Increase dose of lexapro

What To Expect When Increasing Lexapro Dosage

Medically reviewed by Katelyn Hagerty, FNP

Written by Our Editorial Team

Last updated 8/11/2022

Antidepressant dosages can change over time, and that’s no different when it comes to the antidepressant Lexapro®. Whether you’re starting an antidepressant for the first time or altering your dosage after years, changes to your effective dosage aren’t uncommon. They also may come with some unexpected side effects, so many people may be concerned with what to expect when increasing Lexapro dosage.

Every worry is fair game when it comes to changes in antidepressant dosage. Will you experience mood swings? Will your mood become temporarily unmanageable? Will you gain temporary superpowers? So many things are possible (not the superpowers thing, of course) that it can be hard to know what to expect.

There’s plenty of information out there on anecdotal experiences that people have when changing Lexapro dosage, but it can be hard to tell fact from fiction.

Why Your Lexapro Dosage Might Increase

Lexapro is the brand name for a medication called escitalopram, which is itself an effective antidepressant called in the selective serotonin reuptake inhibitor (SSRI) family.

These medications are generally used to help people with mood and psychiatric disorders (like generalized anxiety disorder, for instance). They work by helping regulate certain neurotransmitters that are critical to proper brain chemistry — namely, serotonin levels and norepinephrine levels.

In a nutshell, your healthcare provider might change raise or lower your dosage of Lexapro (or its generic version, escitalopram) for one reason: to make sure you’re getting the most out of this medication to support your mental health.

If you’re not taking enough Lexapro and your depression symptoms either don’t improve or get worse, your provider may raise your dosage.

If, on the other hand, you’re experiencing harsh side effects like dizziness, nausea, fatigue or trouble sleeping (among others, which we’ll get to in a moment!), your provider may give you a lower dose in order to keep you comfortable.

And if you have a pre-existing medical condition like kidney, heart or liver disease, your provider may modify your dosage so as not to worsen those conditions.

There are also some potential drug interactions that healthcare professionals will ask about if you’re experiencing certain adverse reactions to Lexapro.

You shouldn’t use it concurrently with other SSRIs, SNRIs or Tryptophan, and should talk to your healthcare provider if you’re using any NSAIDs, aspirin or any drugs that may affect your body’s hemostasis.

We know — it sounds a little arbitrary. But you have remember that every single person is different.

Consequently, so is every single person’s mental health treatment, every single person’s brain chemistry, every single person’s tolerance to the effects of prescription drugs like Lexapro or other SSRIs, etc.

These medications help people with psychiatric disorders and mood disorders — they’re an acute treatment engineered to help regulate certain aspect of individual brain chemistry in order to help effectively treat some of the symptoms of depression. .

Essentially, escitalopram is a maintenance treatment for your mental health that helps your brain never run out of serotonin, where normally it will reabsorb its own supply throughout the day. More on-hand supply means more on-demand supplies of this specific neurotransmitter, which, in turn, means your brain doesn’t have to struggle as much to stabilize your mood.

SSRIs like Lexapro are generally better tolerated than other antidepressants like monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs).

These medications are approved by the Food and Drug Administration for depression treatment, and unlike the herbal supplements, illegal drugs and over-the-counter drugs some people may use in lieu of prescription medication, they’re actually considered both safe and effective.

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The Side Effects of Increased Lexapro Dosage

Lexapro is generally considered effective in the daily dose range of 10mg to 20mg, give or take. Chances are, if you’re on the low end of that spectrum and still seeing overwhelming or unmanageable symptoms of major depression or another mood disorder, you may indeed be in need of a dosage adjustment.

When your dose increases, however, so do the effects of escitalopram—and so do the possibilities and risks for adverse effects or side effects even from a single dose.

Lexapro is known to cause sexual side effects for both male and female patients, for instance, and affect your sexual function. There are cases in which elderly patients can experience heart issues, and depressed both adolescent patients and adult patients with depressive symptoms may also experience withdrawal symptoms by sudden discontinuation of treatment.

