SHESTO PLUS

SHESTO PLUS

Escitalopram Oxalate & Clonazepam Tablets I.P.

Shesto-Plus (Escitalopram Oxalate & Clonazepam Tablets I.P.) combines two well-known salts that target both the root and the immediate symptoms of anxiety and related disorders. Escitalopram oxalate is a selective serotonin reuptake inhibitor (SSRI) that increases serotonin signaling in brain circuits controlling mood, worry, sleep and concentration. By steadily restoring this chemical balance, it reduces persistent anxiety and depression over weeks. Clonazepam is a benzodiazepine that enhances the calming effect of GABA, the brain’s main inhibitory neurotransmitter. This provides faster relief from excessive arousal, panic, restlessness and sleep disturbance while the SSRI is building its longer-term benefit. Together, the combination can ease daytime anxiety, panic attacks, autonomic symptoms (palpitations, sweating, tremor) and insomnia associated with anxiety disorders. Some patients may notice temporary drowsiness, dizziness, slowed reaction time, nausea, dry mouth, headache or mild stomach upset; these usually settle as dosing is optimized.

Shesto-Plus is prescribed under medical supervision for generalized anxiety disorder, panic disorder (with or without agoraphobia) and other anxiety states where the clinician judges that a short-acting benzodiazepine is helpful while escitalopram establishes sustained control. It may also be used when anxiety coexists with depressive symptoms and the prescriber considers the escitalopram–clonazepam combination appropriate.

Dosing is individualized. Clinicians commonly begin with a low dose of escitalopram oxalate (for example 5–10 mg once daily) together with a small dose of clonazepam (for example 0.25–0.5 mg once or twice daily), then adjust weekly based on response and tolerability. Once the SSRI benefit is established, the clonazepam component is usually tapered and used short term to reduce the risk of dependence and daytime sedation. Take the tablet at the same time each day with water; evening dosing may reduce drowsiness during the day. Do not drive or operate machinery until you know how the medicine affects you. Do not stop either component abruptly unless your doctor tells you to, as a gradual taper helps avoid withdrawal symptoms such as rebound anxiety, insomnia, tremor or flu-like feelings.

Storage: Store Shesto-Plus in a cool, dry place away from moisture and direct sunlight, and keep it out of the reach of children.

Common Side Effects: Escitalopram may cause nausea, loose stools or constipation, headache, sweating, tremor, insomnia or sleepiness and changes in sexual function. Clonazepam can add drowsiness, dizziness, poor coordination, slowed reaction time and, in some people, memory difficulty. Appetite or weight may change slightly. Seek medical help promptly if you develop unusual bleeding or bruising, rash or hives, severe agitation, eye pain with visual changes, thoughts of self-harm, or signs of allergic swelling or breathing difficulty.

Drug Warnings: Before taking Shesto-Plus, inform your doctor if you have high blood pressure, heart-rhythm problems or a family history of long QT, thyroid issues, glaucoma or prostate conditions, liver disease, sleep apnea or other breathing problems, myasthenia gravis, a history of substance use disorder, bipolar disorder or mania, seizures, or if you are pregnant, planning pregnancy or breastfeeding. Avoid taking this medicine with other sedating medications unless advised, as it may increase drowsiness and impair alertness.

Drug–Drug Interactions: Do not use monoamine oxidase inhibitors (MAOIs) or within 14 days of stopping one; the risk of serotonin syndrome is high. Use with other serotonergic drugs (other SSRIs/SNRIs, tramadol, triptans, lithium, St John’s wort) requires medical supervision. Escitalopram may increase bleeding tendency with aspirin, NSAIDs or anticoagulants. Strong CYP2C19/CYP2D6 inhibitors or inducers can alter escitalopram levels; benzodiazepines and other CNS depressants (opioids, alcohol, sedating antihistamines, sleep medicines, antipsychotics) add to sedation and, rarely, respiratory depression with clonazepam. Always tell your doctor about every prescription, over-the-counter medicine and supplement you take.

Drug–Food Interactions: Shesto-Plus can be taken with or without food. Alcohol should be limited or avoided, as it markedly increases sleepiness, slows reaction time and can worsen breathing problems during sleep.

Drug–Disease Interactions: Patients with liver impairment generally require lower escitalopram doses and careful monitoring; clonazepam should be used cautiously in respiratory disease, sleep apnea and severe liver disease. Use with caution in people with glaucoma, urinary retention, depression with suicidality, bipolar disorder, seizure disorders and older adults at risk of falls. Always share your full medical history to ensure safe and effective use of Shesto-Plus (escitalopram oxalate + clonazepam).