Escitalopram (Cipralex)

Escitalopram (Tradename: Cipralex/Lexapro) is a medication in the Selective Serotonin Reuptake Inhibitors (SSRI) class.

Metabolized by CYP2C19, 3A4

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
• Starting: 10mg
• Maximum: 20mg
• Starting: 5mg
• Maximum: 10mg
Taking omeprazole* • Starting: 20mg
• Maximum: 20mg
• Starting: 5mg
• Maximum: 10mg
  • Start at 10mg
  • Maximum dose is 20mg per day, due to QTc concerns[1]
Adult Dosing
  • Max dose is 20mg
Geriatric Dosing
  • Start at 5mg and increase to 10mg, max dose is 10mg in geriatric population
  • 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)[2]
  • 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

Dose should be reduced in patients with hepatic impairment and/or age > 65.

Citalopram and escitalopram both have a dose-dependent QTc prolongation. This effect is greater in citalopram than escitalopram (due to escitalopram only having S-enantiomer). The threshold for clinical significance of the QTc interval is an absolute duration of 500 ms or longer or a change from baseline of 60 ms or more.[3][4]