From the Guidelines
To transition from Zoloft (sertraline) 50mg to Lexapro (escitalopram), a cross-taper approach is generally recommended, starting by reducing Zoloft to 25mg daily while simultaneously beginning Lexapro at 5mg daily for one week, then discontinuing Zoloft and increasing Lexapro to 10mg daily. This approach is based on the principle of minimizing withdrawal symptoms from Zoloft while allowing the body to adjust to Lexapro, as both medications are SSRIs but have different chemical structures and potencies 1, 2.
Key Considerations
- The cross-taper method is preferred because it reduces the risk of withdrawal symptoms and allows for a smoother transition between the two medications.
- Escitalopram is generally more potent on a milligram basis than sertraline, which should be considered when determining the target dose.
- During the transition, patients may experience temporary side effects such as mild headache, nausea, or sleep disturbances, which typically resolve within 1-2 weeks as the body adjusts to the new medication.
- It is essential to make this medication change under medical supervision, as individual factors may require adjustments to this general approach, and severe side effects should be reported to the healthcare provider immediately.
Medication Characteristics
- Sertraline (Zoloft) and escitalopram (Lexapro) are both SSRIs, but they have different pharmacological profiles, which can influence the transition process 3.
- The American College of Physicians recommends selecting second-generation antidepressants, including SSRIs, based on adverse effect profiles, cost, and patient preferences, highlighting the importance of individualized treatment plans 1, 2.
From the FDA Drug Label
2. 6 Switching a Patient to or from a Monoamine Oxidase Inhibitor (MAOI) Intended to Treat Psychiatric Disorders At least 14 days should elapse between discontinuation of an MAOI intended to treat psychiatric disorders and initiation of therapy with Escitalopram tablets Conversely, at least 14 days should be allowed after stopping Escitalopram tablets before starting an MAOI intended to treat psychiatric disorders[see Contraindications (4.1)].
The FDA drug label does not answer the question.
From the Research
Transitioning from Zoloft to Lexapro
To transition a patient from Zoloft (sertraline) 50mg to Lexapro (escitalopram), consider the following steps:
- Cross-tapering: Gradually reduce the dose of Zoloft while simultaneously introducing and increasing the dose of Lexapro 4, 5.
- Dose equivalence: Note that the dose equivalence between Zoloft and Lexapro is not directly established, but a common starting dose for Lexapro is 10mg/day 5, 6.
- Monitoring: Closely monitor the patient's response to the new medication and adjust the dose as needed 7, 8.
Key Considerations
- Pharmacokinetics: Escitalopram and sertraline have different pharmacokinetic profiles, with escitalopram having a more favorable tolerability profile 4, 6.
- Efficacy: Both medications have been shown to be effective in treating depression and anxiety disorders, but escitalopram may have a more rapid onset of action 5, 8.
- Side effects: Monitor for potential side effects, such as changes in aldosterone/renin ratio, and adjust the dose or discontinue the medication if necessary 7.
Special Populations
- Pediatric patients: When transitioning pediatric patients from Zoloft to Lexapro, consider the potential for increased exposure to escitalopram in poor metabolizers and adjust the dose accordingly 6.
- Geriatric patients: In older adults, such as those with Alzheimer's disease, escitalopram and sertraline may be effective in treating depression and apathy, but careful monitoring is necessary due to potential interactions and side effects 8.