What is the recommended dose of escitalopram (Lexapro)?

Recommended Dosage of Escitalopram (Lexapro)

The standard recommended dose of escitalopram for adults is 10 mg once daily, which can be increased to 20 mg once daily after a minimum of one week if needed. 1

Initial Dosing Guidelines

• Escitalopram tablets should be administered once daily, either in the morning or evening, with or without food 1
• For adults with major depressive disorder (MDD), start with 10 mg once daily 1
• For generalized anxiety disorder (GAD), start with 10 mg once daily 1
• For elderly patients and those 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 use with caution in severe renal impairment 1

Dose Adjustments

• If needed, the dose may be increased to 20 mg once daily after a minimum of one week on the initial dose 1
• Clinical trials have shown that both 10 mg and 20 mg doses are effective, but failed to demonstrate a greater benefit of 20 mg over 10 mg in many cases 1, 2
• For adolescents with MDD, the recommended dose is 10 mg once daily, with potential increase to 20 mg after a minimum of three weeks 1

Special Populations

• Elderly patients: 10 mg/day is the recommended dose 1
• Patients with hepatic impairment: 10 mg/day is the recommended dose 1
• Patients with renal impairment: No adjustment needed for mild to moderate impairment; use with caution in severe impairment 1
• Therapeutic drug monitoring (TDM) suggests a therapeutic reference range of 15-80 ng/mL for escitalopram 3

Effectiveness and Safety Considerations

• Escitalopram 10 mg/day has been shown to be as effective as sertraline flexibly dosed from 50-200 mg/day in treating major depressive disorder 2
• In severe depression, escitalopram has demonstrated better efficacy than citalopram, with benefits observed as early as week 1 4
• For generalized anxiety disorder, significant improvement compared to placebo has been observed as early as 1-2 weeks after starting treatment 5
• QTc prolongation is a potential concern with escitalopram, but TDM-guided dosing has not shown significant correlation between plasma concentration and QTc prolongation 6

Duration of Treatment

• For MDD, maintenance treatment beyond the acute episode is generally recommended for several months or longer 1
• For GAD, the efficacy beyond 8 weeks has not been systematically studied 1
• Patients should be periodically reassessed to determine the need for continued maintenance treatment 1

Discontinuation

• When discontinuing treatment, a gradual reduction in dose is recommended rather than abrupt cessation 1
• If intolerable symptoms occur during discontinuation, resuming the previously prescribed dose may be considered, followed by a more gradual taper 1
• Monitor for discontinuation symptoms such as irritability, anxiety, insomnia, and sensory disturbances 1

Common Side Effects and Monitoring

• Most common side effects include fatigue, headache, and nausea 3
• Adverse reactions may increase by approximately 3.2% per ng/ml increase in escitalopram plasma concentration 6
• Screen for bipolar disorder prior to starting escitalopram 1
• Monitor for emergence of suicidal thoughts or behaviors, particularly in adolescents and young adults 3

Remember that while the standard dose is 10 mg daily, individual response and tolerability should guide dosing decisions, with careful monitoring for both therapeutic effects and adverse reactions.