From the FDA Drug Label
The recommended dose of Escitalopram tablets is 10 mg once daily. Adults The recommended dose of Escitalopram tablets is 10 mg once daily.
The starting dose of escitalopram is 10 mg once daily.
- The dose can be increased to 20 mg after a minimum of one week for adults.
- There is no specific information about weaning from Librium 5mg twice a day in the provided drug labels 1, 2, or 3.
From the Research
The starting dose of escitalopram while weaning from Librium (chlordiazepoxide) 5mg twice daily is typically 5mg once daily for the first week, then increasing to 10mg daily if needed and tolerated. When transitioning from a benzodiazepine like Librium to an SSRI like escitalopram, it's essential to implement a gradual taper of the Librium rather than stopping it abruptly, as abrupt cessation can lead to severe withdrawal symptoms, including anxiety, insomnia, and irritability 4. A common approach is to reduce the Librium by 25% every 1-2 weeks while the escitalopram takes effect. For example, reduce to 5mg in the morning and 2.5mg at night for 1-2 weeks, then to 2.5mg twice daily, and so on. This gradual approach helps minimize withdrawal symptoms from the benzodiazepine while allowing the escitalopram to reach therapeutic levels.
Key Considerations
- Escitalopram typically takes 2-4 weeks to show full therapeutic effect, so patience during this transition period is crucial 5.
- Patients should be monitored for withdrawal symptoms from Librium (anxiety, insomnia, irritability) and potential side effects from escitalopram (nausea, headache, increased anxiety initially).
- Elderly patients or those with hepatic impairment may require lower starting doses of escitalopram (2.5mg daily) 6.
Monitoring and Adjustments
- Regular monitoring of the patient's condition and adjustment of the tapering schedule as needed is vital to ensure a safe and effective transition.
- The patient's response to the tapering schedule and the escitalopram dose should be closely monitored, and adjustments made accordingly to minimize the risk of withdrawal symptoms or adverse effects.