ESCIPRAM 10 mg. 30 tablets

WHAT ESCIPRAM AND WHAT IT IS USED?
ESCIPRAM contains escitalopram and is used to treat depression (major depressive episodes) and anxiety disorders (such as panic disorder with or without agoraphobia, which is fear of you in places where you might not get help, social anxiety disorder (fear of meeting with people), OCD (obsessive thoughts and compulsive actions).
Escitalopram belongs to the group of antidepressants, known as selective inhibitors of serotonin reuptake inhibitors (SSRIs). These drugs act on the serotonin system in the brain by increasing serotonin levels. Violations of the serotonin system are considered an important factor in development of depression and related diseases.

2. BEFORE TAKE ESIPRAM
Do not take ESIPRAM if:
• if you are allergic (hypersensitive) to escitalopram or any of the other ingredients of ESIPRAM (see section 6 "Further information").
• if you take other medicines that belong to a group called MAO inhibitors, including selegiline (used to treat Parkinson's disease), moklobamid (used to treat depression) and linezolid (an antibiotic).
• If you were born or have had an episode of abnormal heart rhythm (established EKG; study of cardiac function)
• if you are taking medicines for heart rhythm problems or that may affect heart rhythm (see. Section 2 "Taking other medicines")

Take special care with ESCIPRAM
Please tell your doctor if you have any other condition or illness, as you may have to take it into account. In particular, tell your doctor:
• if you experience seizures for the first time in his life or suffer from epilepsy and frequent notice of seizure must discontinue Estsilram (* see also section 4 "Possible side effects * ').
• if you suffer from impaired liver or kidney function. It may need a dose adjustment by your doctor.
• if you have diabetes. Treatment with ESIPRAMmay alter glycemic control. It may need a dose adjustment of insulin and / or oral hypoglycemic agents.
• If you have low sodium level in the blood.
• If you have a tendency to bleed easily or bruises.
• If you are having electroconvulsive therapy.
• if you suffer from coronary heart disease.
• if you have or have had other heart problems or have recently had a heart attack.
• if you have a slow heart rate and / or you know that it is possible to have a depletion of salts in the body due to severe diarrhea and vomiting (disease) or use of diuretics (water tablets).
• If you notice a rapid or irregular heartbeat, weakness, fainting or dizziness when standing, this may be an indication of abnormal heart rate.

Please note
As with other drugs used to treat depression or related diseases, the improvement is not achieved immediately. It is possible to pass a few weeks after initiating treatment with Estsipram, until you notice improvement. In the treatment of panic disorder usually takes 2-4 weeks to mark the improvement. At the beginning of treatment, some patients may have amplified the concerns which resolved with continued therapy. For this reason it is very important that you follow exactly your doctor's instructions and not to stop treatment or change the dose without consulting him.

Thoughts of suicide and worsening of your depression or anxiety disorder
If you are depressed and / shi have anxiety disorders you can sometimes have thoughts of harming or killing yourself. These may be increased when taking antidepressants for the first time since all these take time before you start to work, usually about two weeks but sometimes longer.

There are more likely to think so:
- If you have previously had thoughts about killing or harming yourself
If you have thoughts of harming or killing yourself, contact your doctor immediately and go to hospital.
It may be helpful to tell a relative or close friend that you are depressed or have an anxiety disorder, and ask them to read this leaflet. You might ask them to tell you if they think your depression or anxiety is getting worse, or if they are worried about changes in your behavior.
Some patients with manic-depressive illness may enter the manic phase. It is characterized by unusual and rapidly changing ideas, inappropriate happiness and excessive physical activity. If you notice these events, contact your doctor.
Symptoms such as restlessness or difficulty sitting or standing in a peaceful state can also occur during the first few weeks of treatment. If you notice these events, contact your doctor immediately.
Sometimes you may not notice the above mentioned symptoms and therefore can decide that will be helpful to ask a friend or relative to help in monitoring the occurrence of any signs of change in your behavior.
Tell your doctor immediately or go to the nearest hospital if you have sad thoughts or experiences, or if any of the above symptoms occur during treatment.
ESIPRAM normally should not be used in children and adolescents under 18 years of age. Moreover, it should know that patients under 18 have an increased risk of side effects such as suicide attempts, suicidal thoughts and hostile behavior (predominantly aggression, oppositional behavior and anger) when they take drugs from this group. However, your doctor may prescribe Estsipram of patients under 18 because he / she believes that it is in their interest. If your doctor has prescribed ESIPRAM a patient under 18 and you wish to discuss this, please go back to your doctor. You must inform him if or worsen any of the above symptoms when patients under 18 years of age receive Estsipram. Moreover, in this age group have not been proven safety durable Estsipram in terms of growth, maturation and cognitive and behavioral development.

