Escitalopram Aurovitas

Leaflet attached to the packaging: information for the user

Warning! The leaflet should be kept. Information on the immediate packaging in a foreign language.

Escitalopram Aurovitas (Escitalopram Aurobindo 20 mg), 20 mg, film-coated tablets

Escitalopramum
Escitalopram Aurovitas and Escitalopram Aurobindo 20 mg are different trade names for the same medicine.

You should carefully read the contents of the leaflet before taking the medicine, as it contains important information for the patient.

• You should keep this leaflet, so that you can read it again if you need to.
• If you have any doubts, you should consult a doctor or pharmacist.
• This medicine has been prescribed to a specific person. It should not be given to others. The medicine may harm another person, even if the symptoms of their illness are the same.
• If the patient experiences any side effects, including any side effects not listed in this leaflet, they should tell their doctor, pharmacist, or nurse. See section 4.

Table of contents of the leaflet:

• 1. What is Escitalopram Aurovitas and what is it used for
• 2. Important information before taking Escitalopram Aurovitas
• 3. How to take Escitalopram Aurovitas
• 4. Possible side effects
• 5. How to store Escitalopram Aurovitas
• 6. Contents of the packaging and other information

1. What is Escitalopram Aurovitas and what is it used for

Escitalopram Aurovitas contains the active substance escitalopram. Escitalopram Aurovitas belongs to a group of antidepressant medicines called selective serotonin reuptake inhibitors (SSRIs). These medicines work on the serotonin system in the brain by increasing the levels of serotonin.
Escitalopram Aurovitas is used to treat depression (major depressive episodes), anxiety disorders (such as panic disorder with or without agoraphobia, social anxiety disorder, generalized anxiety disorder, and obsessive-compulsive disorder).
It may take several weeks of treatment before you start to feel better. You should continue to take Escitalopram Aurovitas even if you do not feel better immediately. If you do not feel better or feel worse, you should consult your doctor.

2. Important information before taking Escitalopram Aurovitas

When not to take Escitalopram Aurovitas

• if you are allergic to escitalopram or any of the other ingredients of this medicine (listed in section 6),
• if you are taking other medicines that belong to a group called monoamine oxidase inhibitors (MAOIs), including selegiline (used to treat Parkinson's disease), moclobemide (used to treat depression), and linezolid (an antibiotic),
• if you have been born with a heart rhythm disorder or if you have had a heart rhythm disorder (visible on an ECG; a test that assesses heart function),
• if you are taking medicines used to treat heart rhythm disorders or medicines that may affect heart rhythm (see "Escitalopram Aurovitas and other medicines").

Warnings and precautions

Before starting treatment with Escitalopram Aurovitas, you should discuss it with your doctor or pharmacist. You should tell your doctor if you have other disorders or diseases, as your doctor should take this information into account. In particular, you should inform your doctor:

• If you have epilepsy. If you experience seizures for the first time or if their frequency increases, you should stop therapy with Escitalopram Aurovitas (see also section 4 "Possible side effects").
• If you have liver or kidney problems. Dose adjustment may be required by your doctor.
• If you have diabetes. Taking Escitalopram Aurovitas may affect blood sugar control. It may be necessary to adjust the dose of insulin and/or oral medicines that lower blood sugar levels.
• If you have low sodium levels in your blood.
• If you have an increased tendency to bleeding and bruising or if you are pregnant (see "Pregnancy, breastfeeding, and fertility").
• If you are being treated with electroconvulsive therapy.
• If you have coronary heart disease.
• If you have had heart problems or if you have recently had a heart attack.
• If you have a slow resting heart rate and/or if you may have electrolyte deficiencies due to prolonged severe diarrhea, vomiting, or use of diuretics (medicines that increase urine production).
• If you experience rapid or irregular heartbeat, fainting, collapse, or dizziness when standing up, which may indicate an abnormal heart rate.
• If you have had eye problems, such as certain types of glaucoma (increased pressure inside the eyeball).
• Medicines like escitalopram (so-called SSRIs/SNRIs) may cause sexual dysfunction (see section 4). In some cases, these symptoms may persist after treatment has stopped.
• If you are taking medicinal products containing buprenorphine. Taking these medicines with Escitalopram Aurovitas may lead to a condition called serotonin syndrome, a potentially life-threatening condition (see "Escitalopram Aurovitas and other medicines").

