What is a suitable taper schedule for escitalopram (Lexapro) 10 mg daily?

Escitalopram 10 mg Daily Taper Schedule

For escitalopram 10 mg daily, reduce the dose by 10% of the most recent dose every 2-4 weeks, which translates to approximately 1 mg reductions initially, with progressively smaller decrements as you approach discontinuation. 1

Specific Tapering Protocol

Initial Reduction Phase

• Week 0-2: Continue 10 mg daily
• Week 2-4: Reduce to 9 mg daily (10% reduction)
• Week 4-6: Reduce to 8 mg daily (11% reduction from 9 mg)
• Week 6-8: Reduce to 7 mg daily (12.5% reduction from 8 mg)
• Week 8-10: Reduce to 6 mg daily (14% reduction from 7 mg)

Final Reduction Phase

• Week 10-12: Reduce to 5 mg daily (17% reduction from 6 mg)
• Week 12-14: Reduce to 4 mg daily (20% reduction from 5 mg)
• Week 14-16: Reduce to 3 mg daily (25% reduction from 4 mg)
• Week 16-18: Reduce to 2 mg daily (33% reduction from 3 mg)
• Week 18-20: Reduce to 1 mg daily (50% reduction from 2 mg)
• Week 20-22: Discontinue completely

Total taper duration: Approximately 20-22 weeks (5-5.5 months) 1

Critical Implementation Details

Obtaining Smaller Doses

• Use liquid formulation if available to achieve precise dose reductions 2
• Do NOT use alternate-day dosing (e.g., taking 10 mg every other day to achieve an "average" of 5 mg daily), as this causes severe fluctuations in receptor occupancy and dramatically increases withdrawal risk 3
• Consider having a compounding pharmacy prepare custom capsules for doses below 5 mg 1

Monitoring and Adjustment

• If withdrawal symptoms emerge: Return to the previous well-tolerated dose and hold for 2-4 weeks before attempting a smaller reduction (5% instead of 10%) 1, 2
• Common withdrawal symptoms include dizziness (44%), muscle tension (44%), chills (44%), confusion (40%), and crying (28%) 4
• Higher doses and plasma concentrations of escitalopram increase ADS risk, making gradual tapering essential 4

Slower Taper for Long-Term Users

• If you have been on escitalopram for ≥1 year: Consider reducing by 10% per month instead of every 2-4 weeks, extending the total taper to 10-11 months 1
• The FDA label explicitly states "a gradual reduction in the dose rather than abrupt cessation is recommended whenever possible" 2

Managing Withdrawal Symptoms

Symptomatic Treatment

• For anxiety or irritability: Consider short-term trazodone 1
• For sleep disturbances: Implement sleep hygiene measures and consider short-term sleep aids 1
• For gastrointestinal symptoms: Use appropriate symptomatic treatments 1

Key Distinction

• Do not mistake withdrawal symptoms for recurrence of your original condition 1
• Withdrawal symptoms typically appear within days of dose reduction and last 1-3 days per step 1
• Protracted withdrawal may occur months after complete discontinuation, manifesting as dysphoria, irritability, insomnia, or anhedonia 1

Common Pitfalls to Avoid

• Never taper faster than 10% every 2 weeks as this dramatically increases withdrawal risk 1
• Never abruptly discontinue escitalopram 2
• Avoid setting arbitrary deadlines for completing the taper; prioritize tolerability over speed 1
• Do not use alternate-day dosing as a tapering strategy, as this causes dangerous fluctuations in drug levels and receptor occupancy 3

When to Pause or Seek Help

• Pause the taper if withdrawal symptoms become intolerable, and restart when ready 1
• Consider cognitive-behavioral therapy during tapering to increase success rates 1
• Seek additional help if symptoms of your original condition (depression or anxiety) worsen significantly during tapering 1