What is the recommended tapering schedule for discontinuing 10 mg of Lexapro (escitalopram)?

Tapering Off 10 mg Lexapro (Escitalopram)

Gradually reduce escitalopram over several weeks to months rather than stopping abruptly, as the FDA label explicitly recommends a gradual dose reduction whenever possible to minimize discontinuation symptoms. 1

FDA-Recommended Approach

The FDA label for escitalopram clearly states that patients should be monitored for discontinuation symptoms when stopping treatment, and a gradual reduction in dose rather than abrupt cessation is recommended whenever possible 1. If intolerable symptoms occur following a dose decrease or upon discontinuation, resuming the previously prescribed dose should be considered, followed by decreasing the dose at a more gradual rate 1.

Recommended Tapering Schedule

Standard Taper Duration

• Taper escitalopram over a minimum of 4 weeks or longer 2. Research demonstrates that tapers lasting more than 4 weeks are associated with better outcomes and fewer withdrawal symptoms compared to shorter tapers 2.

• For patients on escitalopram long-term (months to years), consider extending the taper to several months 3. Studies show that tapers over months down to doses much lower than minimum therapeutic doses have shown greater success in reducing withdrawal symptoms compared to the commonly recommended 2-4 week tapers 3.

Specific Dose Reduction Strategy

Hyperbolic (percentage-based) tapering is superior to linear tapering 3. This means:

• Reduce by 25% of the current dose (not the original dose) every 1-2 weeks initially 3
• As you approach lower doses, slow the taper further and consider 10% reductions of the current dose 3
• Final doses before complete cessation may need to be very small (1-2.5 mg or less) to prevent large receptor-level changes 3

Example tapering schedule from 10 mg:

• Weeks 1-2: Reduce to 7.5 mg (25% reduction)
• Weeks 3-4: Reduce to 5-6 mg (20-25% of current dose)
• Weeks 5-6: Reduce to 4-5 mg
• Weeks 7-8: Reduce to 3 mg
• Weeks 9-10: Reduce to 2 mg
• Weeks 11-12: Reduce to 1 mg
• Weeks 13-14: Reduce to 0.5 mg or alternate-day dosing
• Week 15+: Discontinue completely

This schedule can be extended further if withdrawal symptoms emerge 1.

Common Withdrawal Symptoms to Monitor

Discontinuation symptoms are generally mild and self-limiting but can be distressing 4, 2:

Somatic symptoms:

• Dizziness and light-headedness 4
• Nausea and vomiting 4
• Fatigue, lethargy, myalgia, chills, and flu-like symptoms 4
• Headache 2
• Sleep disturbances 4, 2
• Sensory disturbances 4

Psychological symptoms:

• Anxiety and/or agitation 4
• Mood swings 2
• Irritability 4
• Crying spells 4

Managing Withdrawal Symptoms

• For mild symptoms, reassure the patient that they are usually transient 4
• For more severe symptoms, return to the previous well-tolerated dose and slow the taper rate 1, 4
• Pause the taper if needed - there is no requirement to maintain a rigid schedule 5
• Monitor patients at least monthly during the taper, with more frequent contact during difficult phases 5

Critical Pitfalls to Avoid

• Never abruptly discontinue escitalopram - this significantly increases the risk of withdrawal symptoms 1, 2
• Do not mistake withdrawal symptoms for relapse of depression or physical illness - misdiagnosis may lead to unnecessary tests and treatment 4
• Avoid tapering too quickly with standard 2-4 week protocols - these show minimal benefit over abrupt discontinuation and are often not tolerated 3
• Do not stop at "therapeutic minimum doses" (5 mg) - taper to much lower doses before complete cessation 3
• Never abandon the patient during tapering - frequent follow-up is essential 5

Special Considerations

• Escitalopram has a shorter half-life than fluoxetine, making gradual tapering more important 4
• The taper rate must be determined by the patient's tolerance, not a rigid schedule 5
• If symptoms re-emerge after discontinuation, consider restarting at the last effective dose 1