And in regards to higher doses, you’re just inviting more extreme versions of existing side effects.

The common side effects of Lexapro are similar to other SSRIs. They include:

Experiencing any of these side effects as a result of an increase in Lexapro dosage isn’t necessarily a cause for alarm. Generally, side effects are expected when dosage changes, and they are likely to go away with time.

It’s when they don’t go away — or when you far exceed the recommended maximum dosage — that you have cause to worry.

Is Lexapro Safe at Higher Doses?

As we mentioned, there’s a top line to the safety of Lexapro, generally considered to be around 20mg orally. Luckily, you would have to exceed that several times over to cause substantial risk of life-threatening issues.

An overdose of escitalopram can cause more of those same adverse effects we listed above, but it can also cause heart issues and blood pressure problems, not to mention the risk of serotonin syndrome (and the symptoms of serotonin syndrome can be fatal).

Symptoms of overdose regardless of the risk for serotonin syndrome may include dizziness, vomiting, nausea, drowsiness, seizures, a fast or pounding heartbeat and potential loss of consciousness and coma. If you overdose yourself, seek medical attention.

These are serious issues, and if you believe you have or another person has overdosed on Lexapro or another SSRI, you should call the poison control center or an emergency line immediately, especially if the above symptoms are occurring.

Talking to a Professional About Lexapro Dosage

It is common to question whether or not your Lexapro dosage is working, or even if Lexapro is the right medication for you.

The reality is that very few people end up with the perfect medication and the perfect dose on the first try. Even then, it can take weeks or months for someone to adjust to a medication to the point of having an impact on their quality of life.

When starting Lexapro or another course of antidepressant medication, your healthcare provider usually sets expectations — namely, that the drugs can take a few weeks to begin alleviating symptoms, and that side effects may come or go, especially when beginning or changing to a higher dosage.

If you’ve been on the medication for some time and don’t yet notice the therapeutic effects — or have bothersome or serious side effects — seek guidance from your healthcare provider.

At the end of the day, they’re the ones who can ultimately help you decide what your path to recovery looks like.

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Lexapro Dosage: The Big Picture

If you’re not seeing adequate results with Lexapro, it may be time to have a conversation with a mental health professional or health care provider, but it may also be time to take a larger, more holistic look at your mental health.

At some point, there’s no higher dose, and other tools may be useful for your mental health.

If you’ve ever considered therapy, it might be time to give it a try — our online psychiatry offerings can help you clarify questions and get the answers you need.

It can all start right now, so whether you’re unhappy with current medications or just looking for guidance, consider talking to a professional today.

4 Sources

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references.

Landy K, Rosani A, Estevez R. Escitalopram. Updated 2022 Jan 19. In: StatPearls Internet. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557734/.
U.S. National Library of Medicine. (n.d.). Escitalopram: Medlineplus Drug Information. MedlinePlus. Retrieved May 17, 2022, from https://medlineplus.gov/druginfo/meds/a603005.html.
Mayo Foundation for Medical Education and Research. (2019, December 31). Antidepressants: Selecting one that's right for you. Mayo Clinic. Retrieved May 22, 2022, from https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20046273.
Can a dietary supplement help ease your depression? Harvard Health. (2019, December 1). Retrieved May 22, 2022, from https://www. health.harvard.edu/depression/can-a-dietary-supplement-help-ease-your-depression.

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

Lexapro for Anxiety | Side Effects | Dosage

WHAT IS LEXAPRO?
LEXAPRO DOSES, USES, AND WITHDRAWAL
WHAT HAPPENS IF I OVERDOSE?
SIDE EFFECTS OF LEXAPRO
PRECAUTIONS AND WARNINGS
LEXAPRO PROS AND CONS
RESOURCES

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WHAT IS LEXAPRO?

