What is the starting dose of Lexapro (escitalopram)?

Starting Dose of Lexapro (Escitalopram)

The recommended starting dose of escitalopram is 10 mg once daily for most adult patients. 1, 2

Adult Dosing Guidelines

• Escitalopram tablets should be administered once daily, in the morning or evening, with or without food 1
• The standard dosage range for adults is 10 to 20 mg per day for outpatient treatment 2
• If dose increase to 20 mg is needed, this should occur after a minimum of one week of treatment 1
• Fixed-dose trials demonstrated effectiveness of both 10 mg and 20 mg doses, but failed to show greater benefit of 20 mg over 10 mg in most cases 1

Special Populations

• For elderly patients (≥65 years), 10 mg/day is the recommended dose 1
• For patients with hepatic impairment, 10 mg/day is the recommended dose 1
• No dosage adjustment is necessary for patients with mild or moderate renal impairment, but escitalopram should be used with caution in severe renal impairment 1
• Lower starting doses (approximately 50% of the adult starting dose) are often recommended for older adults due to their greater risk of adverse drug reactions 2

Pharmacokinetic 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, making once-daily dosing appropriate 3
• Steady-state concentrations are achieved within 7-10 days of administration 3
• The absorption of escitalopram is not affected by food 3

Dose Optimization Based on Condition Severity

• For moderate depression (MADRS score 22-29), 10 mg/day appears to be the optimal dose 4
• For severe depression (MADRS score ≥30), 20 mg/day may be more effective 4

Discontinuation Considerations

• When discontinuing treatment, a gradual reduction in dose rather than abrupt cessation is recommended 1
• Monitor patients for discontinuation symptoms including dizziness, fatigue, lethargy, headaches, nausea, insomnia, and anxiety 2
• If intolerable symptoms occur during dose reduction, resuming the previously prescribed dose may be considered before attempting a more gradual taper 1

Common Pitfalls to Avoid

• Failing to screen for bipolar disorder before initiating treatment, which should be done to avoid precipitating mania 1
• Not allowing sufficient time (at least one week) before increasing the dose from 10 mg to 20 mg 1
• Abrupt discontinuation rather than gradual tapering, which can lead to withdrawal symptoms 2, 1
• Not considering drug interactions, although escitalopram has relatively low potential for clinically significant drug-drug interactions compared to some other antidepressants 3