Unveiling potential adverse events associated with escitalopram oxalate: A real-world analysis based FDA adverse event reporting system database

OBJECTIVE

The study aimed to conduct a multidimensional evaluation of potential adverse events (AEs) of escitalopram oxalate based on the FDA adverse event reporting system (FAERS) database.

METHODS

This study utilized the reporting odds ratio (ROR), proportional reporting ratio (PRR), Bayesian confidence propagation neural network (BCPNN), and multi-item gamma-poisson shrinker (MGPS) to mine and analyze data from the FAERS database from the first quarter of 2004 to the second quarter of 2023.

RESULTS

There was a total of 19,854 AE reports related to escitalopram oxalate, extracting 625 preferred terms (PTs), and covering 27 system organ classes (SOCs). The results showed that the number of reports by females was significantly higher than males, accounting for 57.68%. The reporting number was higher in 2018 and 2019, accounting for 9.50% and 10.18% of the total reports, respectively. The main reporters were consumers and other health professionals, accounting for 26.99% and 26.75% respectively. The majority of the reports were primarily from the United States. Newly emerging AE signals such as intentional overdose (n = 691, ROR 8.51, PRR 8.45, IC 3.05, Empirical Bayesian Geometric Mean (EBGM) 8.35), suicide attempt (n = 665, ROR 8.58, PRR 8.52, IC 3.06, EBGM 8.42), serum serotonin (n = 5, ROR 1044.78, PRR 1044.71, IC 2.56, EBGM 392.39), anti-actin antibody positive (n = 5, ROR 626.87, PRR 626.83, IC 2.56, EBGM 313.91), among others, were not mentioned in the drug's label.

CONCLUSION

While escitalopram oxalate has clear benefits in the treatment of depression and other mental health disorders, the presence of AEs also suggests risks associated with its use. Particularly concerning are risks of suicide and changes in serum serotonin levels.

Comparison of tandospirone and escitalopram as a symptomatic treatment in Multiple System Atrophy-cerebellar ataxia: An open-label, non-controlled, 4 weeks observational study

BACKGROUND

Multiple system atrophy (MSA) is a neurodegenerative disorder characterized by autonomic failure and motor dysfunction in parkinsonism and/or cerebellar ataxia. Patients with MSA usually present with depression and anxiety symptoms. This observational study of patients with MSA-cerebellar subtype (MSA-C) with subthreshold depression/anxiety symptoms aimed to compare the efficacy of escitalopram oxalate (an antidepressant drug) and tandospirone citrate (an anxiolytic drug).

METHODS

Fifty-six MSA-C patients were included, with 28 patients in each treatment group. One group received escitalopram oxalate 10 mg/day and the other group received tandospirone citrate 30 mg/day. The patients were evaluated at baseline and after 4 weeks. Several psychiatric and neurological tests were performed, including the Hamilton Anxiety Rating Scale (HAMA), Hamilton Depression Rating Scale (HAMD), Scale for the Assessment and Rating of Ataxia (SARA), and the Scale for Outcomes in Parkinson's Disease for Autonomic Symptoms (SCOPA-AUT). Furthermore, post-void residual urine volume (PVR) and blood pressure were measured.

RESULTS

There was a more substantial reduction in the HAMA/HAMD, scores of stance, finger tracking, and finger nose test in the SARA, and PVR in the tandospirone group. There was a more substantial reduction in scores of dysuria, light-headed when standing up, syncope and hyperhidrosis in the SCOPA-AUT in the escitalopram group (p's < 0.05).

CONCLUSIONS

Tandospirone citrate was more effective in improving depression/anxiety and some cerebellar ataxia symptoms, whereas escitalopram was more effective in improving some autonomic symptoms in MSA-C patients over a short-term period in an open-label observational study without a control group. Further research is needed to evaluate the long-term effects of tandospirone and escitalopram in MSA-C in long-term placebo controlled trials.

Investigation of the degradation and in-situ amorphization of the enantiomeric drug escitalopram oxalate during Fused Deposition Modeling (FDM) 3D printing

Hot-melt extrusion (HME) and subsequent FDM 3D printing offer great potential opportunities in the formulation development and production of customized oral dosage forms with poorly soluble drugs. However, thermal stress within these processes can be challenging for thermo-sensitive drugs. In this work, three different formulations were prepared to investigate the degradation and the solid state of the thermo-sensitive and poorly soluble drug escitalopram oxalate (ESC-OX) during the two heat-intensive processes HME and FDM 3D printing. For this purpose, hydroxypropyl methyl cellulose (HPMC) and basic butylated methacrylate copolymer (bPMMA) were chosen as polymers. DSC and XRD measurements revealed that ESC-OX is amorphous in the HPMC based formulations in both, extrudates and 3D printed tablets. In contrast, in-situ amorphization of the drug from crystalline state in bPMMA filaments was observed during FDM 3D printing. With regard to the content, it was found that degradation of ESC-OX in extrudates with bPMMA could be avoided and in 3D printed tablets almost fully reduced. Furthermore, a possible conversion into the R-enantiomer in the formulation with bPMMA could be excluded using a chiral column. Compared to the commercial product Cipralex®, drug release from extrudates and tablets with bPMMA was slower but still qualified as immediate drug release.

