Pexep: Advanced SSRI Therapy for Major Depressive Disorder
Pexep
| Product dosage: 10mg | |||
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| Product dosage: 20mg | |||
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Synonyms | |||
Pexep (escitalopram oxalate) represents a significant advancement in the pharmacological management of major depressive disorder and anxiety conditions. As a highly selective serotonin reuptake inhibitor (SSRI), it demonstrates superior receptor affinity and cleaner pharmacokinetics compared to earlier antidepressants. This medication is specifically formulated to restore serotonin balance in the central nervous system with minimal interference with other neurotransmitter systems. Clinical evidence supports its efficacy in achieving rapid and sustained remission of depressive symptoms while maintaining a favorable tolerability profile for long-term maintenance therapy.
Features
- Contains escitalopram oxalate 10mg and 20mg tablet formulations
- High selectivity for serotonin transporter proteins (SERT)
- Minimal affinity for dopamine, norepinephrine, or muscarinic receptors
- Linear pharmacokinetics with dose proportionality
- Mean elimination half-life of 27-32 hours
- Steady-state plasma concentrations achieved within one week
- Bioavailability approximately 80% following oral administration
- Metabolism primarily hepatic via CYP2C19, CYP3A4, and CYP2D6 isoenzymes
Benefits
- Achieves significant improvement in Montgomery-Åsberg Depression Rating Scale (MADRS) scores within 2-4 weeks
- Reduces anxiety symptoms commonly comorbid with depression through serotonergic modulation
- Demonstrates lower rates of discontinuation due to adverse effects compared to other SSRIs
- Provides once-daily dosing convenience with minimal peak-trough fluctuation
- Shows minimal impact on cognitive function or psychomotor performance
- Established efficacy in preventing relapse during long-term maintenance therapy
Common use
Pexep is primarily indicated for the acute and maintenance treatment of major depressive disorder in adults. It is also approved for the management of generalized anxiety disorder, panic disorder, social anxiety disorder, and obsessive-compulsive disorder. Off-label applications include treatment of post-traumatic stress disorder, premenstrual dysphoric disorder, and vasomotor symptoms associated with menopause. The therapeutic action stems from potent inhibition of serotonin reuptake in the presynaptic neuron, thereby increasing synaptic serotonin availability and enhancing serotonergic neurotransmission.
Dosage and direction
Initiate treatment with 10mg once daily, with or without food. Based on individual response and tolerability, the dosage may be increased to 20mg daily after a minimum of one week. For elderly patients (over 65 years) or those with hepatic impairment, recommended starting dose is 5mg daily with maximum dose not exceeding 10mg daily. Administration should occur at approximately the same time each day, preferably in the morning to minimize potential sleep disturbances. Therapeutic effects typically emerge within 1-2 weeks, though full response may require 4-8 weeks of continuous therapy.
Precautions
Patients should be monitored closely for clinical worsening, suicide risk, or unusual changes in behavior, particularly during the initial months of therapy or following dosage adjustments. Caution is advised when prescribing to patients with history of mania/hypomania, seizure disorders, or bleeding tendencies. SSRIs may impair judgment, thinking, or motor skills; patients should exercise caution when operating machinery until they understand how Pexep affects them. Regular monitoring of sodium levels is recommended in elderly patients, those taking diuretics, or patients otherwise volume-depleted due to risk of hyponatremia.
Contraindications
Pexep is contraindicated in patients with known hypersensitivity to escitalopram, citalopram, or any component of the formulation. Concomitant use with monoamine oxidase inhibitors (MAOIs) is absolutely contraindicated due to risk of serotonin syndrome. A minimum 14-day washout period must be observed when switching between MAOIs and Pexep. Additional contraindications include patients with congenital long QT syndrome or those taking drugs that prolong QT interval. Use is not recommended during the third trimester of pregnancy due to potential neonatal complications.
Possible side effects
Common adverse reactions (≥5% incidence) include nausea (15%), insomnia (9%), ejaculation disorder (9%), fatigue (6%), and somnolence (6%). Less frequent effects include increased sweating, decreased libido, anxiety, agitation, yawning, and gastrointestinal disturbances. Serious but rare adverse events include clinical worsening and suicide risk, serotonin syndrome, abnormal bleeding, angle-closure glaucoma, hyponatremia, and QT interval prolongation. Most side effects are dose-dependent and tend to diminish with continued therapy.
Drug interaction
Concomitant use with serotonergic drugs (tramadol, triptans, other antidepressants) increases risk of serotonin syndrome. Strong inhibitors of CYP2C19 (omeprazole, fluconazole) may increase escitalopram concentrations. Drugs that prolong QT interval (antiarrhythmics, antipsychotics, antibiotics) should be used with caution. NSAIDs, aspirin, or other anticoagulants may increase bleeding risk. Pexep may decrease the efficacy of tamoxifen through CYP2D6 inhibition. Close monitoring is recommended when co-administering with drugs highly bound to plasma proteins.
Missed dose
If a dose is missed, it should be taken as soon as remembered unless it is接近 time for the next scheduled dose. In that case, the missed dose should be skipped and the regular dosing schedule resumed. Patients should not take a double dose to make up for a missed dose. Consistent daily administration is important for maintaining stable plasma concentrations and therapeutic effect.
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. There is no specific antidote for escitalopram overdose. Management should include supportive measures and symptomatic treatment. Gastric lavage with airway protection may be considered if presented early after ingestion. Activated charcoal may be administered. ECG monitoring is recommended for at least 24 hours in symptomatic patients.
Storage
Store at controlled room temperature 20°-25°C (68°-77°F) with excursions permitted between 15°-30°C (59°-86°F). Keep container tightly closed and protect from moisture and light. Keep out of reach of children and pets. Dispose of unused medication through medication take-back programs or according to local regulations. Do not flush medications down the toilet or pour into drain unless instructed to do so.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Treatment decisions should be made in consultation with a qualified healthcare professional who can consider individual patient factors. The prescribing physician should be familiar with the complete prescribing information and latest clinical data. Patients should not discontinue medication without medical supervision due to risk of discontinuation symptoms.
Reviews
Clinical trials demonstrate response rates of 60-70% in major depressive disorder with remission rates of 30-40% at 8 weeks. Meta-analyses show superior efficacy compared to other SSRIs with number needed to treat (NNT) of 6 for response versus placebo. Long-term studies indicate maintained efficacy with 65% of patients remaining relapse-free at 52 weeks. Patient-reported outcomes indicate significant improvement in quality of life measures and functional capacity. The medication receives consistently high physician satisfaction ratings for efficacy and tolerability profile.