Lexapro: Uses, dosage, side effects, warnings & patient reviews

What is Lexapro (Escitalopram)?

Lexapro is the brand name for escitalopram oxalate, a selective serotonin reuptake inhibitor (SSRI) antidepressant. For patients new to this class of medication, a general guide to antidepressants provides helpful context.

Escitalopram is the S-enantiomer of citalopram. Its primary mechanism of action is the potent and selective inhibition of serotonin (5-HT) reuptake in the presynaptic neuron, which increases serotonergic activity in the central nervous system. Lexapro exhibits minimal affinity for adrenergic, muscarinic, histamine, or dopamine receptors.

The therapeutic effect for depressive and anxiety symptoms typically requires consistent daily dosing for 2 to 4 weeks. Lexapro is available as brand-name and generic (escitalopram) tablets and oral solution.

How to Take Lexapro

Lexapro is administered orally, once daily, in the morning or evening. It may be taken with or without food.

Dosage and Administration

The recommended therapeutic dosage for most adults is 10 mg once daily. Depending on individual patient response, the dosage may be increased to a maximum of 20 mg daily after a minimum of one week.

For elderly patients or those with hepatic impairment, a recommended starting dose is 5 mg daily, with a maximum recommended dose of 10 mg daily.

It is essential to take Lexapro exactly as prescribed. Do not stop taking Lexapro abruptly, as this may lead to discontinuation symptoms. Dose reduction should be managed under medical supervision.

Missed Dose

If a dose is missed, it should be taken as soon as remembered, unless it is close to the time of the next dose. In that case, the missed dose should be skipped. Do not take a double dose to make up for a missed one.

Side Effects of Lexapro

The following adverse reactions are categorized by incidence. This is not a complete list.

What is Lexapro Used For?

Lexapro (escitalopram) is approved by the U.S. Food and Drug Administration (FDA) for the following indications:

FDA-Approved Uses

• Major Depressive Disorder (MDD): Treatment of acute and maintenance therapy for MDD in adults and adolescents aged 12-17 years.
• Generalized Anxiety Disorder (GAD): Treatment of GAD in adults.

Like other SSRIs such as Zoloft (sertraline), Lexapro requires several weeks of consistent use to achieve its full therapeutic effect on mood and anxiety symptoms.

Important Treatment Considerations

Lexapro is a treatment for the diagnosed conditions listed above. It is not indicated for immediate relief of isolated stressful situations. Efficacy has been established in controlled clinical trials; individual response may vary. The prescribing physician will determine if Lexapro is appropriate based on a comprehensive psychiatric and medical evaluation.

Important Safety Concerns and Considerations

Suicidality and Antidepressant Drugs

Lexapro carries a Black Box Warning, the FDA’s most serious safety alert. Antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults in short-term studies. This risk must be balanced with the clinical need. All patients starting therapy should be monitored closely for clinical worsening, suicidality, or unusual changes in behavior.

Sexual Dysfunction

SSRIs, including Lexapro, commonly cause sexual side effects such as decreased libido, ejaculatory delay, anorgasmia, and erectile dysfunction. These effects can be a significant cause of treatment non-adherence. Management strategies should be discussed with the prescribing physician. For further insight into this common issue, see a doctor’s guide to antidepressants and sexual dysfunction.

Discontinuation Syndrome

Abrupt discontinuation of Lexapro may lead to withdrawal symptoms such as dizziness, paresthesias, irritability, nausea, and sleep disturbances. A gradual dose taper under medical supervision is recommended when discontinuing treatment.

Activation of Mania/Hypomania

Lexapro may induce a manic or hypomanic episode in patients with bipolar disorder. It is not approved for treating bipolar depression. Screening for bipolar disorder is essential prior to initiation. Treatment for emerging manic symptoms may require additional medications such as mood stabilizers or atypical antipsychotics (e.g., Seroquel).

Critical Warnings for Lexapro Use

Serotonin Syndrome

The development of a potentially life-threatening serotonin syndrome has been reported with SSRIs, including Lexapro, particularly with concomitant use of other serotonergic drugs (e.g., other SSRIs, SNRIs, triptans, tricyclic antidepressants, fentanyl, tramadol, tryptophan, buspirone, St. John’s Wort) or drugs that impair serotonin metabolism (e.g., MAOIs). Symptoms include mental status changes, autonomic hyperactivity, and neuromuscular abnormalities. Concurrent use with MAOIs intended to treat psychiatric disorders is contraindicated.

