What is the best time to take Lexapro (escitalopram)?

Best Time to Take Lexapro (Escitalopram)

Lexapro (escitalopram) can be taken once daily, either in the morning or evening, with or without food, according to the FDA drug label. 1

Factors to Consider When Choosing the Time of Day

Morning Administration

• Beneficial for patients who experience insomnia as a side effect
• Aligns with the pharmacokinetic profile showing maximum plasma concentrations in approximately 3-4 hours after administration 2
• May be preferred for patients who tend to forget evening doses

Evening Administration

• Better option for patients who experience daytime drowsiness or fatigue
• May help mitigate nausea, which is a common but typically mild and transient side effect 3
• Could potentially improve adherence by incorporating into bedtime routine

Pharmacokinetic Considerations

Escitalopram has favorable pharmacokinetic properties that support once-daily dosing:

• Long elimination half-life of 27-33 hours 2
• Steady-state concentrations achieved within 7-10 days of administration 2
• Absorption not affected by food 2

Special Populations

For elderly patients and those with hepatic impairment:

• The recommended dose is 10 mg/day 1
• The timing of administration (morning or evening) follows the same principles as for the general population

Clinical Recommendations

When initiating Lexapro:

1. Consider the patient's daily routine and potential side effects
2. If insomnia is a concern, morning administration is preferable
3. If sedation or nausea occurs, evening administration may be better
4. Consistency in timing is more important than the specific time chosen

Monitoring and Follow-up

• Assess for side effects and therapeutic response within 1-2 weeks of starting treatment 4
• Monitor for improvement in both anxiety and depression symptoms, as well as sleep quality 4
• Consistency in the timing of administration is important for maintaining steady blood levels

Common Pitfalls to Avoid

• Switching between morning and evening dosing frequently, which may affect steady-state concentrations
• Taking the medication with certain foods or beverages that might affect absorption
• Abrupt discontinuation - a gradual reduction in dose is recommended when stopping treatment 1

The decision about the best time to take Lexapro should be based on individual side effect profile and daily routine, but the medication's long half-life ensures that it will be effective regardless of whether it's taken in the morning or evening.