All of us suffer from anxiety now and then. If anxiety is severe and persists, however, it may be considered an anxiety disorder. If you are dealing with an anxiety disorder, it is advisable to go to a specialist who may suggest you take medication to reduce symptoms. There are many anti-anxiety medications on the market and it’s important to find the one for you. Lexapro is one to consider. This article will look at what is involved with taking Lexapro for anxiety so you can determine if it is a medication you should be adding to your daily routine. ¹

Also known by the Lexapro generic name escitalopram, Lexapro is a medication prescribed to treat anxiety and depression. It belongs to the class of drugs known as selective serotonin reuptake inhibitors.

How Does Lexapro Work?

Lexapro restores serotonin balance in the brain. It helps to elevate mood and relieve anxiety and depression.²

How Does Lexapro Make You Feel the First Week?

Do not count on Lexapro for immediate effects. This medication takes a while to work so you may not feel anything after the first week of taking it or you may feel slightly better. You may or may not experience Lexapro’s side effects during the first week.

How Long Does It Take for Lexapro to Work?

While you may feel the effects of Lexapro after a week or two, it typically takes four weeks for it to provide full results.

Is Lexapro the Same as Xanax?

No, Xanax and Lexapro are not the same. While both treat anxiety, they work in different ways. Lexapro blocks the reuptake of serotonin so there is more of the chemical in the brain. Xanax increases the effects of GABA which is responsible for calming nerve activity in the brain. ³

LEXAPRO DOSES, USES, AND WITHDRAWAL

Here is a bit about Lexapro’s uses and doses and what withdrawal is like.

Lexapro Uses

Lexapro is used to treat anxiety and depression.

Lexapro Dosage

The Lexapro dosage you are prescribed will depend on your medical condition, your age and medical history, your response to treatment, and other medications you may be taking. However, here are some general guidelines that will let you know what you can expect the doctor to prescribe.

Major Depressive Disorder

Individuals with major depressive disorder are typically prescribed dosage of Lexapro 10mg. and day. If your symptoms are severe, you may want to talk to your doctor about increasing the Lexapro dosage from 10mg to 20mg.

Generalized Anxiety Disorder

Patients with GAD may also take Lexapro dosage range of 10mg to 20mg Lexapro dosage depending on the severity of the disorder.

Special Populations

Elderly patients and those with hepatic impairment should take no more than 10mg of Lexapro a day. ⁴

WHAT HAPPENS IF I OVERDOSE?

It is possible to overdose if you take too much Lexapro. Symptoms of an overdose include:

Low blood pressure
Difficulty sleeping
Dizziness
Nausea and vomiting
Fast heart rate
Seizures
Coma

If you think you may have overdosed, call a doctor or the poison control center right away. If your symptoms are severe, call 911.

Lexapro Withdrawal

After taking Lexapro for long periods, your body will get used to having it in its system. If you stop taking it abruptly, Lexapro withdrawal will occur producing unpleasant mental and physical symptoms.

Lexapro withdrawal symptoms include the following:

Irritability
Agitation
Mood swings
Anxiety
Headache
Shaking
Confusion
Difficulty sleeping
Nausea
Sweating
The sensation of electric currents running through your body

If you would like to stop taking Lexapro, it’s best to talk to a doctor. They will advise you on how to wean off the drug without producing withdrawal symptoms.

SIDE EFFECTS OF LEXAPRO

Lexapro can produce side effects. Here are some that may be experienced.

Common Side Effects

Common side effects include:

Dry mouth
Nausea
Difficulty sleeping
Constipation
Drowsiness
Dizziness
Increased sweating
Weight gain

Serious Side Effects

In rare cases, serious side effects may occur. These include:

Decreased interest in sex
Changes in sexual performance
Easy bruising or bleeding
Bloody stools
Fainting
Irregular heartbeat
Vomit that looks like coffee grounds
Vision changes
Eye swelling or pain
Widened pupils
Seizures
A prolonged erection lasting 4 hours or more
Serotonin syndrome
A severe allergic reaction
Suicidal thoughts

It is worth noting that serotonin syndrome occurs due to a buildup of serotonin in the body. It can produce mild symptoms such as shivering and diarrhea, or severe symptoms like muscle rigidity, fever, and seizures.

If you are experiencing any of the side effects listed above, speak to a doctor, or call 911.

