Esertia 20 mg film-coated tablets

Package leaflet: Information for the user

Introduction

Package leaflet: information for the user

Esertia 20 mg film-coated tablets

escitalopram

Read the entire leaflet carefully before you start taking this medicine because it contains important information for you.

• Keep this leaflet. You may need to read it again.
• If you have any questions, ask your doctor or pharmacist.
• This medicine has been prescribed for you only and must not be given to other people, even if they have the same symptoms as you, because it could harm them.
• If you experience any adverse effects, consult your doctor or pharmacist, even if they are effects not listed in this leaflet. See section 4.

Leaflet contents

1. What Esertia is and what it is used for

2. What you need to know before taking Esertia

3. How to take Esertia

4. Possible side effects

5. How to store Esertia

6. Contents of the pack and other information

1. What Esertia is and what it is used for

Esertia contains the active substance escitalopram. Esertia belongs to a group of antidepressants known as selective serotonin reuptake inhibitors (SSRIs).

Esertia contains escitalopram and is indicated for the treatment of depression (major depressive episodes) and anxiety disorders (such as panic disorder with or without agoraphobia, social anxiety disorder, generalized anxiety disorder, and obsessive-compulsive disorder).

It may take a couple of weeks before you start to feel better. Continue taking Esertia even if it takes some time to notice improvement.

You should consult a doctor if your condition worsens or does not improve.

2. What you need to know before taking Esertia

Do not take Esertia

• 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 belonging to the group called MAO inhibitors, including selegiline (used for the treatment of Parkinson’s disease), moclobemide (used for the treatment of depression), and linezolid (an antibiotic).
  • If you were born with or have had an episode of heart rhythm disorder (detected on an ECG, a test that evaluates heart function).
  • If you are taking medicines for heart rhythm problems or that may affect heart rhythm (see section 2 “Using Esertia with other medicines”).

Warnings and precautions

Talk to your doctor or pharmacist before starting to take Esertia.

Please inform your doctor if you have any other disorder or illness, as your doctor may need to take this into account. Specifically, tell your doctor:

• If you have epilepsy. Treatment with Esertia should be discontinued if you experience seizures for the first time or notice an increase in seizure frequency (see also section 4 “Possible side effects”).

• If you have liver or kidney impairment. Your doctor may need to adjust your dose.

• If you have diabetes. Treatment with Esertia may alter glycaemic control. A dose adjustment of insulin and/or oral hypoglycaemic agents may be necessary.

• If you have low sodium levels in your blood.

• If you tend to bleed or bruise easily, or if you are pregnant (see “Pregnancy, breastfeeding and fertility”).

• If you are receiving electroconvulsive therapy.

• If you have coronary artery disease.

• If you have or have had heart problems or recently suffered a heart attack.

• If your resting heart rate is slow and/or you know you may have low salt levels due to severe and prolonged diarrhoea and vomiting (being ill) or use of diuretics.

• If you experience rapid or irregular heartbeats, fainting, collapse, or dizziness upon standing, which may indicate abnormal heart rhythm.

• If you have or have previously had eye problems, such as certain types of glaucoma (increased pressure in the eye).

Please note:

Some patients with bipolar disorder may enter a manic phase. This is characterised by unusually rapid and frequent changes in thoughts, excessive happiness, and excessive physical activity. If you experience this, contact your doctor.

Symptoms such as restlessness or difficulty sitting or standing still may also occur during the first weeks of treatment. Inform your doctor immediately if you experience these symptoms.

Some medicines in the same class as Esertia (called SSRIs/SNRIs) may cause sexual dysfunction symptoms (see section 4). In some cases, these symptoms persist after stopping treatment.

Suicidal thoughts and worsening of depression or anxiety disorder

If you are depressed and/or suffer from an anxiety disorder, you may occasionally have thoughts of harming or killing yourself. These may increase when starting antidepressants, as all these medicines require time to begin working—usually about two weeks, although in some cases it may take longer. You are more likely to have such thoughts:

• If you have previously had thoughts of killing or harming yourself.
• If you are a young adult. Clinical trial data have shown an increased risk of suicidal behaviour in patients under 25 years of age with psychiatric disorders treated with an antidepressant.