Warning

In some patients with bipolar affective disorder, a manic phase may occur. This is characterized by unusual and rapidly changing ideas, unjustified feelings of happiness, and excessive physical activity. If these symptoms occur, you should consult your doctor.
In the first few weeks of treatment, symptoms such as anxiety or difficulty sitting or standing still may also occur. If such symptoms occur, you should immediately inform your doctor.

Suicidal thoughts and worsening of depression or anxiety disorder

People with depression or anxiety disorders may sometimes have thoughts of self-harm or suicide. These symptoms or behaviors may worsen at the start of treatment with antidepressant medicines, as these medicines usually start to work only after about 2 weeks, sometimes later.
These symptoms are more likely to occur in:

• patients who have had thoughts of self-harm or suicide before;
• young adults. Clinical trial data have shown an increased risk of suicidal behavior in people under 25 with mental disorders who were treated with antidepressant medicines.

If you experience thoughts of self-harm or suicide, you should contact your doctor or go to the hospital immediately.
It may be helpful to inform your relatives or close friends about your depression or anxiety disorder and ask them to read this leaflet. You may ask them to tell you if they notice that your depression or anxiety is getting worse or if you are experiencing worrying changes in your behavior.

Children and adolescents

Escitalopram Aurovitas should not be used in children and adolescents under 18 years of age.
It should also be noted that in the case of taking medicines of this class, patients under 18 years of age are at increased risk of side effects, such as suicidal attempts, suicidal thoughts, and hostility (especially aggression, rebellious behavior, and manifestations of anger). However, your doctor may prescribe Escitalopram Aurovitas to patients under 18 years of age if they consider it to be in their best interest. If your doctor has prescribed Escitalopram Aurovitas to a patient under 18 years of age and you have any doubts, please contact your doctor. If the above-mentioned symptoms develop or worsen in patients under 18 years of age taking Escitalopram Aurovitas, you should inform your doctor. Additionally, as yet, there is no data on the long-term safety of Escitalopram Aurovitas in this age group regarding growth, maturation, and cognitive and behavioral development.

Escitalopram Aurovitas and other medicines

You should tell your doctor or pharmacist about all medicines you are currently taking or have recently taken, as well as any medicines you plan to take.
You should inform your doctor if you are taking any of the following medicines:

• Non-selective monoamine oxidase inhibitors (MAOIs) containing substances such as phenelzine, iproniazid, isocarboxazid, nialamide, and tranylcypromine. If you have taken any of these medicines, you should wait 14 days before starting to take Escitalopram Aurovitas. After stopping treatment with Escitalopram Aurovitas, you should wait 7 days before taking any of these medicines.
• Reversible, selective monoamine oxidase A (MAO-A) inhibitors containing moclobemide (used to treat depression).
• Irreversible monoamine oxidase B (MAO-B) inhibitors containing selegiline (used to treat Parkinson's disease). These medicines increase the risk of side effects.
• The antibiotic linezolid.
• Lithium (used to treat bipolar affective disorder) and tryptophan.
• Imipramine and desipramine (used to treat depression).
• Sumatriptan and similar medicines (used to treat migraine) and tramadol and similar medicines (opioids, used to treat severe pain). They may increase the risk of side effects.
• Cimetidine, lansoprazole, and omeprazole (used to treat stomach ulcers), fluconazole (used to treat fungal infections), fluvoxamine (an antidepressant), and ticlopidine (used to reduce the risk of stroke). These medicines may cause an increase in escitalopram levels in the blood.
• St. John's Wort (Hypericum perforatum) - a herbal medicine used to treat depression.
• Acetylsalicylic acid and non-steroidal anti-inflammatory medicines (used to treat pain or to thin the blood, known as anticoagulants). They may increase the risk of bleeding.
• Warfarin, dipyridamole, and phenprocoumon (used to thin the blood, known as anticoagulants). Your doctor may order a blood test to check the blood clotting time at the start and after stopping treatment with Escitalopram Aurovitas to determine if the dose of the anticoagulant is still appropriate.
• Mefloquine (used to treat malaria), bupropion (used to treat depression), and tramadol (used to treat severe pain) due to the possible risk of lowering the seizure threshold.
• Antipsychotics (used to treat schizophrenia, psychosis) and antidepressants (tricyclic antidepressants and SSRIs) due to the possible risk of lowering the seizure threshold.
• Flecainide, propafenone, and metoprolol (used to treat heart conditions), clomipramine and nortriptyline (antidepressants), and risperidone, thioridazine, and haloperidol (antipsychotics). Dose adjustment of Escitalopram Aurovitas may be required.
• Medicines that lower potassium or magnesium levels in the blood increase the risk of life-threatening heart rhythm disorders.