Effects of escitalopram oxalate plus low-dose trazodone on psychological state and quality of life in patients with treatment-refractory depression

OBJECTIVE

To analyze the effect of escitalopram oxalate (ESC) plus low-dose (LD) trazodone (TRA) on the psychological state and quality of life (QOL) of patients with treatment-refractory depression (TRD).

METHODS

In this retrospective study, we selected 111 TRD patients treated in the People's Hospital of Oedos Dongsheng District between February 2019 and February 2021; 54 patients who were treated with ESC were assigned to the control group (the Con) and the remaining 57 patients treated with ESC + LD-TRA were placed into the research group (the Res). The scores of Hamilton Anxiety/Depression Scale (HAMA, HAMD), Generic Quality of Life Inventory (GQOLI), Pittsburgh Sleep Quality Index Scale (PSQI), and Treatment Emergent Signs and Symptoms (TESS), as well as the levels of brain-derived neurotrophic factor (BDNF), S-100B protein (S-100B), and neuron-specific enolase (NSE) were determined before and after intervention. Besides, the curative effect and incidence of adverse reactions were compared. Furthermore, the risk factors affecting treatment ineffectiveness in TRD patients were analyzed by the multivariate Logistic model.

RESULTS

Evident reductions were observed in the Res in terms of HAMA, HAMD and PSQI scores and S-100B and NSE levels after intervention. Eight weeks after intervention, the TESS score was significantly reduced in the Res but not significantly different from the Con; while the scores of various dimensions of the GQOIL and the BDNF level were elevated markedly in the Res that were higher than those of the Con. Moreover, the Res presented with an evidently higher overall response rate than the Con. The two groups had no statistical significance in the overall incidence of adverse reactions (fever, irritability, insomnia, nausea, etc.). Based on the multivariate Logistic model analysis, HAMA, HAMD, PSQI, TESS, BDNF, S-100B, NSE, and treatment modality were not independent risk factors for treatment ineffectiveness in TRD patients.

CONCLUSIONS

ESC + LD-TRA can significantly improve the psychological status, QOL, sleep quality and neurological function of patients with TRD while improving efficacy and ensuring patient safety.

[Curative effect of the combined therapy of warm acupuncture at back-shu points of five zang organs and western medicine on depression of yang deficiency pattern and its attenuating effect]

OBJECTIVE

To compare the therapeutic results and the occurrence of adverse reactions of medicine between the combined therapy of warm acupuncture at back-shu points of five zang organs and the western medicine and the simple wes-tern medication, and observe the therapeutic effect and attenuating effect of this combined therapy in treatment on depression of yang deficiency pattern.

METHODS

A total of 80 patients with depression of yang deficiency pattern were randomly divided into an observation group and a control group （39 cases/group）. In the control group, escitalopram oxalate tablets were administered orally every day. In the observation group, on the base of the medication as the control group, warm acupuncture therapy was exerted at back-shu points of five zang organs, for 30 min each time, 5 times a week. The duration of treatment was 6 weeks in two groups. Before and after treatment, the scores of Hamilton depression scale (HAMD) and the antidepressant side effect scale (SERS) were evaluated and electroencephalogram (EEG) was detected; and the curative effect was assessed according to HAMD reduction rate in patients of the two groups.

RESULTS

After treatment, the HAMD and SERS scores were lower than those before treatment in both groups. Compared with the control group, the HAMD and SERS scores were lower (P<0.05, P<0.01), and the EEG result was improved (P<0.01) in the observation group. The clinical total effective rate of the observation group was 97.43% (38/39), higher than 92.30% (36/39) of the control group (P<0.05).

CONCLUSION

The combined therapy of warm acupuncture at back-shu points of five zang organs and western medicine effectively relieves depression of yang deficiency pattern in the patients and its overall therapeutic effect is better than simple western medication, besides, the combined therapy alleviates the adverse reactions induced by simple western medication.

Zero order spectrophotometric method for estimation of escitalopram oxalate in tablet formulations

A new, simple, fast and reliable zero order spectrophotometric method has been developed for determination of Escitalopram Oxalate in bulk and tablet dosage forms. The quantitative determination of drug was carried out using the zero order values (absorbance) measured at 238 nm. Calibration graph constructed at 238 nm was linear in concentration range of 2-20 µg/ml with correlation coefficient 0.9999. The method was found to be precise, accurate, specific, and validated as per ICH guidelines and can be used for determination of Escitalopram Oxalate in tablet formulations.

Colorimetric method for the estimation of escitalopram oxalate in tablet dosage form

A colorimetric method for the analysis of escitalopram oxalate in pure form and in tablets has been developed based on the formation of chloroform soluble ion associates with bromocresol green acidic dye. The extract of ion associates exhibited absorption maxima at 417 nm obeying Beer's law in the range of 2-10 µg/ml. The method is simple, precise and accurate with recovery of 98-102% and does not require any separation of soluble excipients from tablet dosage form.