Escitalopram: Difference between revisions
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{{MedTemplate | {{MedTemplate | ||
| generic | | generic = Escitalopram | ||
| brand | | brand = Lexapro | ||
| structure | | structure = | ||
| classes | | classes = [[:Category:SSRIs|Selective serotonin reuptake inhibitor (SSRI)]], [[:Category:Antidepressants|Antidepressant]], [[:Category:Anxiolytics|Anxiolytic]] | ||
| | | uses = <vote slug="major-depressive-disorder-use">Major depressive disorder (FDA, ages 12+)</vote>, <vote slug="generalized-anxiety-disorder-use">Generalized anxiety disorder (FDA, adult)</vote>, <vote slug="panic-disorder-use">Panic disorder (off-label)</vote>, <vote slug="ocd-use">Obsessive-compulsive disorder (off-label)</vote>, <vote slug="ptsd-use">Posttraumatic stress disorder (off-label)</vote>, <vote slug="premenstrual-dysphoric-disorder-use">Premenstrual dysphoric disorder (off-label)</vote>, <vote slug="menopausal-vasomotor-use">Menopausal vasomotor symptoms (off-label)</vote> | ||
| uses | | starting_dose = 10 mg PO once daily; titrate to 20 mg/day after 1-2 weeks if needed | ||
| starting_dose | | preparations = Tablets 5, 10, 20 mg; oral solution 1 mg/mL | ||
| preparations | | fda_max = 20 mg/day (adult); 10 mg/day in elderly and in hepatic impairment | ||
| fda_max = | | pill_id = | ||
| routes | | routes = Oral | ||
| onset | | onset = Antidepressant effect emerges over 1-2 weeks; full clinical effect 4-6 weeks | ||
| duration | | duration = 24 hours (once-daily dosing) | ||
| halflife | | halflife = 27-32 hours<ref name="lexapro-label">FDA Prescribing Information, Lexapro (escitalopram oxalate), AbbVie/Allergan, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/021323s047lbl.pdf</ref> | ||
| bioavailability = ~80% (oral)<ref name="lexapro-label" /> | |||
| pregnancy = Observational signal for persistent pulmonary hypertension of the newborn (small absolute risk) and neonatal adaptation syndrome with third-trimester exposure; weigh against the risks of untreated maternal depression.{{citation needed}} | |||
| legal = [[USLegal:Prescription only|Rx-only]] in US. Carries the antidepressant '''Boxed Warning''' for suicidality in children, adolescents, and young adults<ref name="lexapro-label" /> | |||
| | | mechanism = <vote slug="escitalopram-mech-claim">Highly selective serotonin reuptake inhibitor. Escitalopram is the (S)-enantiomer of citalopram, which carries essentially all of the serotonin transporter (SERT) binding activity; the (R)-enantiomer contributes little SERT activity and may carry the QT-prolonging liability that prompted the FDA's 2011 citalopram dose ceiling, giving escitalopram a more favorable QT profile.</vote> CYP2C19 + CYP3A4 metabolism, with CPIC PGx guidance: poor CYP2C19 metabolizers have ~3-fold higher exposure and benefit from a lower starting dose; ultrarapid metabolizers may have inadequate response<ref name="cpic-ssri">CPIC Guideline for CYP2D6 and CYP2C19 Genotypes and Dosing of Selective Serotonin Reuptake Inhibitors, 2023. https://cpicpgx.org/guidelines/guideline-for-selective-serotonin-reuptake-inhibitors-and-cyp2d6-and-cyp2c19/</ref>. | ||
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}} | }} | ||
== References == | |||
<references /> | |||
[[Category:SSRIs]] | |||
[[Category:Antidepressants]] | [[Category:Antidepressants]] | ||
[[Category:Anxiolytics]] | |||
Latest revision as of 06:24, 23 May 2026
Escitalopram
Lexapro
Experience
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Problems
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Effects
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Summary
Common uses
Major depressive disorder (FDA, ages 12+)0, Generalized anxiety disorder (FDA, adult)0, Panic disorder (off-label)0, Obsessive-compulsive disorder (off-label)0, Posttraumatic stress disorder (off-label)0, Premenstrual dysphoric disorder (off-label)0, Menopausal vasomotor symptoms (off-label)0
Pharmacy
Starting dose
10 mg PO once daily; titrate to 20 mg/day after 1-2 weeks if needed
Preparations
Tablets 5, 10, 20 mg; oral solution 1 mg/mL
US FDA Max
20 mg/day (adult); 10 mg/day in elderly and in hepatic impairment
Pharmacology
Routes
Oral
Onset
Antidepressant effect emerges over 1-2 weeks; full clinical effect 4-6 weeks
Duration
24 hours (once-daily dosing)
Half-life
27-32 hours[2]
Bioavailability
~80% (oral)[2]
Pregnancy
Observational signal for persistent pulmonary hypertension of the newborn (small absolute risk) and neonatal adaptation syndrome with third-trimester exposure; weigh against the risks of untreated maternal depression.[citation needed]
Legal status
Purported mechanism
Highly selective serotonin reuptake inhibitor. Escitalopram is the (S)-enantiomer of citalopram, which carries essentially all of the serotonin transporter (SERT) binding activity; the (R)-enantiomer contributes little SERT activity and may carry the QT-prolonging liability that prompted the FDA's 2011 citalopram dose ceiling, giving escitalopram a more favorable QT profile.0 CYP2C19 + CYP3A4 metabolism, with CPIC PGx guidance: poor CYP2C19 metabolizers have ~3-fold higher exposure and benefit from a lower starting dose; ultrarapid metabolizers may have inadequate response[1].
References
- ↑ CPIC Guideline for CYP2D6 and CYP2C19 Genotypes and Dosing of Selective Serotonin Reuptake Inhibitors, 2023. https://cpicpgx.org/guidelines/guideline-for-selective-serotonin-reuptake-inhibitors-and-cyp2d6-and-cyp2c19/
- ↑ 2.0 2.1 2.2 FDA Prescribing Information, Lexapro (escitalopram oxalate), AbbVie/Allergan, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/021323s047lbl.pdf