Starting Dose of Lexapro (Escitalopram)
The standard starting dose of escitalopram is 10 mg once daily for most adult patients with depression or generalized anxiety disorder, taken in the morning or evening with or without food. 1, 2
Standard Adult Dosing
- For both major depressive disorder and generalized anxiety disorder, initiate treatment at 10 mg once daily 1, 2
- The therapeutic dosage range is 10-20 mg per day for outpatient treatment 1
- If dose escalation to 20 mg is needed, this should occur after a minimum of one week for adults 2
- Fixed-dose trials demonstrated effectiveness of both 10 mg and 20 mg, though 20 mg did not show greater benefit than 10 mg in depression 2
Special Population Considerations
For elderly patients (≥65 years) and those with hepatic impairment, reduce the starting dose to approximately 50% of the standard adult dose due to significantly greater risk of adverse drug reactions 1, 2
- The recommended dose for most elderly patients is 10 mg/day maximum 2
- Lower starting doses minimize adverse effects like agitation or dizziness in older adults 3
- No dosage adjustment is necessary for patients with mild or moderate renal impairment 3, 2
- Use caution in patients with severe renal impairment 2
Important Clinical Considerations
Screen all patients for personal or family history of bipolar disorder, mania, or hypomania prior to initiating escitalopram 2
- Behavioral activation or agitation may occur early in treatment, particularly in younger patients, supporting slow up-titration when necessary 3
- Expected plasma levels at 10 mg daily are approximately 27-28 ng/mL, within the therapeutic range of 15-80 ng/mL 3
- Patients should be monitored for treatment response and adverse effects, particularly during the first months of treatment and following dosage adjustments 3
Discontinuation Precautions
- Always use gradual dose reduction rather than abrupt cessation to minimize discontinuation symptoms 4, 1, 2
- Discontinuation symptoms can include dizziness, fatigue, lethargy, headaches, nausea, insomnia, and anxiety 4, 1
- Distinguish between discontinuation symptoms and relapse of the underlying condition 4