From the Guidelines
Escitalopram can be increased up to 20 milligrams, but dosage increases should only occur under medical supervision, usually after a minimum of one week at the lower dose to assess tolerance. When considering a dosage increase, it is essential to weigh the potential benefits against the risks of increased side effects, such as headache, nausea, insomnia, increased sweating, fatigue, and sexual dysfunction 1. The decision to increase the dosage should be based on a thorough assessment of the patient's response to the current dose, taking into account their specific condition, such as major depressive disorder or severe anxiety, and their individual tolerance to the medication.
Key considerations for dosage increases include:
- Starting with a subtherapeutic dose as a "test" dose to assess tolerance and minimize the risk of adverse effects 1
- Gradually increasing the dose in small increments, typically at 1- to 2-week intervals for shorter half-life SSRIs like escitalopram, to optimize the benefit-to-harm ratio 1
- Carefully monitoring patients for symptoms of serotonin syndrome, particularly when concomitantly administering other serotonergic drugs 1
- Being aware of potential drug-drug interactions, especially with medications that prolong the QT interval or are metabolized by CYP450 isoenzymes 1
It is crucial to note that patients with liver impairment or those over 65 years old typically should not exceed 10mg daily, and any dosage adjustments should be made under close medical supervision to minimize the risk of adverse effects 1. Ultimately, the decision to increase the dosage of escitalopram to 20 milligrams should be made on a case-by-case basis, taking into account the individual patient's needs and circumstances.
From the FDA Drug Label
Escitalopram tablets should be administered once daily, in the morning or evening, with or without food. A flexible-dose trial of Escitalopram (10 to 20 mg/day) demonstrated the effectiveness of Escitalopram [see Clinical Studies (14. 1)]. If the dose is increased to 20 mg, this should occur after a minimum of three weeks for adolescents and after a minimum of one week for adults.
The dosage of escitalopram (Lexapro) can be increased up to 20 milligrams, but this should occur after a minimum of one week for adults and three weeks for adolescents. 2
From the Research
Dosage of Escitalopram
The dosage of escitalopram (Lexapro) can be increased up to 20 milligrams, as indicated in several studies 3, 4, 5.
- The standard dose of escitalopram is 10-20 mg/day, with some studies showing efficacy and safety at this dose range 3, 4, 5.
- One study found that escitalopram 10 or 20 mg/day produced significant improvements in depressive symptoms compared to placebo 5.
- Another study showed that escitalopram 10-20 mg/day demonstrated a favorable safety and tolerability profile over 12 months of treatment 4.
Higher Doses of Escitalopram
Some studies have investigated the use of higher doses of escitalopram, up to 50 mg/day 6 or 30 mg/day 7.
- A pilot study found that dose escalation of escitalopram up to 50 mg/day was effective in achieving remission in some patients with major depressive disorder (MDD) 6.
- Another study found that dose escalation of escitalopram up to 30 mg/day was well-tolerated and may be beneficial for treating depressive symptoms in non-remitters after standard treatment 7.
- However, these higher doses may not be necessary for all patients, and the standard dose of 10-20 mg/day may be sufficient for many individuals 3, 4, 5.
Key Findings
Key findings from these studies include:
- Escitalopram is effective and well-tolerated in the treatment of MDD and anxiety disorders 3, 4, 5.
- The standard dose of escitalopram is 10-20 mg/day, but higher doses may be necessary for some patients 6, 7.
- Dose escalation of escitalopram may be beneficial for treating depressive symptoms in non-remitters after standard treatment 7.