PRECAUTIONS AND WARNINGS

There are certain things you should be aware of before taking Lexapro. Here are some precautions and warnings to take note of.

Before Taking This Medicine

Before taking this medicine, you should see a doctor. He or she will examine you to determine if this drug is the best one for you to take for your disorder.

You must also make sure that you are not at high risk for any serious side effects. You should see to it that you are not taking any medications that will cause a strong reaction to this drug. When it comes to Lexapro side effects for women, it should not be taken by those who are pregnant.

What to Avoid

People using Lexapro should avoid alcohol. They should also not drive or engage in potentially dangerous activities until they know how the drug will affect them.

What Happens if I Miss a Dose?

If you miss a dose, it may not work as effectively. You should take your next pill as soon as possible. However, if it is almost time for your next dose when you realize you skipped the last one, take it at your regularly scheduled time and do not worry about making up for the one that was missed.

What Other Drugs Affect Lexapro?

Several drugs will have negative interactions with Lexapro. Here are some that are most reported.

Anti-inflammatory drugs like ibuprofen, naproxen, celecoxib and others
Abilify
Adderall
Ambien
Aspirin
Clonazepam
Gabapentin
Lamictal
Levothyroxine
Lipitor
Lisinopril
Metformin
Omeprazole
Seroquel
Synthroid
Tramadol
Trazodone
Vitamin D3
Xanax
Zyrtec

What to Expect When Increasing Lexapro Dosage

If you increase your Lexapro dosage, your mood may improve, but you may also find yourself at a higher risk for unpleasant side effects. Your doctor will likely increase your dose gradually to see how it’s affecting you before having you take a stronger dose regularly.

LEXAPRO PROS AND CONS

Lexapro comes with its share of pros and cons. Here are some to consider:

Cons

You may experience side effects that can be serious.
You may have Lexapro withdrawal symptoms if you stop taking the drug.
Lexapro may interact with other drugs you are taking including vitamins and pain killers

Pros

It is effective in treating anxiety and depression.
It is generally well tolerated.
It has fewer drug interactions than antidepressants.
It is less likely to cause drowsiness than other antidepressants.

Patient Tips

Here are some patient tips that may be helpful if you take Lexapro.

Best Time to Take Lexapro for Anxiety: Lexapro can be taken any time of day as long as you stick to the same time each day. If you are having trouble sleeping while taking Lexapro at night, try taking it during the day.
Should I Take Lexapro with Food? Lexapro can be taken with or without food.
Will Lexapro Make Me Drowsy? It might cause you to be drowsy. It is best not to drive or operate machinery when on this medication if it makes you feel drowsy or impairs your judgment.
Measuring Liquid Lexapro: if you are taking Lexapro in liquid form, measure it with a medical spoon. If you use a household spoon, you may end up getting the dose wrong.

USER REVIEWS FOR LEXAPRO

Lexapro received an average rating of 7.5 out of 10 on Drugs.com. 68% of users said it had a positive effect while 16% said it had a negative effect. Here’s how it ranked based on the condition it was prescribed to treat.⁵

Anxiety: 7.5 of 10
Depression: 7.2 of 10
Generalized Anxiety Disorder: 8. 3 out of 10
Major Depressive Disorder: 6.2 out of 10

Many individuals who used Lexapro said it changed their life in a good way. They said that they were able to overcome their mental health issues and enjoy the things they loved doing again.

Those who were unhappy taking Lexapro experienced unpleasant side effects. Some individuals reported signs of impulsiveness or dullness.

If you feel like you need help with your anxiety issues, reach out to AMFM Treatment today. We offer treatment for a variety of mental disorders. We have an impressive two-to-one client-to-staff ratio. We provide personalized treatment that you can trust. Let us assist you in getting on a path to happier, healthier living.

