When is escitalopram (Lexapro) usually administered?

From the Guidelines

Escitalopram (Lexapro) is usually administered once daily, typically in the morning or evening, and treatment is continued for at least 4 to 9 months after a satisfactory response in patients with a first episode of major depressive disorder.

Key Administration Details

• The American College of Physicians recommends that clinicians assess patient status, therapeutic response, and adverse effects of antidepressant therapy on a regular basis beginning within 1 to 2 weeks of initiation of therapy 1.
• Treatment should be modified if the patient does not have an adequate response to pharmacotherapy within 6 to 8 weeks of the initiation of therapy for major depressive disorder 1.
• Escitalopram is a second-generation antidepressant, and its efficacy and effectiveness are similar to other SSRIs, such as citalopram, fluoxetine, and sertraline 1.

Important Considerations

• Clinicians should discuss adverse event profiles with patients before selecting a medication, as escitalopram can cause adverse effects such as nausea, headache, and insomnia 1.
• The risk of suicide attempts is greater during the first 1 to 2 months of treatment, and patients should be closely monitored for increases in suicidal thoughts and behaviors 1.
• The response rate to drug therapy may be as low as 50%, and multiple pharmacologic therapies might be required for patients who do not respond to first- or second-line treatments 1.

From the FDA Drug Label

Escitalopram tablets should be administered once daily, in the morning or evening, with or without food. The usual administration of escitalopram (Lexapro) is once daily, and it can be taken in the morning or evening, with or without food 2.

• The dose can be increased, but this should occur after a minimum of one week for adults or three weeks for adolescents.
• The recommended dose is 10 mg once daily for both adolescents and adults.

From the Research

Administration of Escitalopram

• Escitalopram is usually administered once daily, due to its elimination half-life of about 27-33 hours 3.
• The absorption of escitalopram is not affected by food, and it has a bioavailability of 80% 4, 3.
• Steady-state concentrations of escitalopram are achieved within 7-10 days of administration 3.

Dosage and Pharmacokinetics

• Escitalopram has linear pharmacokinetics, with plasma levels increasing proportionately and predictably with increased doses 3, 5.
• The therapeutic dose range of escitalopram is typically 10-30 mg/day, with once-daily administration 3, 5.
• Escitalopram is metabolised by the cytochrome P450 isoenzymes CYP2C19, CYP2D6, and CYP3A4, but has negligible inhibitory effects on these enzymes 3.

Clinical Use

• Escitalopram is approved for the treatment of depression and anxiety disorders, including generalised anxiety disorder, panic disorder, social phobia, and obsessive-compulsive disorder 4, 6.
• It is considered a first-line agent for the pharmacotherapy of these conditions, due to its efficacy and favourable tolerability profile 4, 6.
• Escitalopram has been shown to be effective in decreasing depressive symptoms and improving anxiety symptoms in clinical trials 7, 6.