Taking other medicines
Please tell your doctor if you are taking or have recently taken any other medicines, including medicines obtained without a prescription.
Do not take ESIPRAM if you are taking medicines that may have
certain antibacterial agents (eg. sparfloksashyu, moksifloksapin, Erythromycin IV. lentamtsdin, anti-malarial agents, particularly halofantrine), some antihistamines (astemizole. mizolastine). If you have further questions, consult your doctor.

Tell your doctor if you are taking any of the following medications:
• "Non-selective monoamine oxidase inhibitors (MAOIs)", containing phenelzine, iproniazid, isocarboxazid, nialamide and tranylcypromine as active ingredients. If you are taking any of these medicines will need to wait 14 days before you start taking Estsipram. After stopping treatment with Estsipram must pass seven days before taking any of these medicines.
• "Reversible selective MAO-A inhibitors", containing moclobemide (used to treat depression).
• "Irreversible MAO-B inhibitors", containing selegiline used to treat Parkinson's disease). These drugs increase the risk of side effects.
• The antibiotic linezolid.
• Lithium (used to treat manic depressive disorders) and trnptofan.
Imipramine and desipramine • (both used to treat depression).
• Sumatriptan and similar medicines (used to treat migraine) and tramadol (used to treat severe pain). These drugs increase the risk of side effects.
• Cimetidine and omeprazole (used to treat stomach ulcers), fluvoxamine (antidepressant) and ticlopidine (used to reduce the risk of stroke). These drugs can cause increased blood levels of Estsipram.
• St. John's wort (hypericum perforatum) - vegetable medicine used for depression.
• Aspirin and nonsteroidal anti-inflammatory drugs (drugs for pain relief or to thin the blood, so called. Anticoagulants). They could enhance the bleeding tendencies.
• Warfarin, dipyridamole, and phenprocoumon (medicines to thin the blood, so called. Anticoagulants). Your doctor will probably examine the clotting time of your blood when starting and stopping treatment with Estsipram to confirm that anticoagulant dose you are taking is still adequate.
• Mefloquine (used to treat malaria), bupropion (used to treat depression) and tramadol (used to treat severe pain) due to a possible risk of lowering the threshold for seizures.
• Neuroleptics (medicines to treat schizophrenia, psychosis) due to a possible risk of lowering the threshold for seizures and anttsdepresanti.
• flecanide, propafenone and metoprolol (used in cardiovascular diseases), desipramine, nortriptyline and clomipramine (antidepressants) and risperidone, thioridazine and haloperidol (antipsychotics). It may need a dose adjustment of Estsipram.

Taking ESCIPRAM with food and drink
 ESCIPRAMcan be taken with or without food (see. Section 3 "How to take Estsipram
As with many drugs is not recommended combining Estsipram alcohol, although not expected to ESCIPRAM interaction with alcohol.
Pregnancy, lactation and fertility
Tell your doctor if you are pregnant or planning to become pregnant. Estsipram Do not take if you are pregnant unless you have discussed this with your doctor about the risks and benefits arising from this.
If you take ESCIPRAM in the last three months of pregnancy, it is necessary to know that these side effects could be observed in the newborn baby: trouble breathing, bluish skin, fits, body temperature changes, feeding difficulties, vomiting, low blood sugar, stiffness or floppiness of muscles, vivid reflexes, tremor, jitteriness, irritability, lethargy, constant crying, somnolence and difficulty sleeping. If your baby has any of these symptoms, please contact your doctor immediately.
Make sure your midwife and / or doctor know that you take Estsipram. When given during pregnancy, especially during the last three months, as Estsipram drugs could increase the risk of a serious condition in babies, known as persistent pulmonary hypertension in the newborn, in which the baby's breathing is rapid and it looks livid. Usually these symptoms occur within the first 24 hours after birth. If this happens to your baby you should tell your midwife and / or doctor immediately.
If ESIPRAM be used during pregnancy, it should never be interrupted suddenly.
Do not take ESIPRAM if breast-feeding unless you have discussed with your doctor about the risks and benefits arising from this.
In the studies in experimental animals has been found that citalopram, escitalopram product as a lowered quality of semen. Theoretically, this can affect fertility, but so far there was no effect on fertility in humans.
Ask your doctor or pharmacist before taking any medicine.
Driving and using machines
It is not recommended to drive or operate machinery until you know how you act Estsipram.

