhamija P, Kant R, Dhar M, Mittal S. A rare adverse drug reaction to escitalopram. J Family Med Prim Care. 2018 Mar-Apr;7(2):466-467. Abstract
  8. Kronenfeld N, Ziv Baran T, Berlin M, Karra N, Dinavitser N, Cohen R, Wiener Y, Schwartzberg E, Berkovitch M. Chronic use of psychotropic medications in breastfeeding women: Is it safe? PLoS One. 2018 May 21;13(5):e0197196. Abstract
  9. Delaney SR, Malik PRV, Stefan C, Edginton AN, Colantonio DA, Ito S. Predicting Escitalopram Exposure to Breastfeeding Infants: Integrating Analytical and In Silico Techniques. Clin Pharmacokinet. 2018 Dec;57(12):1603-1611. Abstract
  10. Grzeskowiak LE, Leggett C, Costi L, Roberts CT, Amir LH. Impact of serotonin reuptake inhibitor use on breast milk supply in mothers of preterm infants: a retrospective cohort study. Br J Clin Pharmacol. 2018 Jun;84(6):1373-1379. Abstract Full text (link to original source)
  11. Kaba D, Öner Ö. Galactorrhea After Selective Serotonin Reuptake Inhibitor Use in an Adolescent Girl: A Case Report. J Clin Psychopharmacol. 2017 Jun;37(3):374-376. Abstract
  12. Weisskopf E, Panchaud A, Nguyen KA, Grosjean D, Hascoët JM, Csajka C, Eap CB, Ansermot N; collaborators of the SSRI-Breast Milk study.. Simultaneous determination of selective serotonin reuptake inhibitors and their main metabolites in human breast milk by liquid chromatography-electrospray mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci. 2017 Jul 1;1057:101-109. Abstract
  13. Venkatesh KK, Castro VM, Perlis RH, Kaimal AJ. Impact of antidepressant treatment during pregnancy on obstetric outcomes among women previously treated for depression: an observational cohort study. J Perinatol. 2017 Sep;37(9):1003-1009. Abstract
  14. Leggett C, Costi L, Morrison JL, Clifton VL, Grzeskowiak LE. Antidepressant Use in Late Gestation and Breastfeeding Rates at Discharge from Hospital. J Hum Lact. 2017 Nov;33(4):701-709. Abstract
  15. Orsolini L, Bellantuono C. Serotonin reuptake inhibitors and breastfeeding: a systematic review. Hum Psychopharmacol. 2015 Jan;30(1):4-20. Abstract
  16. Sriraman NK, Melvin K, Meltzer-Brody S. ABM Clinical Protocol #18: Use of Antidepressants in Breastfeeding Mothers. Breastfeed Med. 2015 Abstract Full text (link to original source) Full text (in our servers)
  17. Davanzo R, Bua J, Paloni G, Facchina G. Breastfeeding and migraine drugs. Eur J Clin Pharmacol. 2014 Abstract
  18. Neuman G, Colantonio D, Delaney S, Szynkaruk M, Ito S. Bupropion and Escitalopram During Lactation. Ann Pharmacother. 2014 Abstract
  19. Bellantuono C, Orsolini L, Bozzi F. [The safety profile of escitalopram in pregnancy and breastfeeding]. Riv Psichiatr. 2013 Abstract
  20. Bellantuono C, Bozzi F, Orsolini L. Safety of escitalopram in pregnancy: a case series. Neuropsychiatr Dis Treat. 2013 Abstract Full text (link to original source) Full text (in our servers)
  21. Rowe H, Baker T, Hale TW. Maternal medication, drug use, and breastfeeding. Pediatr Clin North Am. 2013 Feb;60(1):275-94. Abstract
  22. Bellantuono C, Bozzi F, Orsolini L, Catena-Dell'Osso M. The safety of escitalopram during pregnancy and breastfeeding: a comprehensive review. Hum Psychopharmacol. 2012 Abstract
  23. Gorman JR, Kao K, Chambers CD. Breastfeeding among women exposed to antidepressants during pregnancy. J Hum Lact. 2012 Abstract
  24. Patil AS, Kuller JA, Rhee EH. Antidepressants in pregnancy: a review of commonly prescribed medications. Obstet Gynecol Surv. 2011 Abstract
  25. Berle JO, Spigset O. Antidepressant Use During Breastfeeding. Curr Womens Health Rev. 2011 Abstract Full text (link to original source) Full text (in our servers)
  26. Davanzo R, Copertino M, De Cunto A, Minen F, Amaddeo A. Antidepressant drugs and breastfeeding: a review of the literature. Breastfeed Med. 2011 Abstract
  27. Amir LH, Pirotta MV, Raval M. Breastfeeding--evidence based guidelines for the use of medicines. Aust Fam Physician. 2011 Sep;40(9):684-90. Review. Abstract Full text (link to original source) Full text (in our servers)
  28. Lanza di Scalea T, Wisner KL. Antidepressant medication use during breastfeeding. Clin Obstet Gynecol. 2009 Abstract Full text (link to original source) Full text (in our servers)
  29. Shim SH, Lee YJ, Lee EC. A case of galactorrhea associated with excitalopram. Psychiatry Investig. 2009 Abstract Full text (link to original source) Full text (in our servers)
  30. Potts AL, Young KL, Carter BS, Shenai JP. Necrotizing enterocolitis associated with in utero and breast milk exposure to the selective serotonin reuptake inhibitor, escitalopram. J Perinatol. 2007 Abstract Full text (link to original source) Full text (in our servers)
  31. Gulsun M, Algul A, Semiz UB, Ates MA, Doruk A, Ebrinc S, Basoglu C, Cetin M. A case with euprolactinemic galactorrhea induced by escitalopram. Int J Psychiatry Med. 2007 Abstract
  32. Hackett LP, Ilett KF, Rampono J, Kristensen JH, Kohan R. Transfer of reboxetine into breastmilk, its plasma concentrations and lack of adverse effects in the breastfed infant. Eur J Clin Pharmacol. 2006 Abstract
  33. Gentile S. Escitalopram late in pregnancy and while breast-feeding. Ann Pharmacother. 2006 Abstract
  34. Rampono J, Hackett LP, Kristensen JH, Kohan R, Page-Sharp M, Ilett KF. Transfer of escitalopram and its metabolite demethylescitalopram into breastmilk. Br J Clin Pharmacol. 2006 Abstract Full text (link to original source) Full text (in our servers)
  35. Castberg I, Spigset O. Excretion of escitalopram in breast milk. J Clin Psychopharmacol. 2006 Abstract

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