What is the recommended dosing for Lexapro (escitalopram)?

Recommended Dosing for Lexapro (Escitalopram)

The recommended initial dose of Lexapro (escitalopram) is 10 mg once daily for most adults, with a maximum recommended dose of 20 mg daily. 1

Initial Dosing

• Adults with Major Depressive Disorder (MDD):

  • Start with 10 mg once daily
  • May increase to 20 mg after a minimum of one week if clinically indicated
  • FDA-approved studies showed both 10 mg and 20 mg were effective, but failed to demonstrate greater benefit of 20 mg over 10 mg 1

• Adults with Generalized Anxiety Disorder (GAD):

  • Start with 10 mg once daily
  • May increase to 20 mg after a minimum of one week if needed 1

• Special Populations:

  • Elderly patients: 10 mg/day recommended
  • Patients with hepatic impairment: 10 mg/day recommended
  • Patients with mild to moderate renal impairment: No dosage adjustment necessary
  • Patients with severe renal impairment: Use with caution 1

Administration

• Can be taken in the morning or evening
• Can be taken with or without food 1
• Once-daily dosing is sufficient due to the long half-life of escitalopram

Duration of Treatment

• Acute Phase: 4-8 weeks is typically needed for full therapeutic trial 2
• Maintenance Phase:
  • For MDD: Continue treatment for at least 4-12 months after response to acute episode 2
  • For GAD: Efficacy beyond 8 weeks has not been systematically studied, but maintenance treatment is often recommended 1

Dose Titration

• Increase dose using increments of initial dose every 5-7 days until therapeutic benefits or significant side effects become apparent 2
• After successful treatment period (typically 9 months), dosage reduction can be used to reassess the need for continued medication 2

Discontinuation

• Gradual reduction rather than abrupt cessation is recommended
• Monitor for discontinuation symptoms (dizziness, sensory disturbances, anxiety, sleep disturbances)
• If intolerable symptoms occur during discontinuation, resuming the previously prescribed dose may be considered, then continue decreasing at a more gradual rate 1

Common Pitfalls and Considerations

1. Avoid abrupt discontinuation: This can lead to withdrawal symptoms. Taper the medication over 10-14 days to limit withdrawal symptoms 2, 1

2. Screen for bipolar disorder: Prior to initiating treatment, screen patients for personal or family history of bipolar disorder, mania, or hypomania to avoid triggering manic episodes 1

3. Drug interactions: Escitalopram may prolong the half-life of other drugs by inhibiting cytochrome P450 isoenzymes, though it has less effect on metabolism of other medications compared to other SSRIs 2, 3

4. QT prolongation: The maximum recommended dose is 20 mg due to dose-dependent QT interval prolongation 1

5. Early response monitoring: Assess efficacy and safety at least monthly for the first 3 months and at least quarterly thereafter. Early responders (>5% weight loss after 3 months) tend to have improved long-term outcomes 2

Escitalopram has demonstrated efficacy in both short-term and long-term studies, with research showing continued improvement in depression symptoms over 12 months of treatment 4. It is generally well-tolerated with a favorable side effect profile compared to many other antidepressants 2, 5.