Resources

https://www.webmd.com/drugs/2/drug-63990/lexapro-oral/details
https://www.hormone.org/your-health-and-hormones/glands-and-hormones-a-to-z/hormones/serotonin#:~:text=Serotonin%20is%20the%20key%20hormone,sleeping%2C%20eating%2C%20and%20digestion.
https://www.webmd.com/vitamins-and-supplements/gaba-uses-and-risks
https://www.nuventra.com/resources/blog/pharmacokinetics-and-hepatic-impairment/#:~:text=The%20liver%20is%20responsible%20for,drugs%20interact%20with%20the%20body.
https://www.drugs.com/comments/escitalopram/lexapro.html

Memorial Sloan Kettering Cancer Center

Adult Medication

This document, provided by Lexicomp ^® , contains all the information you need to know about this medicine, including indications, directions for use, side effects, and when your healthcare provider should be contacted.

Trade names: USA

Lexapro

Trade names: Canada

ACH-Escitalopram; ACT Escitalopram ODT; AG-Escitalopram; APO Escitalopram; Auro Escitalopram; BIO-Escitalopram; Cipralex; JAMP Escitalopram; KYE-Escitalopram; M-Escitalopram; Mar-Escitalopram; MINT-Escitalopram; MYLAN-Escitalopram; NAT-Escitalopram; NRA-Escitalopram; PMS-Escitalopram; PMSC-Escitalopram; RAN-Escitalopram; RIVA Escitalopram; SANDOZ Escitalopram; TEVA-Escitalopram

Warning

For all patients taking this drug:

Drugs like this have been shown to increase the likelihood of suicidal thoughts or actions in children and young adults. This risk may be higher in people who have tried or had suicidal thoughts in the past. All people taking this drug must be closely monitored. Call your doctor right away if you have signs such as depressed mood (depression), nervousness, anxiety, grouchiness or panic attacks, or if other mood or behavior changes occur or worsen. Contact your doctor immediately if you have suicidal thoughts or suicide attempts.

Children:

This drug is not approved for use in children of all ages. Talk to your doctor to make sure this drug is right for your child.

What is this drug used for?

Used to treat depression.
Used to treat anxiety.
This drug may be used for other indications. Consult your doctor.

What should I tell my doctor BEFORE taking this drug?

If you are allergic to this drug, any of its ingredients, other drugs, foods, or substances. Tell your doctor about your allergies and how they have manifested.
If you are taking any of the following: linezolid or methylene blue.
If you are taking one of the following: citalopram or pimozide.
If you have taken drugs for depression or Parkinson's disease in the past 14 days. These include isocarboxazid, phenelzine, tranylcypromine, selegiline, or rasagiline. An episode of very high blood pressure may occur.

This list of drugs and conditions that may interfere with this drug is not exhaustive.

Tell your doctor and pharmacist about all medicines you take (prescription and over-the-counter, natural products and vitamins) and any health problems you have. You need to make sure that this drug is safe for your conditions and in combination with other drugs you are already taking. Do not start or stop taking any drug or change the dosage without your doctor's advice.

What do I need to know or do while taking this drug?

Tell all your healthcare providers that you are taking this drug. These are doctors, nurses, pharmacists and dentists.
Avoid driving and other activities that require increased attention until you see how this drug affects you.
Do not stop this drug abruptly without talking to your doctor. This can increase the risk of side effects. If necessary, taking this drug should be stopped gradually, in accordance with the recommendations of the doctor.
Avoid drinking alcohol while taking this drug.
Talk to your doctor before using marijuana, other forms of cannabis, or prescription or over-the-counter drugs that can slow you down.
Sleep and appetite may improve quickly after starting this drug. It may take up to 4 weeks for other symptoms of depressed mood to improve.
This drug may increase the risk of bleeding. Sometimes bleeding can be life-threatening. Consult your doctor.
This drug may cause low sodium levels. Very low sodium levels can be life-threatening, leading to convulsions, fainting, difficulty breathing, or death.
If you are 65 years of age or older, use this drug with caution. You may experience more side effects.
In some cases, the drug may affect the growth rate in children and adolescents. They may need regular growth rate checks. Consult your doctor.
Tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. The benefits and risks for you and your child will need to be discussed.
Taking this drug during the third trimester of pregnancy may cause some health problems in the newborn. Consult your doctor.

