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.
| Substrate of (Metabolized by) | 2C19, 3A4 |
|---|---|
| Induces | |
| Inhibits |
| 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 |
| Starting | 10 mg PO daily |
|---|---|
| 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 |
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]