What is the recommended starting dose of Lexapro (escitalopram) for adults?

Lexapro (Escitalopram) Starting Dose for Adults

The recommended starting dose of Lexapro (escitalopram) for adults is 10 mg once daily. 1

Dosing Guidelines

The FDA-approved drug label clearly outlines the following dosing recommendations for adults:

• Initial dose: 10 mg once daily
• Administration: Can be taken in the morning or evening, with or without food
• Dose titration: If needed, the dose may be increased to 20 mg, but only after a minimum of one week on the initial dose
• Maximum dose: 20 mg daily

Dosing Based on Condition

Major Depressive Disorder

• Starting dose: 10 mg once daily
• A fixed-dose trial demonstrated effectiveness of both 10 mg and 20 mg doses, but failed to show greater benefit of 20 mg over 10 mg for most patients 1
• For severe depression (MADRS score ≥30), the 20 mg dose may be more effective than 10 mg 2

Generalized Anxiety Disorder

• Starting dose: 10 mg once daily
• May increase to 20 mg after minimum of one week if needed 1

Special Populations

Reduced dosing (10 mg daily maximum) is recommended for:

• Elderly patients
• Patients with hepatic impairment
• Patients with severe renal impairment (use with caution) 1

Clinical Considerations

Efficacy

• Symptom improvement may begin within 1-2 weeks of starting treatment 3
• In moderate depression, 10 mg shows adequate efficacy
• In severe depression, 20 mg may be needed for optimal response 2

Monitoring

• Prior to initiating treatment, screen patients for personal or family history of bipolar disorder, mania, or hypomania 1
• Monitor patients for emergence of adverse effects, particularly during the first few weeks

Discontinuation

• When discontinuing treatment, gradually reduce the dose rather than stopping abruptly
• If intolerable symptoms occur during dose reduction, consider resuming the previously prescribed dose and decrease more gradually 1

Drug Interactions

• Allow at least 14 days between discontinuation of an MAOI and initiation of escitalopram
• Allow at least 5 weeks after stopping escitalopram before starting an MAOI 1

Common Pitfalls to Avoid

1. Starting at too high a dose: Beginning with 20 mg rather than 10 mg may lead to unnecessary side effects without additional benefit for most patients
2. Increasing dose too quickly: Waiting at least one week before dose increases allows for better tolerability
3. Abrupt discontinuation: Can lead to discontinuation symptoms; always taper gradually
4. Overlooking special populations: Elderly patients and those with hepatic impairment require lower dosing

Remember that while 10 mg is the standard starting dose for most adults, clinical response should be evaluated after several weeks to determine if dose adjustment is necessary.