What side effects should I report to my doctor immediately?

WARNING. In rare cases, this drug can cause serious and sometimes deadly side effects in some patients. Call your doctor right away or get medical help if you have any of the following signs or symptoms that could be associated with serious side effects:

Signs of an allergic reaction such as rash, hives, itching, red and swollen skin with blisters or peeling, possibly associated with fever, wheezing or wheezing, chest or throat tightness, difficulty breathing, swallowing or speaking, unusual hoarseness , swelling in the mouth, face, lips, tongue or throat.
Signs of low sodium levels such as headache, trouble concentrating, memory impairment, confusion, weakness, seizures, balance problems.
Signs of bleeding such as vomiting or coughing up blood; vomiting of the type of coffee grounds; blood in the urine; black, red, or tarry stools; bleeding from the gums; non-cyclic vaginal bleeding; bruises that appear or increase for no reason; bleeding that you cannot stop.
Convulsions.
Fever or chills.
Painful erections or erections that last more than 4 hours.
Sexual dysfunctions have been observed while taking such drugs. These included decreased interest in sex, problems achieving orgasm, problems ejaculating, or problems getting or maintaining an erection. If you have problems with sexual function or have questions, consult your doctor.
There may be an increased risk of eye problems when using this drug in some patients. Your doctor may order an eye examination to see if you are at increased risk for these eye problems. Call your doctor right away if you have eye pain, vision changes, swelling or redness around the eye.
A severe and sometimes fatal complication called serotonin syndrome can occur. This risk may be increased if certain other drugs are taken at the same time. Call your doctor right away if you experience agitation, balance problems, confusion, hallucinations, high fever, tachycardia or abnormal heart rhythms, flushing, muscle twitching or stiffness, seizures, tremors or tremors, excessive sweating, severe diarrhea, nausea or vomiting , a very severe headache.

What are some other side effects of this drug?

Any medicine can have side effects. However, for many people, side effects are either minor or non-existent. Contact your doctor or seek medical attention if these or any other side effects bother you or do not go away:

Feeling dizzy, drowsy, tired or weak.
Nausea.
Diarrhea or constipation.
Dry mouth.
Sleep disorders.
Excessive sweating.
Influenza-like symptoms.
Runny nose.
Headache.
Yawn.

This list of possible side effects is not exhaustive. If you have any questions about side effects, please contact your doctor. Talk to your doctor about side effects.

You can report side effects to the National Health Board.

You can report side effects to the FDA at 1-800-332-1088. You can also report side effects at https://www.fda.gov/medwatch.

What is the best way to take this drug?

Use this drug as directed by your doctor. Read all the information provided to you. Strictly follow all instructions.

All editions:

Take this drug with or without food.
Keep taking this drug as your doctor or other health care professional tells you to, even if you feel well.

Oral solution:

Care should be taken when measuring liquid doses. Use the dispenser that comes with the medicine. If the dispenser is not provided in the package, ask the pharmacist for a dosing agent for this drug.

What if I miss a dose of a drug?

Take the missed dose as soon as you can.
If it is time for your next dose, do not take the missed dose and then return to your regular dosing schedule.
Do not take 2 doses or an additional dose at the same time.

How do I store and/or discard this drug?

Store at room temperature in a dry place. Do not store in the bathroom.
Keep all medicines in a safe place. Keep all medicines out of the reach of children and pets.
Dispose of unused or expired drugs. Do not empty into a toilet or sewer unless instructed to do so. If you have any questions about disposing of medicines, ask your pharmacist. Drug disposal programs may be in place in your area.

General information about drugs

If your health does not improve or even worsens, call your doctor.
Do not give your medicine to anyone or take other people's medicine.
Some medicines may come with other patient information sheets. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other health care professional.
A separate patient leaflet is included with this product. Please read this information carefully. Reread it each time you refill your supply. If you have any questions about this drug, ask your doctor, pharmacist, or other health care professional.
If you think you have overdosed, call a poison control center or get medical attention right away. Be prepared to tell or show what drug you took, how much, and when it happened.