If at any time you have thoughts of harming or killing yourself, contact your doctor or go directly to a hospital.

It may help to tell a relative or close friend that you are depressed or have an anxiety disorder and ask them to read this leaflet. You may ask them whether they think your depression or anxiety disorder has worsened or if they are concerned about changes in your behaviour.

Children and adolescents

Esertia should not normally be used to treat children and adolescents under 18 years of age. Also, you should know that in patients under 18 years of age, there is an increased risk of adverse effects such as suicide attempts, suicidal thoughts, and hostility (mainly aggression, confrontation behaviour, and irritability) when taking this type of medicine. Nevertheless, your doctor may prescribe Esertia to patients under 18 years of age if they decide it is in the patient’s best interest. If your doctor has prescribed Esertia to a patient under 18 years of age and you wish to discuss this decision, please return to your doctor. You must inform your doctor if any of the previously described symptoms worsen or develop complications while patients under 18 years of age are taking Esertia. In addition, the long-term effects on safety and on growth, maturation, and cognitive and behavioural development of Esertia in this age group have not yet been established.

Other medicines and Esertia

Tell your doctor or pharmacist if you are using, have recently used, or might need to use any other medicines.

Inform your doctor if you are taking any of the following medicines:

• “Non-selective monoamine oxidase inhibitors (MAOIs)” containing phenelzine, iproniazid, isocarboxazide, nialamide, or tranylcypromine as active ingredients. If you have taken any of these medicines, you must wait 14 days before starting Esertia. After stopping Esertia, 7 days must pass before taking any of these medicines.

• “Reversible selective MAO-A inhibitors” containing moclobemide (used in the treatment of depression).

• “Irreversible MAO-B inhibitors” containing selegiline (used in the treatment of Parkinson’s disease). These increase the risk of side effects.

• The antibiotic linezolid.

• Lithium (used in the treatment of bipolar disorder) and tryptophan.

• Imipramine and desipramine (both used for the treatment of depression).

• Sumatriptan and similar medicines (used for the treatment of migraine) and tramadol and similar medicines (opioids, used for severe pain). These increase the risk of side effects.

• Cimetidine, lansoprazole, and omeprazole (used for the treatment of stomach ulcers), fluconazole (used to treat fungal infections), fluvoxamine (an antidepressant), and ticlopidine (used to reduce the risk of stroke). These may cause increased blood levels of escitalopram.

• St John’s wort (Hypericum perforatum) – a herbal remedy used for depression.

• Acetylsalicylic acid and non-steroidal anti-inflammatory drugs (medicines used to relieve pain or reduce the risk of thrombosis, also called anticoagulants). These may increase the tendency to bleed.

• Warfarin, dipyridamole, and phenprocoumon (medicines used to reduce the risk of thrombosis, also called anticoagulants). Your doctor will likely monitor your blood clotting time at the start and end of Esertia treatment to ensure the anticoagulant dose remains appropriate.

• Mefloquine (used for the treatment of malaria), bupropion (used for the treatment of depression), and tramadol (used for the treatment of severe pain), due to the possible risk of lowering the seizure threshold.

• Neuroleptics (medicines used for the treatment of schizophrenia, psychosis) and antidepressants (tricyclic antidepressants and SSRIs) due to the possible risk of lowering the seizure threshold.

• Flecainide, propafenone, and metoprolol (used in cardiovascular diseases), clomipramine and nortriptyline (antidepressants), and risperidone, thioridazine, and haloperidol (antipsychotics). The dose of Esertia may need to be adjusted.

• Medicines that reduce potassium or magnesium levels in the blood, as this increases the risk of life-threatening heart rhythm disturbances.

Do not take Esertia if you are taking medicines for heart rhythm problems or that may affect heart rhythm, e.g. Class IA and III antiarrhythmics, antipsychotics (e.g. phenothiazine derivatives, pimozide, haloperidol), tricyclic antidepressants, certain antimicrobial agents (e.g. sparfloxacin, moxifloxacin, IV erythromycin, pentamidine, antimalarial treatments particularly halofantrine), certain antihistamines (astemizole, hydroxyzine, mizolastine). Contact your doctor for any further questions.