Some medicines may increase the side effects of Escitalopram Aurovitas and sometimes may cause very serious reactions. While taking Escitalopram Aurovitas, you should not take any other medicines without consulting your doctor, especially:

• medicines containing buprenorphine. These medicines may interact with Escitalopram Aurovitas and may cause symptoms such as involuntary, rhythmic muscle contractions, including muscles that control eye movements, agitation, hallucinations, coma, excessive sweating, tremors, increased reflexes, muscle tension, body temperature above 38°C. If such symptoms occur, you should contact your doctor.

You should not take Escitalopram Aurovitas at the same time as medicines used to treat heart rhythm disorders or medicines that may affect heart rhythm, such as anti-arrhythmic medicines of class IA and III, antipsychotics (e.g., phenothiazine derivatives, pimozide, haloperidol), tricyclic antidepressants, certain antibacterial medicines (e.g., sparfloxacin, moxifloxacin, erythromycin IV, pentamidine, anti-malarial medicines - especially halofantrine), certain antihistamines (astemizole, hydroxyzine, mizolastine), etc. You should consult your doctor if you have any further questions.

Escitalopram Aurovitas with food, drink, and alcohol

Escitalopram Aurovitas can be taken with or without food (see section 3 "How to take Escitalopram Aurovitas").
As with many medicines, it is not recommended to take Escitalopram Aurovitas and drink alcohol at the same time, although interactions (effects) of Escitalopram Aurovitas with alcohol are not expected.

Pregnancy, breastfeeding, and fertility

If you are pregnant or breastfeeding, think you may be pregnant, or plan to have a baby, you should consult your doctor or pharmacist before taking this medicine. You should not take Escitalopram Aurovitas during pregnancy and breastfeeding, unless you have discussed the risks and benefits of treatment with your doctor.
If you take Escitalopram Aurovitas during the last 3 months of pregnancy, you should be aware that the following symptoms may occur in the newborn: breathing difficulties, blue skin, seizures, changes in body temperature, difficulties in sucking, vomiting, low blood sugar levels, muscle stiffness or flaccidity, increased reflexes, tremors, tremors, irritability, lethargy, constant crying, and sleep disturbances. If any of these symptoms occur in the newborn, you should contact your doctor immediately.
You should inform your doctor and/or midwife about taking Escitalopram Aurovitas.
Taking medicines like Escitalopram Aurovitas, especially in the last 3 months of pregnancy, may increase the risk of serious complications in the newborn, called persistent pulmonary hypertension of the newborn (PPHN). This condition is characterized by rapid breathing and blue discoloration of the skin. These symptoms usually occur in the first day after birth. If such symptoms occur in the newborn, you should contact your doctor and/or midwife immediately.
You should not stop taking Escitalopram Aurovitas during pregnancy.
If you take Escitalopram Aurovitas at the end of pregnancy, there may be an increased risk of severe bleeding from the uterus soon after delivery, especially if you have had bleeding disorders in the past. Your doctor or midwife should know that you are taking Escitalopram Aurovitas, so they can advise you.
It is assumed that escitalopram passes into breast milk.
In animal studies, it has been shown that citalopram, a medicine similar to escitalopram, lowers sperm quality. This may theoretically affect fertility, although no effect on fertility has been observed in humans so far.

