Pediatric Dosing for Lexapro (Escitalopram)
For adolescents (12-17 years), the recommended dose of Lexapro (escitalopram) is 10 mg once daily, which may be increased to 20 mg after a minimum of three weeks if needed. 1
Dosing Guidelines by Age Group
Adolescents (12-17 years)
- Starting dose: 10 mg once daily
- Maximum dose: 20 mg once daily
- Titration: If needed, increase to 20 mg after at least 3 weeks of treatment
- Administration: Can be taken in the morning or evening, with or without food
Children (7-11 years)
- Escitalopram has shown efficacy and safety in children with generalized anxiety disorder (GAD) aged 7-11 years 2
- While not explicitly FDA-approved for this age group, clinical evidence supports using similar dosing as adolescents when clinically indicated
- Starting dose: 5-10 mg once daily
- Maximum dose: 10-20 mg once daily
Children under 7 years
- Safety and efficacy not established
- Use not recommended
Clinical Considerations
Indications in Pediatric Population
- FDA-approved: Major Depressive Disorder in adolescents (12-17 years) 1
- Evidence supports use in: Generalized Anxiety Disorder in children and adolescents (7-17 years) 2
Dose Adjustments
- Hepatic impairment: 10 mg/day is the recommended maximum dose 1
- Elderly patients: 10 mg/day is the recommended dose 1
- Renal impairment:
- Mild to moderate: No dosage adjustment necessary
- Severe: Use with caution 1
Monitoring
- Initial period: Monitor closely for clinical worsening, suicidality, or unusual changes in behavior
- Ongoing: Reassess periodically to determine need for maintenance treatment
- Discontinuation: Gradual dose reduction rather than abrupt cessation to minimize withdrawal symptoms 1
Important Precautions
Before Starting Treatment
- Screen for bipolar disorder or history of mania/hypomania 1
- Consider baseline vital signs and weight for monitoring changes during treatment
- Discuss potential side effects with patient and caregivers
Common Side Effects in Pediatric Patients
- Headache, nausea, insomnia, vomiting, influenza-like symptoms, diarrhea 3
- Most adverse events are mild to moderate in severity
Safety Considerations
- Extended treatment (beyond 8 weeks) has been shown to be generally safe in adolescents 3
- Monitor for emergence of suicidal ideation or behavior, particularly early in treatment or with dose changes
- The risk of suicidal thinking and behavior is increased in children, adolescents, and young adults taking antidepressants
Pharmacokinetics in Pediatric Patients
- Absorption is not affected by food 4
- Elimination half-life is approximately 27-33 hours, consistent with once-daily dosing 4
- Steady-state concentrations are achieved within 7-10 days 4
- Adolescents do not have clinically relevant differences in pharmacokinetics compared with healthy young adults 4
Remember that pediatric patients are not simply "small adults" and require individualized dosing based on age, size, and organ maturity 5. Always monitor response and adjust treatment accordingly.