Maximum Dosage of Lexapro (Escitalopram) for Adults
The maximum recommended dosage of Lexapro (escitalopram) for adults is 20 mg per day. 1, 2
Standard Dosing Guidelines
- The standard starting dose of escitalopram is 10 mg once daily for most adult patients 3, 1
- Dose increases should occur after a minimum of one week of treatment 1
- The FDA-approved dosage range for escitalopram in adults is 10-20 mg per day 1, 3
- Escitalopram can be administered in the morning or evening, with or without food 1
Maximum Dose Considerations
- Doses above 20 mg are not FDA-approved and carry increased risks of side effects, particularly QT prolongation 2
- Clinical trials have demonstrated that 20 mg of escitalopram is effective for severe depression, while 10 mg may be sufficient for moderate depression 4
- A fixed-dose trial demonstrated effectiveness of both 10 mg and 20 mg doses, but failed to demonstrate a greater benefit of 20 mg over 10 mg in major depressive disorder 1
Special Populations
- For elderly patients and those with hepatic impairment, 10 mg/day is the recommended maximum dose 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
Pharmacokinetics and Dosing
- Escitalopram reaches steady-state concentrations within 7-10 days of administration 5
- The elimination half-life of escitalopram is approximately 27-33 hours, which is consistent with once-daily dosing 5
- Escitalopram exhibits linear and dose-proportional pharmacokinetics in the 10-30 mg/day dose range 5
Risks of Exceeding Maximum Dose
- QT prolongation risk increases in a dose-dependent manner with escitalopram 2
- Higher doses may increase the likelihood of common SSRI side effects including insomnia, somnolence, dizziness, and headache 2
- While some research has investigated doses up to 50 mg in treatment-resistant depression, tolerability appears to decline above 40 mg with 26% of patients unable to tolerate 50 mg 6
Important Considerations
- If 20 mg is insufficient, consider augmentation strategies rather than exceeding the maximum dose, such as addition of another agent (e.g., bupropion, mirtazapine) 2
- When discontinuing treatment, a gradual reduction in dose rather than abrupt cessation is recommended to minimize discontinuation symptoms 1
- Symptoms associated with discontinuation may include dizziness, fatigue, lethargy, headaches, nausea, insomnia, and anxiety 3