Taking Esertia with food, drinks, and alcohol

Esertia can be taken with or without food (see section 3 “How to take Esertia”).

As with many medicines, combining Esertia with alcohol is not recommended, although an interaction between Esertia and alcohol is not expected.

Pregnancy, breastfeeding, and fertility

If you are pregnant or breastfeeding, think you may be pregnant, or plan to become pregnant, consult your doctor or pharmacist before using this medicine.

Do not take Esertia if you are pregnant or breastfeeding unless you and your doctor have discussed the risks and benefits involved.

If you take Esertia during the last 3 months of pregnancy, the following effects may occur in the newborn baby: breathing difficulties, bluish skin, seizures, changes in body temperature, feeding difficulties, vomiting, low blood sugar, muscle stiffness or floppiness, exaggerated reflexes, tremors, restlessness, irritability, lethargy, constant crying, drowsiness, and sleep disturbances.

If your newborn baby has any of these symptoms, please contact your doctor immediately.

Ensure your midwife and/or doctor know that you are being treated with Esertia.

During pregnancy, particularly in the last 3 months, medicines like Esertia may increase the risk of a serious condition in newborns called persistent pulmonary hypertension of the newborn (PPHN), in which the baby breathes rapidly and turns blue. These symptoms usually begin within the first 24 hours after birth. If they occur in your baby, contact your midwife and/or doctor immediately.

If you take Esertia in late pregnancy, there may be an increased risk of heavy vaginal bleeding shortly after delivery, especially if you have a history of bleeding disorders. Your doctor or midwife should be aware that you are taking Esertia so they can advise you.

If Esertia is used during pregnancy, it must never be stopped abruptly.

Esertia is expected to be excreted in breast milk.

Citalopram, a medicine similar to escitalopram, has been shown to reduce sperm quality in animal models. This effect could theoretically affect fertility, but to date, no impact on human fertility has been observed.

Driving and using machines

You are advised not to drive or operate machinery until you know how Esertia affects you.

Esertia contains sodium

This medicine contains less than 23 mg of sodium (1 mmol) per tablet; this is essentially “sodium-free”.

3. How to take Esertia

Follow exactly the instructions for using this medicine as given by your doctor. If you are unsure, consult your doctor or pharmacist again.

Adults

Depression

The normally recommended dose of Esertia is 10 mg taken as a single daily dose. Your doctor may increase it up to a maximum of 20 mg per day.

Panic disorder

The initial dose of Esertia is 5 mg as a single daily dose for the first week before increasing the dose to 10 mg per day. Your doctor may subsequently increase it up to a maximum of 20 mg per day.

Social anxiety disorder

The normally recommended dose of Esertia is 10 mg taken as a single daily dose. Your doctor may reduce your dose to 5 mg per day or increase it up to a maximum of 20 mg per day, depending on your response to the medication.

Generalized anxiety disorder

The normally recommended dose of Esertia is 10 mg taken as a single daily dose. The dose may be increased by your doctor up to a maximum of 20 mg per day.

Obsessive-compulsive disorder

The normally recommended dose of Esertia is 10 mg taken as a single daily dose. The dose may be increased by your doctor up to a maximum of 20 mg per day.

Elderly patients (over 65 years of age)

The recommended initial dose of Esertia is 5 mg taken as a single daily dose. The dose may be increased by your doctor up to 10 mg per day.

Children and adolescents

Esertia should normally not be given to children and adolescents. For further information, please see section 2 “What you need to know before taking Esertia”.

Renal impairment

Caution is advised in patients with severely reduced renal function. Take as prescribed by your doctor.

Hepatic impairment

Patients with liver problems should not receive more than 10 mg per day. Take as prescribed by your doctor.

Patients considered as slow metabolizers of CYP2C19

Patients with this known genotype should not receive more than 10 mg per day. Take as prescribed by your doctor.

You may take Esertia with or without food. Swallow the tablets with water. Do not chew them, as they have a bitter taste.

If necessary, the 10, 15, and 20 mg tablets may be divided by placing the tablet on a flat surface with the score facing upwards. The tablets can be broken by pressing down on each end with the index fingers, as shown in the figure.

The 10, 15, and 20 mg tablets can be divided into equal doses.

