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Is Stalopam safe in the long run?

Wednesday, 13 January 2010
Answered by: Dr Chandra M Gulhati
Editor, MIMS, New Delhi
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Q. I am a 28 years old man taking Betacap TR 80, Losartas 50 in the morning and Stalopam plus 10 mg at night. I have been prescribed Stalopam for depression and I feel great after taking it – I socialize more and attend social gatherings, which earlier was a problem. For how long can I take Stalopam safely; can it be taken lifelong and is Stalopam, SSRI or Clonezepam carcinogenic in the long run?

A.  You have not given any details (history, measurements of blood pressure, etc) with regard to high blood pressure. However, as per globally accepted guidelines on the treatment of blood pressure Betacap (propranolol) should be avoided unless no other treatment is effective because it precipitates (or worsens) diabetes, apart from causing impotence in males. The first line of treatment in high blood pressure in young, sexually active males should be enalapril (Enam) 5-10 mg 1-2 times daily. Stalopam Plus contains two medicines: clonazepam (actually meant for epilepsy but is also used in major depression) and escitalopram (approved for use in major depression, Panic Disorders and Obsessive Compulsive Disorder). None of them is indicated in generalised anxiety disorder. Long-term use of Stalopam Plus will mean additive side effects of the two drugs.

The individual side effects are as follows:

Clonazepam - Central nervous system disturbances including impaired alertness, depression, ataxia, respiratory depression, amnesia, tolerance, behaviour problems, fatigue, dizziness, lightheadedness, confusion, muscle weakness, vertigo. Liver disorders, blood dyscrasias, dependence. Suicidal ideation or behaviour.

Escitalopram - Worsening of depression, suicidal tendency, dizziness, fatigue, sexual dysfunction, ejaculation disorder. Severe agitation-type events including agitation, disinhibition, emotional lability, hostility, aggression and depersonalisation. Acute psychosis. Cardiac failure, diabetes, urticaria, hyperprolactinaemia, deep vein thrombisis, rectal haemorrhage. Serotonin syndrome, neuroleptic malignant syndrome (NMS)-like reactions (serious consequences). It is noticed that precipitation of diabetes can be due to propranolol (Betacap) or escitalopram (Stalopam Plus) or both. Similarly both the ingredients of Stalopam Plus can lead to suicidal ideation. Even though all the side effects may not appear in a patient, one should have the will power to reduce and finally get rid of drug treatment via non-drug methods such as yoga.

A.  You have not given any details (history, measurements of blood pressure, etc) with regard to high blood pressure. However, as per globally accepted guidelines on the treatment of blood pressure Betacap (propranolol) should be avoided unless no other treatment is effective because it precipitates (or worsens) diabetes, apart from causing impotence in males. The first line of treatment in high blood pressure in young, sexually active males should be enalapril (Enam) 5-10 mg 1-2 times daily. Stalopam Plus contains two medicines: clonazepam (actually meant for epilepsy but is also used in major depression) and escitalopram (approved for use in major depression, Panic Disorders and Obsessive Compulsive Disorder). None of them is indicated in generalised anxiety disorder. Long-term use of Stalopam Plus will mean additive side effects of the two drugs.

The individual side effects are as follows:

Clonazepam - Central nervous system disturbances including impaired alertness, depression, ataxia, respiratory depression, amnesia, tolerance, behaviour problems, fatigue, dizziness, lightheadedness, confusion, muscle weakness, vertigo. Liver disorders, blood dyscrasias, dependence. Suicidal ideation or behaviour.

Escitalopram - Worsening of depression, suicidal tendency, dizziness, fatigue, sexual dysfunction, ejaculation disorder. Severe agitation-type events including agitation, disinhibition, emotional lability, hostility, aggression and depersonalisation. Acute psychosis. Cardiac failure, diabetes, urticaria, hyperprolactinaemia, deep vein thrombisis, rectal haemorrhage. Serotonin syndrome, neuroleptic malignant syndrome (NMS)-like reactions (serious consequences). It is noticed that precipitation of diabetes can be due to propranolol (Betacap) or escitalopram (Stalopam Plus) or both. Similarly both the ingredients of Stalopam Plus can lead to suicidal ideation. Even though all the side effects may not appear in a patient, one should have the will power to reduce and finally get rid of drug treatment via non-drug methods such as yoga.

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