Consumer Use of Information and Limitation of Liability

This summary information includes a summary of the diagnosis, treatment, and/or drug product. It is not intended to be a comprehensive source of data and should be used as a tool to help the user understand and/or evaluate potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a particular patient. It should not be considered medical advice or a substitute for medical advice, diagnosis or treatment provided by a physician based on a medical examination and assessment of the patient's specific and unique circumstances. Patients should consult with their physician for full information about their health, medical issues, and treatment options, including any risks or benefits regarding the use of medications. This information is not a guarantee that a treatment or drug is safe, effective, or approved for a particular patient. UpToDate, Inc. and its subsidiaries disclaim any warranties or liabilities related to this information or its use. The use of this information is subject to the Terms of Use found at https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms.

Copyright

Date last updated

Thursday, October 13, 2022

Escitalopram (Escitalopramum) - PsyAndNeuro.ru

: 10 mg tab

: 20 mg tab

Trade names in Russia

Cipralex, Elycea, Lenuxin, Selectra, Escitalopram, ASIPI, Elycea Ku-tab

Contents

Pharmacological group
Nomenclature NbN
Indications
- 0008
- ◊ Use Off-Label
Target Symptoms
Action Mechanism and Pharmacokinetics
Treatment Scheme
- ◊ Dose
- ◊ How quickly
- ◊ expected 9000
- ◊ if
- ◊ How to stop taking
- ◊ Treatment combinations
Warnings and contraindications
Special patient populations
- ◊ Patients with diseased kidneys
- ◊ Patients with a liver from the liver
- ◊ Patients with a sick heart
- ◊ Elderly patients
- ◊ Children and adolescents
- ◊ Pregnant
- ◊ breastfeeding
Analyzes during treatment
Side effects and other risks
- ◊ Mechanism of side effects
- ◊ Side effects
- ◊ Dealing with side effects
- ◊ Long-term use
  F32 Depressive episode
  
  F33 Recurrent depressive disorder
  
  F40. 0 Agorathobia
  
  F41.0 Panic disorder (episodic paroxysmal anxiety)
  
  ◊ Recommendations FDA
- 000 9000 9000 9000 9000 9000 9000 from 12 years old)
- GTR
◊ Recommendations UK Medicines and Healthcare Products Regulatory Agency
- Major depressive episode
- Panic disorder with/without agoraphobia
- Social phobia
- GTR
- OKR
◊ Off-label use
- Vasomotor symptoms in menopause
- Insomnia
- Dysmorphophobia
- Bulimia [5].
Target symptoms
- Depressive mood
- Anxiety
- Panic attacks, avoidance behavior
- Sleep disorder
Mechanism of action and pharmacokinetics

Escitalopram is the S-isomer of citalopram. Selectively inhibits the reuptake of serotonin, increasing the concentration of this neurotransmitter in the synaptic cleft. Escitalopram, like other antidepressants from the SSRI group, practically does not bind to dopamine (D ₁ and D ₂) receptors, α-adrenergic, m-cholinergic receptors, as well as with benzodiazepine and opioid receptors [4]. Long-term use of escitalopram leads to desensitization of somatodendritic 5-HT1A and terminal autoreceptors.
- Bioavailability - 80%.
- Half-life 27-32 hours
- Stable blood concentration is maintained for one week
- Metabolized by CYP3A4, CYP2C19; inhibits CYP2D6
Treatment regimen

