What is the starting dose of Lexapro (escitalopram)?

Starting Dose of Lexapro (Escitalopram)

The recommended starting dose of escitalopram is 10 mg once daily for most adult patients. 1

Standard Adult Dosing

• Initiate treatment at 10 mg once daily, administered in the morning or evening, with or without food 1
• The effective dosage range is 10 to 20 mg per day for outpatient treatment 2
• If dose escalation is needed, increase to 20 mg only after a minimum of one week at the 10 mg dose for major depressive disorder and generalized anxiety disorder 1
• For adolescents with major depressive disorder, the starting dose is also 10 mg once daily, with any increase to 20 mg occurring after a minimum of three weeks 1

Special Population Adjustments

Elderly patients (>65 years) should receive a lower starting dose:

• 10 mg/day is the maximum recommended dose for most elderly patients 1
• Older adults require approximately 50% of the adult starting dose due to significantly greater risk of adverse drug reactions 2
• This same 10 mg/day dosing applies to patients with hepatic impairment 1

Renal impairment considerations:

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

Clinical Pharmacology Supporting Once-Daily Dosing

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

Important Prescribing Considerations

Screen for bipolar disorder before initiating treatment:

• Prior to starting escitalopram, screen patients for personal or family history of bipolar disorder, mania, or hypomania 1

Discontinuation planning:

• When stopping treatment, use gradual dose reduction rather than abrupt cessation to minimize discontinuation symptoms (dizziness, fatigue, lethargy, headaches, nausea, insomnia, anxiety) 2, 1

MAOI interactions:

• Allow at least 14 days between discontinuation of an MAOI and initiation of escitalopram, and vice versa 1