From the FDA Drug Label
1 Major Depressive Disorder Adults The recommended dose of escitalopram tablets is 10 mg once daily. Depending on clinical response and tolerability, dosage may be increased to the maximum recommended dosage of 20 mg once daily at an interval of no less than 1 week.
2 Generalized Anxiety Disorder Adults The recommended starting dosage of escitalopram tablets in adults is 10 mg once daily. Depending on clinical response and tolerability, dosage may be increased to the maximum recommended dosage of 20 mg once daily at an interval of no less than 1 week.
The highest recommended dose of Lexapro (escitalopram) is 20 mg once daily 1.
- The dose can be increased to 20 mg once daily depending on clinical response and tolerability.
- The maximum recommended dosage is the same for both major depressive disorder and generalized anxiety disorder in adults.
From the Research
The highest recommended dose of Lexapro (escitalopram) is 20 mg once daily for adults. This maximum dose applies to most indications including depression and anxiety disorders. For older adults (over 65 years) and patients with hepatic impairment, the maximum recommended dose is lower at 10 mg daily due to slower drug metabolism in these populations. Lexapro is a selective serotonin reuptake inhibitor (SSRI) that works by increasing serotonin levels in the brain, and the 20 mg ceiling exists because clinical trials have not demonstrated additional benefit at higher doses while side effects tend to increase 2. Patients should typically start at a lower dose (usually 10 mg daily) and only increase to 20 mg if needed and tolerated. Taking doses higher than recommended increases the risk of side effects such as nausea, insomnia, sexual dysfunction, and potentially serious conditions like serotonin syndrome without providing additional therapeutic benefit. Although some studies have explored the use of higher doses, such as 50 mg in severe major depressive disorder 3, the current evidence does not support the routine use of doses above 20 mg for most patients.
Some key points to consider when prescribing Lexapro include:
- Starting with a lower dose and titrating up as needed and tolerated
- Monitoring for side effects and adjusting the dose accordingly
- Being aware of potential drug interactions, particularly with other medications that affect the cytochrome P450 enzyme system 4
- Considering the use of lower doses in older adults and patients with hepatic impairment due to decreased drug clearance.
Overall, the recommended dose of Lexapro should be individualized based on the patient's specific needs and circumstances, with careful consideration of the potential benefits and risks of treatment.