From the FDA Drug Label
8.5 Geriatric Use Approximately 6% of the 1144 patients receiving escitalopram in controlled trials of Escitalopram in major depressive disorder and GAD were 60 years of age or older; elderly patients in these trials received daily doses of Escitalopram between 10 and 20 mg The number of elderly patients in these trials was insufficient to adequately assess for possible differential efficacy and safety measures on the basis of age. Nevertheless, greater sensitivity of some elderly individuals to effects of Escitalopram cannot be ruled out SSRIs and SNRIs, including Escitalopram, have been associated with cases of clinically significant hyponatremia in elderly patients, who may be at greater risk for this adverse event [see Hyponatremia (5. 6)]. In two pharmacokinetic studies, escitalopram half-life was increased by approximately 50% in elderly subjects as compared to young subjects and Cmax was unchanged [see Clinical Pharmacology (12.3)]. 10 mg/day is the recommended dose for elderly patients [see Dosage and Administration (2. 3)].
The recommended dose of escitalopram for geriatric patients is 10 mg/day 1, 1, 1. Key considerations for geriatric patients include:
- Greater sensitivity to effects of escitalopram
- Increased risk of clinically significant hyponatremia
- Increased half-life of escitalopram compared to young subjects.
From the Research
For geriatric patients, escitalopram (Lexapro) should typically be started at a lower dose of 5 mg once daily, which is half the standard adult starting dose, as supported by the most recent and highest quality study available 2. After 1-2 weeks of treatment and assessment of tolerability, the dose may be increased to 10 mg daily if needed for adequate symptom control. The maximum recommended dose for elderly patients is generally 10 mg daily, rather than the 20 mg maximum used in younger adults. This conservative dosing approach is necessary because aging is associated with decreased hepatic metabolism and renal clearance, leading to higher blood levels of the medication and increased risk of side effects, as noted in studies such as 3 and 4. Some key points to consider when prescribing escitalopram to geriatric patients include:
- Close monitoring is essential, particularly during the initial weeks of treatment and after any dose adjustments, due to the potential for adverse effects such as hyponatremia, falls, and QT prolongation.
- Treatment should continue for at least 6-12 months after symptom resolution to prevent relapse, with periodic reassessment of the need for ongoing therapy to minimize long-term medication exposure.
- Selective serotonin reuptake inhibitors, including escitalopram, can have various effects on the body, such as altering aldosterone/renin ratio, as seen in studies like 5, which may be relevant in certain patient populations.
- The choice of escitalopram and its dosing should be individualized based on the patient's specific needs and medical history, taking into account the potential benefits and risks, as discussed in reviews like 6.