Duration of treatment

It may take a few weeks before you start to feel better. Continue taking Esertia even if you start to feel better earlier than expected.

Do not change the dose of the medicine without first talking to your doctor.

Continue taking Esertia for the length of time recommended by your doctor. If you stop treatment too early, symptoms may return. It is recommended that treatment continue for at least 6 months after you feel well again.

If you take more Esertia than you should

If you take more Esertia than prescribed, contact your doctor immediately, go to the nearest hospital emergency department, or contact the Toxicology Information Service at telephone number 915 620 420. Do this even if you do not notice any discomfort or signs of poisoning. Some of the signs of overdose may include dizziness, tremor, agitation, seizures, coma, nausea, vomiting, changes in heart rate, decreased blood pressure, and disturbances in the body's fluid and electrolyte balance. Take the Esertia packaging with you if you go to the doctor or hospital.

If you forget to take Esertia

Do not take a double dose to make up for missed doses. If you forget to take a dose and remember before going to bed, take it immediately. The next day, continue as usual. If you remember during the night or the following day, skip the missed dose and continue as usual.

If you stop taking Esertia

Do not stop taking Esertia unless your doctor tells you to. When you have completed your course of treatment, it is generally recommended that the dose of Esertia be gradually reduced over several weeks.

When you stop taking Esertia, especially if abruptly, you may experience withdrawal symptoms. These are common when stopping Esertia treatment. The risk is greater when Esertia has been used for a long time, at high doses, or when the dose is reduced too quickly. Most people find these symptoms to be mild and resolve on their own within two weeks. However, in some patients, they may be severe or prolonged (2–3 months or more). If you experience severe withdrawal symptoms when stopping Esertia, please contact your doctor. Your doctor may ask you to resume taking your tablets and taper them more slowly.

Withdrawal symptoms include:

Dizziness (unstable or loss of balance), tingling sensation, burning sensation, and (less frequently) electric shock-like sensations, even in the head, sleep disturbances (excessively vivid dreams, nightmares, inability to sleep), restlessness, headache, dizziness (nausea), sweating (including night sweats), feelings of unease or agitation, tremor (shakiness), feelings of confusion or disorientation, emotional or irritable feelings, diarrhea (loose stools), visual disturbances, rapid pulse or palpitations.

If you have any further questions about the use of this product, ask your doctor or pharmacist.

4. Possible adverse effects

Like all medicines, this medicine can cause adverse effects, although not everyone will experience them.

Adverse effects usually disappear after a few weeks of treatment. Please be aware that many of these effects may be symptoms of your illness and will therefore improve as you start to feel better.

If you experience any of the following symptoms, you must contact your doctor or go to hospital immediately:

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

• Unusual bleeding, including gastrointestinal bleeding.

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

• Swelling of the skin, tongue, lips, or face, or difficulty breathing or swallowing (allergic reaction).
• High fever, agitation, confusion, tremors, and sudden muscle contractions, which may be signs of a rare condition called serotonin syndrome.

Not known (frequency cannot be estimated from available data):

• Difficulty urinating.
• Seizures (fits), see also section “Warnings and precautions”.
• Yellowing of the skin and whites of the eyes, signs of liver function impairment / hepatitis.
• Rapid or irregular heartbeat, or fainting, symptoms that may indicate a life-threatening condition known as Torsade de Pointes.
• Thoughts of harming yourself or thoughts of killing yourself, see also section “Warnings and precautions”.

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

Very common (may affect more than 1 in 10 people):

• Feeling sick (nausea).
• Headache.

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

• Nasal congestion or mucus (sinusitis).

• Decreased or increased appetite.

• Anxiety, restlessness, abnormal dreams, difficulty falling asleep, feeling drowsy, dizziness, yawning, tremors, skin itching.

• Diarrhea, constipation, vomiting, dry mouth.

• Increased sweating.

• Muscle and joint pain (arthralgia and myalgia).

• Sexual disturbances (delayed ejaculation, erectile dysfunction, reduced sexual drive, and women may experience difficulty achieving orgasm).

• Fatigue, fever.

• Weight gain.

