Escitalopram
LEXAPRO
What it isSSRI, the active S-enantiomer of citalopram; depression and generalized anxiety.
Why this oneMinimal CYP inhibition and little activating or sedating burden make it a common first choice when tolerability matters.
What limits itQT prolongation is dose-related; use lower ceilings in older adults or hepatic impairment. Watch for hyponatremia.
FDA-approved for
- depression (2002)
- GAD (2003)
Off-label
- panic disorder
- PMDD
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Major depressive disorder | Adults | 10 mg QD | 10 mg QD | 20 mg QD |
| Major depressive disorder | Peds >=12 y | 10 mg QD | 10 mg QD | 20 mg QD |
| Generalized anxiety disorder | Adults | 10 mg QD | 10 mg QD | 20 mg QD |
Titration Increase at intervals of no less than 1 week (no less than 3 weeks in pediatrics)
Renal Undefined
Hepatic 10 mg once daily
Instructions
- Administer once daily, morning or evening, with or without food
- When discontinuing, reduce dose gradually
- Elderly: recommended dosage 10 mg once daily
Contraindications
- MAOIs (concurrently or within 14 days) due to risk of serotonin syndrome
- Concomitant pimozide
Cautions
- Serotonin syndrome
- Discontinuation syndrome
- Seizures (caution with history)
- Activation of mania/hypomania (screen for bipolar disorder)
- Hyponatremia/SIADH
- Increased bleeding risk (NSAIDs, aspirin, warfarin)
- Angle-closure glaucoma
- Sexual dysfunction
Adverse reactions
- Insomnia
- Ejaculation disorder
- Nausea
- Increased sweating
- Fatigue
- Somnolence
- Decreased libido
- Anorgasmia
Pregnancy SSRI; late-pregnancy use may cause PPHN and poor neonatal adaptation; no established increase in birth defects
Lactation Undefined
⚠ BOXED WARNING
- Suicidal thoughts and behaviors in patients under 25
Cost, est. cash$4–$80/month
Generic entry2007
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilitySexual/GI effects, hyponatremia, discontinuation and serotonin toxicity; overdose danger varies substantially by agent.
Mechanism of action: Escitalopram ballicule
Open Escitalopram in the interactive console ↗
Memory aids: mascots and interaction avatars
Pram is the British word for baby carriage
Blue cloud → serotonin reuptake inhibitor (SRI)
