What is the starting dose of Lexapro (escitalopram) for a 15-year-old?

Starting Dose of Lexapro (Escitalopram) for a 15-Year-Old

The recommended starting dose of Lexapro (escitalopram) for a 15-year-old adolescent is 10 mg once daily. 1

Dosing Guidelines for Adolescents

The FDA-approved prescribing information for escitalopram provides clear guidance for adolescent dosing:

• Initial dose: 10 mg once daily 1
• Administration: Can be taken in the morning or evening, with or without food 1
• Dose adjustment: If needed, the dose may be increased to 20 mg, but only after a minimum of three weeks at the initial dose 1
• Maximum dose: 20 mg daily for adolescents 1

Pharmacokinetic Considerations

Escitalopram has favorable pharmacokinetic properties that make it suitable for adolescent use:

• Rapid absorption with peak plasma concentrations reached in 3-4 hours 2
• Long elimination half-life of 27-33 hours, allowing for once-daily dosing 2
• Steady-state concentrations achieved within 7-10 days 2
• No clinically relevant differences in pharmacokinetics between adolescents and healthy young adults 2

Monitoring and Follow-up

When initiating escitalopram in a 15-year-old:

• Monitor for clinical response and side effects
• Assess for improvement in depressive symptoms using standardized scales
• Watch for potential adverse effects including:
  • Headache (most common, affecting up to 35% of patients) 3
  • Gastrointestinal symptoms (nausea, diarrhea) 3
  • Nasopharyngitis 3

Important Precautions

• Screen for personal or family history of bipolar disorder before starting treatment 1
• Be aware that escitalopram has a small effect on heart rate (approximately 2 beats per minute decrease) 4
• The QT interval prolongation with escitalopram is minimal (mean difference of 3.5 ms compared to placebo) 4

Special Considerations

• If the patient has hepatic impairment, 10 mg/day is the recommended dose 1
• No dosage adjustment is necessary for patients with mild or moderate renal impairment 1
• Use with caution in patients with severe renal impairment 1

Discontinuation

If discontinuation is needed:

• Implement a gradual dose reduction rather than abrupt cessation 1
• Monitor for discontinuation symptoms 1
• If intolerable symptoms occur during dose reduction, consider resuming the previously prescribed dose and then decrease more gradually 1

Remember that escitalopram has shown efficacy in treating major depressive disorder in adolescents, with a favorable side effect profile compared to other antidepressants.