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

Lexapro Starting Dose for Adults

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

Standard Adult Dosing

• Start at 10 mg daily for the majority of adult patients with major depressive disorder or generalized anxiety disorder 2, 1
• The medication can be administered at any time of day (morning or evening) and does not require food 1
• The dosage range is 10-20 mg per day for outpatient treatment 2

Dose Escalation

• If increasing to 20 mg daily is needed, wait at least 1 week after starting the 10 mg dose before making this adjustment 1
• Fixed-dose trials demonstrated effectiveness of both 10 mg and 20 mg, though the 20 mg dose did not show greater benefit than 10 mg in major depressive disorder 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 approximately 50% of the standard adult dose (around 5 mg daily) 2
• Older adults have significantly greater risk of adverse drug reactions, necessitating this dose reduction 2
• The FDA label specifically recommends 10 mg/day as the dose for most elderly patients, which may represent both starting and maintenance dosing 1

Patients with hepatic impairment:

• Should also receive 10 mg/day as the recommended dose 1

Patients with 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)

• For adolescents with major depressive disorder, the recommended dose is 10 mg once daily 1
• If increasing to 20 mg, wait at least 3 weeks (longer than the 1-week wait for adults) 1

Important Clinical Considerations

Onset of action:

• Escitalopram may show significant improvement over placebo as early as the first week of treatment 3
• However, full therapeutic response typically requires 4-8 weeks 4

Discontinuation:

• Always taper gradually rather than stopping abruptly to minimize withdrawal symptoms 1
• Discontinuation symptoms can include dizziness, fatigue, lethargy, headaches, nausea, insomnia, and anxiety 2
• A gradual dose reduction is recommended whenever possible 1

Screening before initiation:

• Screen all patients for personal or family history of bipolar disorder, mania, or hypomania before starting treatment 1

MAOI interactions:

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

2, 1, 3, 5