What is the recommended starting dose of Lexapro (escitalopram) for adults?

Lexapro Starting Dose

The recommended starting dose of Lexapro (escitalopram) for adults is 10 mg once daily, which can be taken in the morning or evening with or without food. 1, 2

Standard Adult Dosing

• Start at 10 mg once daily for most adult patients with major depressive disorder or generalized anxiety disorder 1, 2
• The medication can be administered at any time of day (morning or evening) and food does not affect absorption 2, 3
• If dose escalation is needed, increase to 20 mg only after a minimum of one week at the 10 mg dose 2
• The therapeutic dosage range is 10-20 mg per day for outpatient treatment 1

Special Populations Requiring Lower Starting Doses

Elderly patients (≥65 years) should start at a lower dose:

• The recommended starting dose for elderly patients is 10 mg daily, which is also the recommended maintenance dose for most elderly patients 2
• Older adults have significantly greater risk of adverse drug reactions and should receive approximately 50% of the standard adult starting dose 1
• In clinical studies of elderly patients with comorbid depression and anxiety, escitalopram 10-20 mg/day was well-tolerated with only 15% withdrawal rate 4

Patients with hepatic impairment:

• Start at 10 mg daily, which is also the recommended maintenance dose 2

Patients with renal impairment:

• No dosage adjustment needed for mild to moderate renal impairment 2
• Use with caution in severe renal impairment 2

Pharmacokinetic Considerations

• Escitalopram reaches maximum plasma concentrations in approximately 3-4 hours after administration 3
• Steady-state concentrations are achieved within 7-10 days of once-daily administration 3
• The elimination half-life is 27-33 hours, supporting once-daily dosing 3
• The drug exhibits linear and dose-proportional pharmacokinetics in the 10-30 mg/day dose range 3

Important Safety Considerations

Prior to initiating treatment:

• Screen all patients for personal or family history of bipolar disorder, mania, or hypomania before starting escitalopram 2

When discontinuing:

• Taper gradually rather than stopping abruptly to minimize discontinuation symptoms 2
• Monitor for withdrawal symptoms including dizziness, fatigue, lethargy, headaches, nausea, insomnia, and anxiety 1
• If intolerable symptoms occur, consider resuming the previous dose and tapering more gradually 2

Drug interactions:

• Allow at least 14 days between discontinuation of an MAOI and initiation of escitalopram 2
• Escitalopram has negligible effects on cytochrome P450 enzymes and is unlikely to cause clinically significant drug-drug interactions 3