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

Starting Dose of Lexapro (Escitalopram)

The recommended starting dose of Lexapro (escitalopram) is 10 mg once daily for most adult patients, administered in the morning or evening with or without food. 1

Standard Adult Dosing

• Start at 10 mg once daily for both major depressive disorder and generalized anxiety disorder in adults 1
• The medication can be taken at any time of day (morning or evening) and food does not affect absorption 1
• If dose escalation is needed to 20 mg daily, wait a minimum of one week before increasing 1
• The therapeutic range is 10-20 mg per day, though clinical trials failed to demonstrate greater benefit of 20 mg over 10 mg for depression 2, 1

Special Population Adjustments

Elderly patients require dose reduction:

• Start at 10 mg daily as the maximum recommended dose for most elderly patients due to significantly greater risk of adverse drug reactions 2, 1
• This represents approximately 50% of the standard adult starting dose 2

Hepatic impairment:

• Use 10 mg daily as the recommended dose for patients with hepatic impairment 1

Renal impairment:

• No dosage adjustment needed for mild or moderate renal impairment 1
• Use with caution in severe renal impairment 1

Adolescent Dosing (Ages 12-17)

• Start at 10 mg once daily for major depressive disorder 1
• If increasing to 20 mg, wait a minimum of three weeks (longer than the one-week wait for adults) 1

Critical Pre-Treatment Screening

Screen for bipolar disorder before initiating treatment:

• Obtain personal and family history of bipolar disorder, mania, or hypomania prior to starting escitalopram 1
• This screening is essential to avoid precipitating manic episodes in undiagnosed bipolar patients

Important Clinical Considerations

Onset of action and titration:

• Clinical studies demonstrate significant superiority over placebo as early as the first week of treatment 3
• Steady-state plasma concentrations are achieved within 7-10 days 4
• The elimination half-life is 27-33 hours, supporting once-daily dosing 4

Discontinuation precautions:

• Never stop abruptly—taper gradually to minimize discontinuation symptoms including dizziness, fatigue, headaches, nausea, insomnia, and anxiety 2, 1
• If intolerable symptoms occur during taper, resume the previous dose and decrease more gradually 1

MAOI interactions:

• Allow at least 14 days between discontinuing an MAOI and starting escitalopram 1
• Allow at least 14 days after stopping escitalopram before starting an MAOI 1