3. HOW TO TAKE ESIPRAM?

Always take ESCIPRAM just as you have been told by your doctor. If you're not sure, ask your doctor or pharmacist.

Mature
Depression
The usual recommended dose of ESIPRAM is 10 mg, once daily. The dose may be increased by your doctor to a maximum of 20 mg daily.

Panic disorder
The starting dose of ESIPRAM is 5 mg once daily for the first week before increasing the dose to 10 mg per day. Further, the dose may be increased by the doctor to a maximum of 20 mg per day.
Social Anxiety Disorder
The usual recommended dose of ESIPRAM is 10 mg once daily. Your doctor can either decrease your dose to 5 mg daily or to raise a maximum of 20 mg daily, depending on your response.

Generalized anxiety disorder
The usual recommended dose of Estsipram is 10 mg, once daily. The dose may be increased by your doctor to a maximum of 20 mg daily.

Obsessive Compulsive Disorder
The usual recommended dose of ESCIPRAM is 10 mg once daily. The dose may be increased by your doctor to a maximum of 20 mg daily.
The recommended dose of Estsipram 5 mg once daily. Your doctor may increase the dose to 10 mg daily.
Children and adolescents (under 18 years)
Estsipram generally should not be given to children and adolescents. For further information please see please point 2 "Before you take Estsipram."
It can take Estsipram with or without food. Swallow the tablets with water. Do not chew them, as they have a bitter taste.
If necessary, you can divide the tablets by first placing the tablet on a flat surface with the score facing upwards. Then, the tablet can be broken by pressing in both end and down with both index fingers.

Duration of treatment
It may take several weeks before you feel better. Keep taking Estsipram, even if it takes some time before you feel any improvement in your condition.
Do not change the dose of your medicine before you have talked about it with your doctor.
Keep taking Estsipram as long as you recommend your doctor. If you stop treatment too soon, your symptoms may reappear. It is recommended to continue treatment for at least 6 months after you feel well again.

If you take more dose Estsipram
If you take more than the prescribed dose Estsipram, immediately contact your doctor or nearest hospital for emergency care. Do this even if there are no signs of discomfort. Some of the signs of overdose can be dizziness, tremor, agitation (agitation), seizures (convulsions), coma, nausea, vomiting, change in heart rhythm, decreased blood pressure and change in the balance of body fluids / salts. Take with you the box / container Estsipram when you go to the doctor or hospital.

If you forget to take ESCIPRAM
Do not take a double dose to make up the missed dose. If you forget to take a dose and you remember before you go to bed, take it straight away. The next day, continue taking the drug as usual. If you remember the missed dose at night or the next day, skip the missed dose and continue taking your medicine as usual.

If you stop taking ESCIPRAM
Do not stop taking ESCIPRAM until your doctor tells you to do. When complete the course of treatment is generally recommended dose of Estsipram to reduce gradually over several weeks.
When you stop taking, ESCIPRAM especially if it is abruptly, it may feel withdrawal symptoms. They are common in discontinuation of Estsipram. The risk of this is greater after prolonged use of Estsipram or too rapid reduction of the dose. Most people find that these symptoms are mild and self-limiting within two weeks. In some patients, however, it may be severe or prolonged (2-3 months or more). If you have severe withdrawal symptoms after discontinuation of Estsipram, please contact your doctor. He or she may ask you to restart taking your tablets and come off them more slowly.
Withdrawal symptoms include: feeling dizzy (unsteady or off-balance), numbness and tingling of extremities, burning sensations and (less commonly) electric shock, including in the head, sleep disturbances (vivid dreams, nightmares inability to sleep), anxiety, headache, nausea, sweating (incl. night sweats), feeling restless or agitated, tremor (shakiness), feeling confused or disorientated, increased emotional or irritable, diarrhea (loose stools), visual disorders, irregular or increased heartbeat (palpitations).
If you have any further questions on the use of this product, ask your doctor or pharmacist.

4. POSSIBLE SIDE EFFECTS
Like all medicines, ESCIPRAM can cause side effects, although not everybody gets them.
Side effects usually disappear a few weeks after starting treatment. Please note that many of the effects may also be symptoms of your illness and therefore when you start to improve.