Escitalopram

Lexapro is indicated for MDD in adults and patients aged 12 years or older, and GAD in adults and patients aged 7 years or older. It is an oral prescription medicine; these age limits do not establish effectiveness below the respective thresholds.

This profile follows the branded Lexapro label. Some generic labels may retain different pediatric indication wording. Other psychiatric uses require an indication-specific assessment and are not represented here as FDA-approved uses.

All listed populations start at 10 mg once daily; 20 mg once daily is the labeled maximum. Increase only after assessing response and tolerability. The adult MDD fixed-dose trial did not establish extra benefit at 20 mg over 10 mg.

Take once daily, morning or evening, with or without food. Lexapro tablets contain 5, 10 or 20 mg; the 10 and 20 mg tablets are scored. The label describes a 1 mg/mL oral solution but explicitly states that this branded solution is not currently marketed.

The recommended dose for most older patients and patients with hepatic impairment is 10 mg daily. Mild or moderate renal impairment needs no dose adjustment; dosing is undetermined at creatinine clearance below 20 mL/min, requiring caution and individualized review.

Reduce gradually whenever possible and monitor withdrawal symptoms. Intolerable symptoms may require returning to the prior dose followed by a slower reduction. Keep at least 14 days between stopping a psychiatric MAOI and starting escitalopram, or stopping escitalopram and starting a psychiatric MAOI.

Do not combine with psychiatric MAOIs or use within the 14-day washout in either direction. Do not initiate during linezolid or intravenous methylene blue treatment. Pimozide coadministration and hypersensitivity to escitalopram, citalopram or ingredients are contraindications.

Common trial effects include nausea, insomnia, sweating, fatigue, somnolence and sexual dysfunction. Ask about baseline and emerging sexual concerns. Postmarketing reports include QT prolongation and torsades de pointes; spontaneous reports do not establish their frequency.

Review other SSRIs/SNRIs, triptans, tramadol, fentanyl, lithium, buspirone, amphetamines, tryptophan and St. John’s wort for serotonin toxicity. MAOIs, linezolid/IV methylene blue and pimozide require the restrictions above. Do not duplicate escitalopram with citalopram.

NSAIDs, aspirin, antiplatelet drugs and anticoagulants increase bleeding risk; monitor INR carefully when warfarin is used. Escitalopram can increase exposure to CYP2D6 substrates, exemplified by desipramine. Review QT-prolonging medicines and electrolyte-depleting drugs using the applicable local cardiac guidance.

Available human data have not established an increased risk of major birth defects or miscarriage. Late exposure can involve neonatal poor adaptation or persistent pulmonary hypertension; use near delivery is associated with postpartum bleeding risk. Discuss untreated illness, relapse and neonatal planning; avoid unsupervised abrupt cessation.

Escitalopram and its metabolite enter milk. LactMed reports low exposure with maternal doses up to 20 mg/day and says a needed treatment is not itself a reason to stop breastfeeding. Monitor infant sedation, restlessness, feeding and weight gain, especially in young exclusively breastfed infants or with multiple psychotropics.

Follow the diagnosis-specific age approval. Monitor height and weight in pediatric patients because appetite and weight changes can occur. Older patients have higher exposure and a greater risk of clinically important hyponatremia; the usual recommended dose is 10 mg daily.

Use the hepatic and renal dosing distinctions above. Recently infarcted or unstable cardiac patients were not systematically evaluated in the clinical program; review cardiovascular status and interacting drugs rather than assuming trial safety generalizes to every cardiac condition.

Escitalopram is the S-enantiomer of citalopram. Its antidepressant activity is associated with potentiating central serotonergic signaling through inhibition of serotonin reuptake.

Peak concentrations follow an oral dose at about 5 hours; food does not materially alter absorption. Protein binding is about 56%. CYP2C19 and CYP3A4 contribute to hepatic metabolism. Terminal half-life is approximately 27–32 hours and steady state is reached in about a week.

Half-life

About 27–32 hours

Steady state

About 1 week

Confirm diagnosis, bipolar/mania history, suicidality, interacting drugs and relevant cardiac or electrolyte risk. Follow mood, function, activation, adverse effects and sexual health. Check sodium when symptoms or risk factors warrant it; pediatric growth requires follow-up.

Take consistently and follow a clinician-directed taper. Avoid driving until the individual response is known; concomitant alcohol use is not advised. Report new suicidality, severe agitation with fever, abnormal bleeding, eye pain or new visual symptoms, fainting, confusion or seizures promptly.

Overdose can produce delayed seizures, QRS/QT changes and arrhythmias. Urgent poison-center or emergency assessment is needed; cardiac monitoring may need to continue after an apparently mild early presentation.

Lexapro 10 mg tablets: white to off-white, round and scored, with F/L on the scored side and 10 on the other. Example bottle of 100: NDC 0456-2010-01. Generic appearance differs; verify the package and manufacturer.

Lexapro tablets contain 5 mg (unscored), 10 mg (scored) or 20 mg (scored). The labeled 1 mg/mL peppermint oral solution is not currently marketed. The DailyMed record lists Allergan as packager; label distribution text identifies AbbVie.

Store at 20–25°C, with permitted excursions to 15–30°C. Keep away from children. Verify the actual dispensed product label when using a generic or other formulation.