Section 19 · Monograph
Escitalopram
Reviewed Nov 2026FDA label
LexaproSSRI
- Forms
- Tab: 5, 10, 20mg | Soln: 1mg/mL
- Dose
- Depression or anxiety: start 5-10mg daily, max 20mg/day (10mg max in older adults and hepatic impairment)
- MOA
- Selective serotonin reuptake inhibition
Black Box Warning
- Increased risk of suicidal thoughts and behavior in children, adolescents and young adults (under 25) — monitor closely
Indications
- Major depressive disorder and generalized anxiety disorderFDA-labeled
Mechanism of Action
- Selective serotonin reuptake inhibitor (S-enantiomer of citalopram)
Full Dosing
Adult / usual
- Start 5-10mg daily; usual 10mg, max 20mg/day
- Dose-dependent QT prolongation; taper gradually when discontinuing
Hepatic
- Older adults and hepatic impairment: 10mg/day maximum
Contraindications
- MAO inhibitors within 14 days (and linezolid or IV methylene blue)
- Pimozide
- Hypersensitivity to escitalopram or citalopram
Drug Interactions
- Serotonergic drugs: serotonin syndrome
- QT-prolonging drugs (ondansetron, antipsychotics, methadone)
- NSAIDs, anticoagulants, antiplatelets: bleeding risk; CYP2C19 inhibitors (omeprazole, fluvoxamine) raise levels
Adverse Effects
- Nausea, insomnia or somnolence, sexual dysfunction
- Hyponatremia/SIADH
- QT prolongation
- Bleeding, serotonin syndrome
Monitoring Parameters
- Suicidality and mood
- Serum sodium in older adults
- ECG when risk factors or interacting QT drugs are present
Pregnancy & Lactation
- Possible neonatal adaptation syndrome and PPHN risk with late-pregnancy use; weigh benefit and risk
- Excreted in milk; monitor infants