Escitalopram
Escitalopram
Lexapro
Experience
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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