- Last edited on February 20, 2021
Escitalopram (Cipralex/Lexapro)
Primer
Escitalopram (Trade name: Cipralex/Lexapro) is an antidepressant in the selective serotonin reuptake inhibitor (SSRI) class commonly used in the treatment of major depressive disorder.
Pharmacokinetics
See also article: Introduction to Pharmacology
Pharmacokinetics of Escitalopram
See also article: Cytochrome (CYP) P450 Metabolism
Escitalopram: Cytochrome P450 Metabolism
Substrate of (Metabolized by) | 2C19, 3A4 |
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Induces | |
Inhibits |
Pharmacodynamics
Mechanism of Action
Toxicity
Indications
Escitalopram vs. Citalopram
Recommended daily dose ranges for citalopram and escitalopram
Population | Citalopram | Escitalopram |
---|---|---|
Adult 18-65 years without risk factors | • Starting: 20mg • Maximum: 40mg | • Starting: 10mg • Maximum: 20mg |
Adult >65 years or impaired hepatic function | • Starting: 10mg • Maximum: 20mg | • Starting: 5mg • Maximum: 10mg |
Taking omeprazole* | • Starting: 20mg • Maximum: 20mg | • Starting: 5mg • Maximum: 10mg |
Dosing
Dosing for Escitalopram
Starting | 10 mg PO daily |
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Titration | Increase by 5 to 10 mg every 1 to 2 weeks, depending on tolerability |
Maximum | 20 mg per day (10 mg in adults >65), due to QTc concerns[1] |
Taper | Tapering/Switching Antidepressants |
Formulations
- Escitalopram comes in
Monitoring
Contraindications
Absolute
Relative
Drug-Drug Interactions
Side Effects
Adverse Events
QTc prolongation
See main article: QT (QTc) Prolongation and Monitoring
Citalopram and escitalopram both have a dose-dependent QTc prolongation, but this effect is greater in citalopram than escitalopram (due to escitalopram only having S-enantiomer).[2][3]
Clinical Pearls
- eScitalopram is the S-enantiomer of the racemic SSRI citalopram
- Compared to citalopram, escitalopram is thought to be a more potent and selective serotonin reuptake inhibitor (though the clinical significance is unclear)[4]
- A good first line choice for medically complex patients due to fewer drug-drug interactions
- May be sedating for some patients, and activating for others
Special Populations
Geriatric
See main article: Geriatric Pharmacology
Pediatric
See main article: Pediatric Pharmacology
Obstetric and Fetal
See main article: Obstetric and Fetal Pharmacology
Medically Ill
See main article: Psychotropic Dosing in the Medically Ill
- Dose should be reduced in patients with hepatic impairment and/or age > 65.
Resources
References
1)
Do, A., Noohi, S., Elie, D., Mahdanian, A. A., Yu, C., Segal, M., ... & Rej, S. (2016). Health Canada warning on citalopram and escitalopram—its effects on prescribing in consultation-liaison psychiatry. Psychosomatics, 57(1), 57-63.
2)
Lam, R. W. (2013). Psychopharmacology for the Clinician. Journal of psychiatry & neuroscience: JPN, 38(2), E5.