Lexapro Starting Dose
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 with 10 mg once 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
- If dose escalation is needed to 20 mg daily, wait a minimum of one week before increasing in adults with generalized anxiety disorder, or a minimum of three weeks in adolescents with depression 1
- The effective dose range is 10-20 mg per day for outpatient treatment 2
Special Populations Requiring Lower Doses
Elderly patients and those with hepatic impairment should start at a reduced dose of 10 mg/day, which is also the recommended maintenance dose for these populations. 1 This lower starting dose (approximately 50% of the standard adult dose) is necessary because older adults have significantly greater risk of adverse drug reactions 2.
For patients with severe renal impairment, use escitalopram with caution, though no specific dosage adjustment is required for mild to moderate renal impairment 1.
Clinical Considerations
- Escitalopram reaches maximum plasma concentrations in approximately 3-4 hours after administration, with steady-state achieved within 7-10 days 3
- The elimination half-life is 27-33 hours, supporting once-daily dosing 3
- Clinical trials have demonstrated that both 10 mg and 20 mg doses are effective, though the 20 mg dose did not show greater benefit than 10 mg in fixed-dose trials for depression 1
- The drug exhibits linear and dose-proportional pharmacokinetics in the 10-30 mg/day range 3
Important Safety Note
Always screen patients for personal or family history of bipolar disorder, mania, or hypomania before initiating escitalopram or any antidepressant. 1