◊ Dosage and dose selection
- Optimal dose for depression, OCD and GAD: 10-20 mg/day
- Start at 10 mg/day if necessary increase to 20 mg
- Take once a day, morning or evening
- 10 mg escitalopram comparable to 40 mg citalopram but no side effects
- 30-40 mg is suitable for some patients [1]
- 10 mg/day is sufficient for relief of vasomotor symptoms in menopause, but may be increased to 20 mg/day if failure occurs within 4 weeks
- If anxiety, insomnia, agitation, akathisia occur at the start of treatment or after interruption of treatment, consider the possibility of bipolar disorder and switch to a mood stabilizer or an atypical antipsychotic
◊ How fast works
- Starts working after 2-4 weeks
- If there is no effect after 6-8 weeks, it is necessary to increase the dose or switch to another drug
- May be taken for many years to prevent relapse.
◊ Expected result
- Complete remission.
- After the disappearance of symptoms of depression, you should continue taking 1 year if it was the treatment of the first episode. If this is a re-episode treatment, treatment can be extended indefinitely.
- Use in the treatment of anxiety and chronic pain may be indefinite.
◊ If not working
- Change dose, switch to another drug, or add an ancillary drug;
- Connect psychotherapy;
- Review diagnosis for comorbid conditions;
- In patients with undiagnosed bipolar affective disorder, treatment may be poor, in which case switching to a mood stabilizer should be considered [1].
- Electroconvulsive therapy should be considered in the acute phase of severe depressive disorder accompanied by psychotic or catatonic symptoms, as well as in patients with actual suicidal ideation [7].
◊ How to stop taking

It is not usually necessary to taper off gradually, but taper off gradually to be sure to avoid withdrawal symptoms. Gradual reduction scheme: dose reduced by 50% - 3 days, again reduced by 50% - 3 days, complete cessation. If withdrawal symptoms appear, increase the dose, wait for the withdrawal symptoms to subside, and continue to decrease [1].

◊ Treatment combinations
- For insomnia: trazadone
- For fatigue, drowsiness, loss of concentration: modafinil [3].
- Combinations with other antidepressants may activate bipolar disorder and suicidal ideation
- For bipolar depression, psychotic depression, resistant depression, resistant anxiety disorder: mood stabilizers, atypical antipsychotics
- For anxiety disorder: gabapentin, tiagabine
Warnings and contraindications
- Use caution if patient has had seizures;
- Use with caution if patient has bipolar disorder;
- Do not use if patient is taking pimozide;
- Do not use if allergic to citalopram or escitalopram [1].
Special patient groups

◊ Patients with diseased kidneys

Use caution if patient has severe kidney disease [1].

◊ Patients with diseased liver

The recommended dose is 10 mg/day [1].

◊ Patients with heart disease

There are no systematic data on the use of escitalopram in people with pathology of the cardiovascular system. Presumably safe. Useful in recovery after a heart attack [1].

◊ Elderly patients

A dose of 10 mg is recommended for elderly patients [1].

◊ Children and adolescents
- Recommended for depression aged 12-17
- It is necessary to check the patient's condition regularly and personally, especially during the first weeks of treatment.
- Use with caution, considering the risk of undiagnosed bipolar affective disorder and suicidal tendencies.
- Inform adults of the risks.
◊ Pregnant
- There have been no adequate studies of pregnant women [1].
- Not recommended for pregnant women, especially in the first trimester
- All risks should be weighed and compared
- Bleeding can be expected at delivery
◊ Breastfeeding
- The drug passes into breast milk.
- If the infant shows signs of irritation or sedation, stop feeding or taking escitalopram
- However, postpartum treatment may be necessary and the risks should be weighed.
Interaction with other substances
- Tramadol increases the risk of seizures
- Cannot be used with MAO inhibitors. After the end of taking MAO inhibitors, 14 days should pass. Start treatment with MAO inhibitors 7 days after the end of escitalopram.
- Together with warfarin, probably increases the risk of bleeding [1].
Tests during treatment

Not required.

Side effects and other risks

◊ Mechanism of side effects

Side effects are caused by increased serotonin. Most side effects occur immediately after the start of treatment and go away over time.

◊ Side effects
- Gastroenterological (decreased appetite, nausea, diarrhea, constipation)
- Insomnia, sedation, agitation, tremor
- Sweating
- Urinary disorders
- Dry mouth
- Dangerous side effects: convulsions, mania, suicidal ideation
- Weight gain: very rare
- Sedation: very rare
- Sexual dysfunction: yes
◊ What to do about side effects
1. Wait
2. Switch to another antidepressant [1].