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

• Hives, skin rash, itching (pruritus).
• Teeth grinding, restlessness, nervousness, panic attacks, confusion.
• Sleep disturbances, taste disturbances, fainting (syncope).
• Dilated pupils (mydriasis), visual disturbances, ringing in the ears (tinnitus).
• Hair loss.
• Excessive menstrual bleeding.
• Irregular menstrual periods.
• Weight loss.
• Rapid heartbeat.
• Swelling of arms and legs.
• Nosebleeds.

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

• Aggression, depersonalization, hallucinations.
• Slow heart rate.

Not known (frequency cannot be estimated from available data):

• Decreased levels of sodium in the blood (symptoms include dizziness, malaise, muscle weakness, or confusion).
• Dizziness upon standing due to low blood pressure (orthostatic hypotension).
• Abnormal liver function tests (increased liver enzymes in the blood).
• Movement disorders (involuntary muscle movements).
• Painful erections (priapism).
• Signs of increased bleeding, e.g. bruising or mucosal bleeding (ecchymoses), and low platelet count in the blood (thrombocytopenia).
• Sudden swelling of the skin or mucous membranes (angioedema).
• Increased secretion of the hormone called ADH, causing water retention in the body and dilution of the blood, leading to reduced sodium levels (inappropriate antidiuretic hormone secretion).
• Increased levels of the hormone prolactin in the blood.
• Milk discharge in men and women who are not breastfeeding.
• Mania.
• An increased risk of bone fractures has been observed in patients treated with this type of medication.
• Changes in heart rhythm (known as “prolongation of the QT interval”, seen on ECG, the heart’s electrical activity).
• Heavy vaginal bleeding shortly after childbirth (postpartum hemorrhage); see “Pregnancy, breastfeeding and fertility” in section 2 for more information.

Other adverse effects are known to occur with drugs that act similarly to escitalopram (the active substance in Esertia). These include:

• Motor restlessness (akathisia).
• Loss of appetite.

Reporting of adverse effects:

If you experience any adverse effect, talk to your doctor or pharmacist, even if it is a possible adverse effect not listed in this leaflet. You can also report them directly via the Spanish Pharmacovigilance System for Human Medicines: https://www.notificaram.es. By reporting adverse effects, you can help provide more information on the safety of this medicine.

5. Storage of Esertia

Keep this medicine out of the sight and reach of children.

Do not use this medicine after the expiry date which is stated on the packaging after EXP. The expiry date is the last day of the month indicated.

This medicine does not require any special storage conditions.

Medicines must not be disposed of via wastewater or household waste. Return unused medicines and their packaging to the SIGRE collection point at your pharmacy. If you have any doubts, ask your pharmacist how to dispose of medicines and packaging you no longer need. This will help protect the environment.

6. Contents of the pack and other information

Composition of Esertia

The active substance is escitalopram.

Each Esertia tablet contains 20 mg of escitalopram (as oxalate).

The other components are:

Core: silicified microcrystalline cellulose, talc, sodium croscarmellose, and magnesium stearate.

Coating: hypromellose, macrogol 400, and titanium dioxide (E-171).

Appearance of the product and contents of the container

Esertia 20 mg is presented as film-coated tablets.

The tablets are white, oval, scored, coated, and marked with “E” and “N” on each side of the score line on one face of the tablet.

The 20 mg tablets can be divided into equal doses.

Esertia 20 mg is available in the following pack sizes:

Blister packs, included in a carton: 14, 28, 56, and 98 tablets.

Polyethylene bottle: 100 and 200 tablets.

Unit dose: 49x1, 56x1, 98x1, 100x1, and 500x1 tablets.

Only certain pack sizes may be commercially available.

Marketing Authorization Holder and Manufacturer

Marketing Authorization Holder

Almirall, S.A.

General Mitre 151

08022 Barcelona

Spain

Manufacturer

• Lundbeck A/S

Ottiliavej 9

2500 Valby

Denmark

This medicinal product was authorized in the EEA Member States under the following names:

Spain: Esertia
Italy: Entact
Sweden: Prilect

Date of the most recent review of this leaflet: November 2024

Detailed information on this medicine is available on the website of the Spanish Agency for Medicines and Health Products (AEMPS) http://www.aemps.gob.es/