What is the common dosing for Lexapro (escitalopram)?

Common Escitalopram (Lexapro) Dosing Guidelines

The standard starting dose of escitalopram is 10 mg once daily for most adult patients, with a dosage range of 10 to 20 mg per day for outpatient treatment. 1, 2

Adult Dosing

• Initial dose is 10 mg once daily, administered in the morning or evening, with or without food 1
• If dose increase is needed, 20 mg may be prescribed after a minimum of one week at the 10 mg dose 1
• Clinical trials have shown that both 10 mg and 20 mg doses are effective, but failed to demonstrate greater benefit of 20 mg over 10 mg in major depressive disorder 1
• Steady-state concentrations are achieved within 7-10 days of administration 3

Special Populations

• For elderly patients: 10 mg/day is the recommended dose 1, 2
• For patients with hepatic impairment: 10 mg/day is recommended 1
• For adolescents with major depressive disorder: 10 mg once daily initially, with potential increase to 20 mg after a minimum of three weeks 1
• No dosage adjustment is necessary for patients with mild or moderate renal impairment, but escitalopram should be used with caution in patients with severe renal impairment 1

Indications and Duration

• Major Depressive Disorder (MDD): 10-20 mg daily 1
• Generalized Anxiety Disorder (GAD): 10-20 mg daily 1
• Maintenance treatment: After acute response, continued treatment at the same dose is recommended to prevent relapse 1
• Long-term studies have demonstrated favorable safety and tolerability over 12 months of treatment 4

Discontinuation

• Gradual dose reduction rather than abrupt cessation is recommended to minimize discontinuation symptoms 1, 5
• Discontinuation symptoms may include dizziness, fatigue, lethargy, headaches, nausea, insomnia, and anxiety 5
• If intolerable symptoms occur during discontinuation, resuming the previously prescribed dose may be considered before attempting a more gradual taper 1

Common Side Effects

• Most common adverse events include nausea, insomnia, ejaculation disorder, diarrhea, dry mouth, and somnolence 6
• Only nausea occurs in >10% of escitalopram-treated patients 6
• The incidence of adverse events tends to decline with time during long-term treatment 4

Clinical Pearls

• Escitalopram has linear pharmacokinetics, with plasma levels increasing proportionately with increased doses 3, 6
• The elimination half-life is approximately 27-33 hours, consistent with once-daily administration 3
• Screen patients for personal or family history of bipolar disorder before initiating treatment 1
• Escitalopram has negligible effects on cytochrome P450 drug-metabolizing enzymes, suggesting a low potential for drug-drug interactions 3, 6