Driving and using machines

You should not drive or use machines until you know how Escitalopram Aurovitas affects you.

Escitalopram Aurovitas contains sodium

This medicine contains less than 1 mmol (23 mg) of sodium per tablet, which means it is essentially "sodium-free".

3. How to take Escitalopram Aurovitas

This medicine should always be taken as directed by your doctor or pharmacist. If you are unsure, you should consult your doctor or pharmacist.
Escitalopram Aurovitas is available in the following strengths: 10 mg, 15 mg, and 20 mg.
Recommended dose
Adults:
Depression
The usual recommended dose of Escitalopram Aurovitas is 10 mg, taken as a single dose once daily. The dose may be increased by your doctor to a maximum of 20 mg daily.
Panic disorder with agoraphobia
The initial dose of Escitalopram Aurovitas is 5 mg once daily for the first week of treatment, then the dose is increased to 10 mg once daily. The dose may then be increased by your doctor to a maximum of 20 mg daily.
Social anxiety disorder
The usual recommended dose of Escitalopram Aurovitas is 10 mg, taken as a single dose once daily. The dose may then be decreased by your doctor to 5 mg daily or increased to a maximum of 20 mg daily, depending on your response to the medicine.
Generalized anxiety disorder
The usual recommended dose of Escitalopram Aurovitas is 10 mg, taken as a single dose 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 Escitalopram Aurovitas is 10 mg, taken as a single dose once daily. The dose may be increased by your doctor to a maximum of 20 mg daily.
Elderly patients (over 65 years)
The recommended initial dose of Escitalopram Aurovitas is 5 mg, taken as a single dose once daily. Your doctor may recommend increasing the dose to 10 mg daily.
Use in children and adolescents
Escitalopram Aurovitas should not normally be used in children and adolescents. Additional information is provided in section 2 "Warnings and precautions".
Kidney problems
Caution should be exercised in patients with severe kidney problems. The medicine should be used as directed by your doctor.
Liver problems
Patients with liver problems should not take more than 10 mg daily. The medicine should be used as directed by your doctor.
Patients who are slow metabolizers of medicines that are metabolized by the CYP2C19 enzyme
Patients with this known genotype should not take a dose of 10 mg daily. The medicine should be used as directed by your doctor.

How to take Escitalopram Aurovitas

Escitalopram Aurovitas can be taken with or without food.
The tablets should be swallowed with water. They should not be chewed, as they have a bitter taste.
If necessary, the tablets can be broken into two equal doses. To do this, place the tablet on a flat surface with the groove facing up, and then break it in half by pressing down on each end with your index fingers, as shown in the picture.

Duration of treatment

You may start to feel better after a few weeks of treatment. You should therefore continue to take Escitalopram Aurovitas, even if it takes some time before you feel better.
You should not change the dose without consulting your doctor.
The medicine should be taken for as long as your doctor recommends. If you stop treatment too early, your symptoms may return. It is recommended to continue treatment for at least 6 months after you start to feel better.

Taking a higher dose of Escitalopram Aurovitas than recommended

If you have taken more Escitalopram Aurovitas than prescribed, you should contact your doctor or go to the emergency room immediately. You should do this even if you do not feel any discomfort. Symptoms of overdose include dizziness, tremors, agitation, seizures, coma, nausea, vomiting, heart rhythm disorders, low blood pressure, and electrolyte disturbances.
You should take the packaging of Escitalopram Aurovitas with you to the doctor or hospital.

Missing a dose of Escitalopram Aurovitas

You should not take a double dose to make up for a missed dose.
If you have forgotten to take a dose and remember before bedtime, you should take the missed dose immediately. You should take the next dose the next day. If you remember that you have missed a dose in the night or the next day, you should skip the missed dose and take the next dose as usual.

