What is the starting dose of Lexapro (escitalopram) for anxiety?

Starting Dose of Lexapro (Escitalopram) for Anxiety

The recommended starting dose of escitalopram for anxiety disorders is 10 mg once daily for most adults. 1, 2

Dosing Guidelines

• Standard adult dosing:

  • Initial dose: 10 mg once daily (morning or evening, with or without food)
  • May increase to 20 mg after minimum of one week if needed 2
  • Maximum dose: 20 mg daily

• Special populations:

  • Elderly patients: 10 mg daily maximum 1, 2
  • Hepatic impairment: 10 mg daily maximum 1, 2
  • Mild to moderate renal impairment: No dosage adjustment necessary 1, 2
  • Severe renal impairment: Use with caution 1, 2

Efficacy for Anxiety Disorders

Escitalopram has demonstrated effectiveness for generalized anxiety disorder (GAD) in multiple clinical trials:

• In placebo-controlled studies, escitalopram showed significant improvement in anxiety symptoms 3, 4
• Escitalopram has a favorable side effect profile compared to other SSRIs, making it a preferred agent for anxiety disorders 1
• Response typically begins within 2-4 weeks, with maximal response achieved within 8-12 weeks 1

Administration Considerations

• Can be taken in the morning or evening 2
• Can be taken with or without food 2
• For maintenance treatment, periodically reassess the need for continued therapy 2

Monitoring and Safety

• Common adverse effects: Nausea, diarrhea, dizziness, dry mouth, fatigue, headache, sexual dysfunction, sweating, and tremor 1
• More serious concerns:
  • QT prolongation risk (dose-dependent)
  • Serotonin syndrome when combined with other serotonergic medications
  • Increased risk of suicidal thoughts and behaviors, especially in young adults 1

Discontinuation

• Gradual dose reduction is recommended rather than abrupt cessation
• Monitor for discontinuation symptoms such as dizziness, sensory disturbances, anxiety, and sleep disturbances 1, 2

Clinical Pearls

• Escitalopram has less effect on CYP450 isoenzymes compared to other SSRIs, reducing potential drug interactions 1
• Consider combining with cognitive behavioral therapy (CBT) for enhanced effectiveness 1
• Treatment should continue for at least 6-12 months after remission to prevent relapse 1
• Screen for bipolar disorder prior to initiating treatment 2

Escitalopram is well-tolerated and effective for anxiety disorders, with a straightforward dosing regimen that typically starts at 10 mg once daily for most adults.