Recommended Starting Dose of Lexapro (Escitalopram)
The recommended starting dose of Lexapro (escitalopram) is 10 mg once daily for most adults. 1 This dose is considered optimal for initiating treatment while minimizing side effects and maintaining efficacy.
Dosing Guidelines for Adults
- Escitalopram should be administered once daily, either in the morning or evening, with or without food 1
- The standard starting dose is 10 mg daily for most adult patients 2, 1
- After a minimum of one week, the dose may be increased to 20 mg daily if clinically indicated 1
- The dosage range for outpatient treatment is 10 to 20 mg per day 2
- No dosage adjustment is necessary for patients with mild or moderate renal impairment 1
Special Populations
- For elderly patients (≥65 years), the recommended starting dose is 10 mg daily 1
- For patients with hepatic impairment, 10 mg daily is the recommended dose 1
- Lower starting doses (approximately 50% of the adult starting dose) are often recommended for older adults due to their significantly greater risk of adverse drug reactions 2
- Escitalopram should be used with caution in patients with severe renal impairment 1
Clinical Considerations
- Escitalopram is rapidly absorbed after oral administration, reaching maximum plasma concentrations in approximately 3-4 hours 3
- The elimination half-life is about 27-33 hours, which is consistent with once-daily administration 3
- Steady-state concentrations are achieved within 7-10 days of administration 3
- Prior to initiating treatment, patients should be screened for personal or family history of bipolar disorder, mania, or hypomania 1
Efficacy Considerations
- In major depressive disorder, a fixed-dose trial demonstrated the effectiveness of both 10 mg and 20 mg doses, but failed to show a greater benefit of 20 mg over 10 mg 1
- For patients with moderate depression (MADRS score 22-29), 10 mg daily appears to be the optimal dose 4
- For patients with severe depression (MADRS score ≥30), 20 mg daily may be more effective 4
Discontinuation
- When discontinuing treatment, a gradual reduction in dose rather than abrupt cessation is recommended to minimize discontinuation symptoms 1
- Discontinuation symptoms may include dizziness, fatigue, lethargy, headaches, nausea, insomnia, and anxiety 5
- Patients should be monitored for these symptoms when discontinuing treatment 1
Common Pitfalls to Avoid
- Avoid starting at doses higher than 10 mg in most patients, as this may increase the risk of side effects without providing additional initial benefit 1, 3
- Avoid abrupt discontinuation or too-rapid tapering, which can trigger discontinuation syndrome, particularly with shorter-acting SSRIs like escitalopram 5
- Be careful to distinguish between discontinuation symptoms and relapse of the underlying condition when reducing or stopping medication 5
- Do not use escitalopram within 14 days of discontinuing an MAOI intended to treat psychiatric disorders 1