Starting Dose of Lexapro (Escitalopram)
The recommended starting dose of Lexapro (escitalopram) is 10 mg once daily for most adults. 1
Dosing Guidelines by Indication
Major Depressive Disorder
- Adults: 10 mg once daily
- Can be increased to 20 mg after a minimum of one week if needed
- FDA-approved drug labeling indicates that both 10 mg and 20 mg doses are effective, but failed to demonstrate greater benefit of 20 mg over 10 mg 1
Generalized Anxiety Disorder
- Adults: 10 mg once daily
- Can be increased to 20 mg after a minimum of one week if needed 1
Special Populations
- Elderly patients: 10 mg/day is the recommended dose 1
- Patients with hepatic impairment: 10 mg/day is recommended 1
- Renal impairment:
- No dosage adjustment necessary for mild to moderate impairment
- Use with caution in severe renal impairment 1
Administration Details
- Can be taken in the morning or evening
- Can be taken with or without food 1
- Steady-state concentrations are achieved within 7-10 days of administration 2
Clinical Considerations
Pharmacokinetics
- Rapidly absorbed after oral administration
- Reaches maximum plasma concentrations in approximately 3-4 hours
- Elimination half-life of about 27-33 hours, consistent with once-daily dosing 2
- Food does not affect absorption 2
Efficacy Based on Depression Severity
- For moderate depression (MADRS score 22-29), 10 mg/day appears to be an effective dose
- For severe depression (MADRS score ≥30), 20 mg/day may be more effective 3
Common Pitfalls to Avoid
- Abrupt discontinuation: Always taper gradually to avoid discontinuation symptoms 1
- Drug interactions: Escitalopram is metabolized by CYP2C19, CYP2D6, and CYP3A4 enzymes, but has minimal inhibitory effects on these enzymes, reducing the risk of drug interactions 2
- Screening for bipolar disorder: Always screen patients for personal or family history of bipolar disorder before initiating treatment 1
- MAOI interactions: Allow at least 14 days between discontinuing MAOIs and starting escitalopram, or between stopping escitalopram and starting MAOIs 1
By following these evidence-based dosing guidelines, clinicians can optimize the therapeutic benefits of escitalopram while minimizing potential adverse effects.