Pexep: Advanced SSRI Therapy for Major Depressive Disorder
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Synonyms | |||
Pexep (escitalopram oxalate) represents a significant advancement in the pharmacological management of major depressive disorder (MDD) and associated anxiety conditions. As a highly selective serotonin reuptake inhibitor (SSRI), it demonstrates superior receptor affinity and cleaner pharmacokinetics compared to earlier antidepressants. This medication offers clinicians a powerful tool for restoring neurochemical balance with a well-characterized efficacy and tolerability profile, making it a first-line choice in evidence-based psychiatric practice. Its optimized molecular structure allows for precise modulation of serotonergic pathways while minimizing off-target effects.
Features
- Contains escitalopram oxalate as the active pharmaceutical ingredient
- Available in 5 mg, 10 mg, and 20 mg film-coated tablets
- Selective serotonin reuptake inhibition with minimal affinity for other neurotransmitter receptors
- Linear pharmacokinetics with dose proportionality
- Mean elimination half-life of approximately 27-32 hours
- Peak plasma concentrations reached within 5 hours post-administration
- Bioavailability of approximately 80% regardless of food intake
- Primarily metabolized by CYP2C19, CYP3A4, and CYP2D6 hepatic enzymes
Benefits
- Rapid and sustained mood stabilization through enhanced serotonergic neurotransmission
- Reduced anxiety symptoms commonly comorbid with depressive disorders
- Improved functional capacity and quality of life measures in clinical trials
- Favorable side effect profile compared to older antidepressant classes
- Once-daily dosing regimen enhances treatment adherence
- Proven efficacy in both acute treatment and maintenance therapy
Common use
Pexep is indicated for the acute and maintenance treatment of major depressive disorder in adults and adolescents aged 12-17 years. It is also approved for the treatment of generalized anxiety disorder (GAD), panic disorder with or without agoraphobia, and social anxiety disorder. Off-label applications include obsessive-compulsive disorder, post-traumatic stress disorder, and premenstrual dysphoric disorder, though these uses should be guided by specialist psychiatric assessment. The medication demonstrates particular utility in patients who have experienced inadequate response or intolerance to other antidepressant therapies.
Dosage and direction
Initial Treatment: For most adults with MDD or GAD, initiate treatment with 10 mg once daily. After a minimum of one week, the dosage may be increased to 20 mg once daily based on therapeutic response and tolerability.
Elderly Patients: Initiate therapy at 5 mg daily due to potentially reduced metabolism. Dose escalation should proceed cautiously with close monitoring.
Adolescents (12-17 years): Recommended starting dose is 10 mg once daily, with possible increase to 20 mg daily after three weeks if inadequate clinical response is observed.
Administration: May be taken with or without food. Tablets should be swallowed whole with water, not crushed or chewed. Consistent timing of administration is recommended to maintain stable plasma concentrations.
Treatment Duration: Continue therapy for at least 6-9 months after achieving symptomatic remission to prevent relapse. Long-term maintenance therapy may be indicated for patients with recurrent depressive episodes.
Precautions
- Monitor patients closely for clinical worsening, suicide ideation, or unusual changes in behavior, particularly during initial treatment and dose adjustments
- Use with caution in patients with history of mania/hypomania
- Screen for bipolar disorder prior to initiation, as antidepressants may precipitate mixed/manic episodes
- Observe for signs of serotonin syndrome, particularly when used concomitantly with other serotonergic drugs
- Caution advised in patients with hepatic impairment; consider reduced dosing
- May cause hyponatremia; monitor sodium levels in elderly patients and those taking diuretics
- May increase risk of bleeding; use caution in patients taking NSAIDs, aspirin, warfarin, or other anticoagulants
- Discontinuation symptoms may occur; taper gradually when stopping treatment
Contraindications
- Hypersensitivity to escitalopram, citalopram, or any excipients in the formulation
- Concurrent use with monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOI therapy
- Patients taking pimozide
- Known congenital long QT syndrome or significant cardiac arrhythmias
- Severe renal impairment (creatinine clearance <30 mL/min)
- Untreated narrow-angle glaucoma
Possible side effects
Very common (≥1/10): Nausea, headache, dry mouth, insomnia, somnolence, increased sweating
Common (≥1/100 to <1/10): Diarrhea, constipation, vomiting, fatigue, dizziness, anxiety, agitation, decreased libido, ejaculation disorder, anorexia
Uncommon (≥1/1,000 to <1/100): Palpitations, sinus tachycardia, blurred vision, tinnitus, weight increase, nightmares, confusion, urticaria
Rare (≥1/10,000 to <1/1,000): Serotonin syndrome, extrapyramidal symptoms, galactorrhea, hyponatremia, angle-closure glaucoma, bleeding abnormalities
Very rare (<1/10,000): QT prolongation, severe cutaneous adverse reactions, suicidal ideation and behaviors
Drug interaction
- MAOIs: Risk of serotonin syndrome; contraindicated
- Serotonergic drugs (tramadol, fentanyl, lithium, tryptophan, St. John’s wort): Increased serotonergic effects
- Drugs that prolong QT interval (antiarrhythmics, antipsychotics, antibiotics): Additive QT prolongation risk
- CYP2C19 inhibitors (omeprazole, fluconazole): May increase escitalopram levels
- CYP2C19 inducers (rifampicin): May decrease escitalopram levels
- Anticoagulants/antiplatelets: Increased bleeding risk
- CNS depressants (alcohol, benzodiazepines): Additive sedative effects
Missed dose
If a dose is missed, take it as soon as remembered unless it is close to the time for the next scheduled dose. Do not double the dose to make up for a missed administration. Maintain regular dosing schedule thereafter. Patients should contact their healthcare provider if multiple doses are missed or if uncertainty exists regarding proper dosing.
Overdose
Symptoms may include dizziness, sweating, nausea, vomiting, tremor, somnolence, sinus tachycardia, and in severe cases, seizures, coma, or ECG changes including QT prolongation. No specific antidote exists. Provide supportive care with continuous ECG monitoring for at least 24 hours. Gastric lavage may be considered if presented early after ingestion. Activated charcoal may be administered. Dialysis is unlikely to be effective due to high protein binding.
Storage
Store at room temperature (15-30°C/59-86°F) in original container. Protect from light and moisture. Keep tightly closed and out of reach of children. Do not use after expiration date printed on packaging. Properly dispose of unused medication through 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 be used only under the supervision of a qualified healthcare professional. Individual response to treatment may vary. Patients should not alter their dosage or discontinue treatment without consulting their prescribing physician. The full prescribing information contains complete details regarding indications, warnings, and precautions.
Reviews
Clinical Studies: Multiple randomized controlled trials demonstrate Pexep’s superiority over placebo with significant improvement in Montgomery-Åsberg Depression Rating Scale (MADRS) scores. Meta-analyses confirm its position among the most efficacious antidepressants with favorable tolerability.
Expert Consensus: Treatment guidelines from the American Psychiatric Association and World Federation of Societies of Biological Psychiatry recognize escitalopram as a first-line treatment option for major depressive disorder based on its established efficacy and safety profile.
Patient Reports: Many patients report improved mood, reduced anxiety, and better functional outcomes within 2-4 weeks of initiation. Common feedback includes appreciation for reduced side effect burden compared to previous antidepressant experiences.