Patients should be warned of the risk, especially with concomitant use of opioids. For more on opioid risks, see a guide to opioid risks.

Increased Risk of Bleeding

SSRIs may increase the risk of bleeding events by impairing platelet aggregation. Concomitant use of aspirin, NSAIDs, warfarin, and other anticoagulants may add to this risk. Patients should be advised of this potential and to report any signs of bleeding to their physician.

QT Prolongation

Escitalopram causes dose-dependent QT interval prolongation. It should be used with caution in patients with congenital long QT syndrome, bradycardia, or electrolyte imbalances, or who are taking other drugs known to prolong the QT interval.

Hyponatremia

Hyponatremia (low blood sodium) has been reported as a result of treatment with SSRIs, including Lexapro. Elderly patients and those taking diuretics or who are otherwise volume-depleted appear to be at greater risk. Symptoms include headache, difficulty concentrating, memory impairment, confusion, weakness, and unsteadiness.

Lexapro Dosage Information

The following dosage recommendations are derived from the FDA-approved prescribing information. All dosing must be individualized by the treating physician.

Important Administration Notes

• Onset of Action: Full antidepressant/anxiolytic effect may not be observed for 2-4 weeks or longer.
• Dose Adjustments: If dose increase is warranted, it should occur after a minimum of one week at the starting dose.
• Maintenance Treatment: For MDD, acute treatment should be followed by a period of maintenance therapy to prevent recurrence. The efficacy of Lexapro for longer-term use (over 8 months) has not been systematically evaluated.
• Discontinuation: A gradual reduction in dose is recommended rather than abrupt cessation.

Drug Interactions with Lexapro

Lexapro (escitalopram) is primarily metabolized by the liver enzymes CYP2C19 and CYP3A4. Its plasma levels and effects can be significantly altered by concomitant medications.

Additional Information

Comprehensive Treatment and Alternatives

Major depressive and anxiety disorders often benefit from a comprehensive treatment plan. This may include psychotherapy (talk therapy) alongside medication. For some patients, or in cases of treatment-resistant depression, other medication classes may be considered. These can include other SSRIs, serotonin-norepinephrine reuptake inhibitors (SNRIs), atypical antidepressants (e.g., bupropion/Wellbutrin), or, in complex cases, augmentation with atypical antipsychotics. Treatment decisions should always be made collaboratively with a healthcare professional.

Storage and Handling

Store Lexapro tablets and oral solution at room temperature, 25°C (77°F); excursions permitted between 15°C-30°C (59°F-86°F). Keep the bottle tightly closed. Store the oral solution in the original bottle. Use an oral syringe or dosing cup for accurate measurement. Keep all medications out of the reach of children and pets.

Overdose

Signs and symptoms of overdose (doses >600 mg have been reported) include dizziness, sweating, nausea, vomiting, tremor, somnolence, sinus tachycardia, amnesia, confusion, coma, convulsions, and ECG changes. There is no specific antidote. Management involves supportive care and close medical observation.

References and Medical Sources

The information on this page is based on the official prescribing information and authoritative clinical guidelines.

1. U.S. Food and Drug Administration (FDA). Lexapro (escitalopram oxalate) Prescribing Information. Revised 2021. https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/021323s055,021365s039lbl.pdf
2. MedlinePlus. Escitalopram. U.S. National Library of Medicine; [Updated 2022]. https://medlineplus.gov/druginfo/meds/a603005.html
3. American Psychiatric Association (APA). Practice Guideline for the Treatment of Patients with Major Depressive Disorder, Third Edition. 2010. https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd.pdf
4. Drugs.com. Escitalopram Professional Monograph. Drugs.com; [Updated 2024]. https://www.drugs.com/monograph/escitalopram.html

Disclaimer: The information on this site is provided for informational purposes only and is not medical advice. It does not replace professional medical consultation, diagnosis, or treatment. Do not self-medicate based on the information presented on this site. Always consult with a doctor or other qualified healthcare professional before making any decisions about your health.