Stopping treatment with Escitalopram Aurovitas

You should not stop taking Escitalopram Aurovitas unless your doctor recommends it. When you stop treatment, it is usually recommended to gradually reduce the dose of Escitalopram Aurovitas over a period of several weeks.
After stopping treatment with Escitalopram Aurovitas, especially if it is stopped abruptly, you may experience withdrawal symptoms. These symptoms are common when treatment with Escitalopram Aurovitas is stopped. The risk is higher if Escitalopram Aurovitas has been taken for a long time, in high doses, or if the dose has been reduced too quickly. In most patients, the symptoms are mild and disappear on their own within two weeks. In some patients, however, they may be more severe or last longer (2-3 months or longer). If you experience severe withdrawal symptoms after stopping treatment with Escitalopram Aurovitas, you should contact your doctor. Your doctor may recommend restarting treatment with the medicine and reducing the dose more slowly.
Withdrawal symptoms include dizziness (unsteady gait, balance disorders), tingling sensation, burning sensation, and (less commonly) a sensation like an electric shock, including in the head, sleep disturbances (vivid dreams, nightmares, insomnia), restlessness, headache, nausea (feeling sick), sweating (including night sweats), restlessness or agitation, tremors, disorientation, emotional instability or irritability, diarrhea (loose stools), vision disturbances, heart palpitations or arrhythmias.
If you have any further doubts about taking this medicine, you should consult your doctor or pharmacist.

4. Possible side effects

Like all medicines, Escitalopram Aurovitas can cause side effects, although not everyone gets them.
Side effects usually disappear after a few weeks of treatment. You should remember that some of these side effects may also be symptoms of the illness, and they will disappear as you start to feel better.

If you experience any of these side effects during treatment, you should contact your doctor or go to the hospital immediately.

Uncommon (may affect up to 1 in 100 people):

• unusual bleeding, including bleeding from the gastrointestinal tract.

Rare (may affect up to 1 in 1,000 people):

• swelling of the skin, tongue, lips, throat, or face, hives, or difficulty breathing or swallowing (severe allergic reaction);
• high fever, agitation, confusion (disorientation), tremors, and sudden muscle contractions, which may be symptoms of a rare disorder called serotonin syndrome.

Side effects with unknown frequency (frequency cannot be estimated from the available data):

• difficulty urinating;
• seizures, see also section "Warnings and precautions";
• yellowing of the skin and whites of the eyes, which is a sign of liver problems/liver inflammation;
• rapid or irregular heartbeat, fainting, which may be a sign of a life-threatening condition called torsades de pointes;
• suicidal thoughts and behaviors, see also section "Warnings and precautions";
• sudden swelling of the skin or mucous membranes (angioedema).

In addition to the above, the following side effects have been reported:

• very common (may affect more than 1 in 10 people):
• nausea;
• headache.

common (may affect up to 1 in 10 people):

• nasal congestion or sinusitis (sinus infection);
• decreased or increased appetite;
• anxiety, restlessness, vivid dreams, sleep disturbances, drowsiness, dizziness, yawning, tremors, tingling sensation in the skin;
• diarrhea, constipation, vomiting, dry mouth;
• increased sweating;
• muscle and joint pain;
• sexual dysfunction (delayed ejaculation, erectile dysfunction, decreased libido, and difficulty achieving orgasm in women);
• feeling tired, fever;
• weight gain.

uncommon (may affect up to 1 in 100 people):

• hives, rash, itching;
• grinding of the teeth, agitation, nervousness, panic attacks, confusion (disorientation);
• sleep disturbances, taste disorders, fainting (syncope);
• dilated pupils, vision disturbances, ringing in the ears (tinnitus);
• hair loss;
• heavy menstrual bleeding;
• irregular menstrual periods;
• weight loss;
• rapid heartbeat;
• swelling of the arms or legs;
• nosebleeds.

rare (may affect up to 1 in 1,000 people):

• aggression, depersonalization (feeling of loss of one's own identity, feeling of not being oneself), hallucinations;
• slow heartbeat.

