Recommended Dosage of Cipralex (Escitalopram)
The recommended starting dose of Cipralex (escitalopram) is 10 mg once daily, which can be increased to a maximum of 20 mg daily after at least one week if needed. 1
Initial Dosing Guidelines
- For adults with major depressive disorder (MDD), the recommended starting dose is 10 mg once daily 1
- For elderly patients (>65 years) and those with hepatic impairment, the recommended dose is 10 mg daily 1
- Cipralex can be taken in the morning or evening, with or without food 1
- If dose increase is needed, this should occur after a minimum of one week at the starting dose 1
Dosing Based on Condition Severity
- For moderate depression (MADRS score 22-29), 10 mg daily is typically effective 2
- For severe depression (MADRS score ≥30), 20 mg daily may be required for optimal efficacy 2
- Clinical response at 10 mg may be observed within 2 weeks for moderate depression, while severe depression may require 4 weeks at 20 mg to show response 2
Maximum Dosage
- The maximum FDA-approved dose is 20 mg daily 1
- Although higher doses (up to 50 mg) have been studied in treatment-resistant depression, these are not FDA-approved and may increase side effect burden 3
- At doses above 40 mg, tolerability appears to decline significantly, with 26% of patients unable to tolerate 50 mg 3
Special Populations
- Adolescents (12-17 years): Starting dose is 10 mg daily, with potential increase to 20 mg after a minimum of three weeks 1
- Elderly patients: 10 mg daily is recommended due to approximately 50% increase in AUC and half-life 1
- Hepatic impairment: 10 mg daily is recommended due to reduced clearance and doubled half-life 1
- Renal impairment: No dosage adjustment is necessary for mild to moderate renal impairment; use with caution in severe renal impairment 1
Maintenance Treatment
- For MDD, several months of treatment beyond acute response is generally recommended 1
- Patients should be periodically reassessed to determine the need for continued maintenance treatment 1
Discontinuation
- A gradual reduction in dose rather than abrupt cessation is recommended to minimize discontinuation symptoms 1
- If intolerable symptoms occur during discontinuation, consider resuming the previously prescribed dose and decreasing more gradually 1
Safety Considerations
- Monitor for emergence of adverse events, particularly in the first few weeks of treatment 4
- Common side effects include headache (35%), nausea (25%), diarrhea (25%), and nasopharyngitis (25%) 3
- Escitalopram has a more favorable cardiac safety profile compared to citalopram, with less QT prolongation risk 4
- Screen patients for bipolar disorder prior to initiating treatment to avoid potential precipitation of mania/hypomania 1