What are the effects of taking Lexapro (escitalopram) 40mg?

From the Guidelines

Taking 40mg of Lexapro (escitalopram) exceeds the maximum recommended dose and can be dangerous, potentially leading to increased morbidity and mortality due to serious side effects. The typical maximum dose for Lexapro is 20mg daily for adults, as indicated in the study published in the American Family Physician in 2015 1. Taking 40mg increases the risk of serious side effects including serotonin syndrome (characterized by confusion, rapid heart rate, high fever, and muscle rigidity), QT interval prolongation (which can cause dangerous heart rhythm problems), seizures, and severe anxiety or agitation.

Key Points to Consider

• The maximum recommended dose of Lexapro is 20mg daily for adults, and exceeding this dose can lead to serious side effects 1.
• QT interval prolongation is a dose-dependent risk, and exceeding the recommended dose of escitalopram can increase this risk 1.
• Serious side effects such as serotonin syndrome, seizures, and severe anxiety or agitation can occur when taking high doses of Lexapro.

Recommendations

• Someone who has taken 40mg of Lexapro should seek immediate medical attention, either by calling poison control (1-800-222-1222 in the US) or going to an emergency room.
• Never adjust medication dosages without consulting a healthcare provider, as antidepressants like Lexapro require careful dosing based on individual factors including age, weight, liver function, and other medications being taken.
• Healthcare providers should carefully monitor patients taking Lexapro and adjust doses accordingly to minimize the risk of serious side effects, as suggested by the study published in the American Family Physician in 2015 1.

From the FDA Drug Label

The most commonly observed adverse reactions in Escitalopram patients (incidence of approximately 5% or greater and approximately twice the incidence in placebo patients) were insomnia, ejaculation disorder (primarily ejaculatory delay), nausea, sweating increased, fatigue, and somnolence TABLE 2 enumerates the incidence, rounded to the nearest percent, of treatment-emergent adverse events that occurred among 715 depressed patients who received Escitalopram at doses ranging from 10 to 20 mg/day in placebo-controlled trials Events included are those occurring in 2% or more of patients treated with Escitalopram and for which the incidence in patients treated with Escitalopram was greater than the incidence in placebo-treated patients. The potential dose dependency of common adverse reactions (defined as an incidence rate of ≥5% in either the 10 mg or 20 mg Escitalopram groups) was examined on the basis of the combined incidence of adverse reactions in two fixed-dose trials The overall incidence rates of adverse events in 10 mg Escitalopram-treated patients (66%) was similar to that of the placebo-treated patients (61%), while the incidence rate in 20 mg/day Escitalopram-treated patients was greater (86%) TABLE 4 shows common adverse reactions that occurred in the 20 mg/day Escitalopram group with an incidence that was approximately twice that of the 10 mg/day Escitalopram group and approximately twice that of the placebo group

The effects of taking Lexapro (escitalopram) 40mg are not directly stated in the provided drug labels, as the labels only discuss doses ranging from 10 to 20 mg/day. However, based on the information provided, it can be inferred that:

• Common adverse reactions may include insomnia, ejaculation disorder, nausea, sweating increased, fatigue, and somnolence.
• Dose dependency of adverse reactions was observed, with higher doses (20 mg/day) associated with a greater incidence of adverse events compared to lower doses (10 mg/day) and placebo.
• Specific adverse reactions that occurred at a higher incidence in the 20 mg/day group compared to the 10 mg/day and placebo groups include insomnia, diarrhea, dry mouth, somnolence, dizziness, sweating increased, constipation, fatigue, and indigestion. It is essential to consult a healthcare provider for personalized advice on taking Lexapro, as individual responses to the medication may vary 2, 2, 2.

From the Research

Effects of Lexapro (Escitalopram) 40mg

• The efficacy, safety, and tolerability of escitalopram in doses up to 50 mg in Major Depressive Disorder (MDD) have been investigated in a pilot study 3.
• In this study, 26% of patients were unable to tolerate 50 mg, and tolerability appeared to decline above a dose of 40 mg.
• The most common adverse events were headache (35%), nausea, diarrhea, and nasopharyngitis (all 25%) 3.
• Minor mean weight gain was found during the study, which did not appear to be dose-related 3.
• A study on the treatment of major depression and anxiety disorders found that escitalopram is at least as effective as other SSRIs, and has a relatively fast onset of action and minimal clinically relevant interactions with other drugs 4.
• Another study evaluated the FDA warning against prescribing citalopram at doses exceeding 40 mg and found that citalopram daily doses >40 mg were associated with lower risks of ventricular arrhythmia and all-cause mortality compared to daily doses of 1-20 mg 5.
• A naturalistic open-label study explored the efficacy and tolerability of high doses of escitalopram for the treatment of obsessive-compulsive disorder and found that doses less than or equal to 40 mg/day were sufficient for symptomatic improvement with good tolerability for most patients 6.