Side effects with unknown frequency (frequency cannot be estimated from the available data):

• decreased sodium levels in the blood (symptoms include nausea and malaise with muscle weakness or confusion);
• dizziness when standing up due to low blood pressure (orthostatic hypotension);
• abnormal liver function test results (increased liver enzyme activity in the blood);
• movement disorders (involuntary muscle movements);
• painful erection of the penis (priapism);
• symptoms of unusual bleeding, such as bleeding from the skin and mucous membranes (ecchymoses);
• increased secretion of antidiuretic hormone (ADH), leading to water retention in the body, dilutional hyponatremia, and decreased sodium levels;
• galactorrhea (milk secretion) in men and women who are not breastfeeding;
• mania;
• patients taking medicines of this class have been observed to have an increased risk of fractures;
• change in heart rhythm (called "QT interval prolongation", visible on an ECG; a test that assesses heart function);
• heavy bleeding from the uterus soon after delivery (postpartum hemorrhage), see "Pregnancy, breastfeeding, and fertility" in section 2.

In addition to the above, the following side effects have been reported for medicines with a similar mechanism of action to escitalopram (the active substance of Escitalopram Aurovitas):

• restlessness (akathisia);
• loss of appetite.

Reporting side effects

If you experience any side effects, including any side effects not listed in this leaflet, you should tell your doctor, pharmacist, or nurse. Side effects can be reported directly to the Department of Drug Safety Monitoring of the Office for Registration of Medicinal Products, Medical Devices, and Biocidal Products, Al. Jerozolimskie 181C, 02-222 Warsaw, Tel.: +48 22 49 21 301, Fax: +48 22 49 21 309
Website: https://smz.ezdrowie.gov.pl
By reporting side effects, you can help provide more information on the safety of this medicine.

5. How to store Escitalopram Aurovitas

The medicine should be stored out of sight and reach of children.
Do not use this medicine after the expiry date stated on the packaging. The expiry date refers to the last day of the month stated.
There are no special precautions for storage.
Medicines should not be disposed of via wastewater or household waste. You should ask your pharmacist how to dispose of medicines that are no longer needed. This will help protect the environment.

6. Contents of the packaging and other information

What Escitalopram Aurovitas contains

Each film-coated tablet contains 20 mg of escitalopram - Escitalopramum(in the form of oxalate).
In addition, the medicine contains
Core:microcrystalline cellulose, silicon dioxide, butylhydroxytoluene (E 321), butylhydroxyanisole (E 320), sodium carboxymethylcellulose, microcrystalline cellulose, colloidal anhydrous silica, talc, magnesium stearate.
Coating:hypromellose, titanium dioxide (E 171), macrogol 400.

What Escitalopram Aurovitas looks like and contents of the pack

Film-coated tablets.
White or almost white, oval, film-coated, biconvex tablets with a score line, engraved with the letter "F" on one side and the number "56" on the other side, with a deep groove separating the "5" and "6". The size of the tablets is 11.6 mm x 7.1 mm. The tablet can be divided into equal doses.
Pack sizes:
PVC/Aclar/Aluminum blisters in a cardboard box: 28 film-coated tablets.
To obtain more detailed information, you should contact the marketing authorization holder or the parallel importer.

Marketing authorization holder in the Netherlands, the country of export:

Aurobindo Pharma B.V.
Baarnsche Dijk 1
3741 LN Baarn, Netherlands

Manufacturer:

APL Swift Services (Malta) Limited
HF26, Hal Far Industrial Estate
Birzebbugia, BBG 3000
Malta
Milpharm Limited
Ares Block, Odyssey Business Park
West End Road
South Ruislip HA4 6QD
United Kingdom
Generis Farmacêutica S.A.
Rua João de Deus, 19
2700-487 Amadora
Portugal

Parallel importer:

Delfarma Sp. z o.o.
ul. Św. Teresy od Dzieciątka Jezus 111
91-222 Łódź

Repackaged by:

Delfarma Sp. z o.o.
ul. Św. Teresy od Dzieciątka Jezus 111
91-222 Łódź
Netherlands marketing authorization number: RVG 111568

Parallel import authorization number: 61/24

This medicine is authorized in the Member States of the European Economic Area under the following names:

Poland:
Escitalopram Aurovitas
Portugal:
Escitalopram Aurovitas
Spain:
ESCITALOPRAM AUROVITAS 10 mg/ 15 mg/ 20 mg film-coated tablets EFG

Date of approval of the leaflet: 12.02.2024

[Information about the trademark]