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QTcF interval was evaluated in a randomizedplacebo and activemoxifloxacin 400 mgcontrolled cross-overescalating multipledose study in 113 healthy subjectsThe maximum mean95upper confidence bounddifference from placebo arm were 4.56.4and 10.712.7msec for 10 mg and supratherapeutic 30 mg escitalopram given once dailyrespectivelyBased on the established exposure-response relationshipthe predicted QTcF change from placebo arm95confidence intervalunder the Cmax for the dose of 20 mg is 6.67.9msecEscitalopram 30 mg given once daily resulted in mean Cmax of 1.7-fold higher than the mean Cmax for the maximum recommended therapeutic dose at steady state20 mgThe exposure under supratherapeutic 30 mg dose is similar to the steady state concentrations expected in CYP2C19 poor metabolizers following a therapeutic dose of 20 mg.

Consideration should be given to changing the therapeutic regimenincluding possibly discontinuing the medicationin patients whose depression is persistently worseor who are experiencing emergent suicidality or symptoms that might be precursors to worsening depression or suicidalityespecially if these symptoms are severeabrupt in onsetor were not part of the patient’s presenting symptoms.

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that risk is increased with narcotic pain medications like oxycodone and mood disorder medications such as lexapro and wellbutrin bupropion .

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