What is the recommended dosing for Lexapro (escitalopram)?

Lexapro (Escitalopram) Dosing Recommendations

The recommended starting dose of Lexapro (escitalopram) is 10 mg once daily, which can be increased to 20 mg after a minimum of one week if clinically indicated. 1

Dosing Guidelines by Condition

Major Depressive Disorder

• Adults:

  • Initial dose: 10 mg once daily
  • Maximum dose: 20 mg once daily
  • Dose increase should occur after minimum of one week 1
  • Maintenance treatment should continue for several months beyond acute response 1

• Adolescents:

  • Initial dose: 10 mg once daily
  • Can increase to 20 mg after minimum of three weeks 1

Generalized Anxiety Disorder

• Adults:
  • Initial dose: 10 mg once daily
  • Maximum dose: 20 mg once daily
  • Dose increase should occur after minimum of one week 1
  • Efficacy beyond 8 weeks has not been systematically studied 1

Special Populations

• Elderly patients: 10 mg/day is recommended 1
• Hepatic impairment: 10 mg/day is recommended 1
• Renal impairment:
  • Mild to moderate: No dosage adjustment necessary
  • Severe: Use with caution 1

Administration Guidelines

• Can be administered in the morning or evening 1
• Can be taken with or without food 1
• Should be administered once daily 1

Discontinuation

• Gradual dose reduction rather than abrupt cessation is recommended 1
• Monitor for discontinuation symptoms (dizziness, sensory disturbances, anxiety, sleep disturbances) 1
• If intolerable symptoms occur during discontinuation, consider resuming the previously prescribed dose and decrease more gradually 1

Important Considerations

• Screen for bipolar disorder prior to starting treatment 1
• Allow at least 14 days between discontinuing MAOIs and starting escitalopram (and vice versa) 1
• Do not start escitalopram in patients being treated with linezolid or intravenous methylene blue due to risk of serotonin syndrome 1

Efficacy and Tolerability

• Fixed-dose trials demonstrated effectiveness of both 10 mg and 20 mg doses, with no greater benefit of 20 mg over 10 mg in major depressive disorder 1
• In clinical studies, escitalopram has shown efficacy in treating both depression and anxiety disorders 2
• Higher doses (up to 50 mg) have been studied in treatment-resistant depression, but tolerability may decline above 40 mg 3

Common Side Effects

• Headache, nausea, diarrhea, dry mouth, insomnia, dizziness, and sexual dysfunction 4
• Monitor for serotonin syndrome (clonus, tremor, hyperreflexia, agitation, mental status changes, diaphoresis, fever) 4

Escitalopram is generally well-tolerated at recommended doses, with clinical trials showing low discontinuation rates due to adverse events compared to other antidepressants 5.