Escitalopram (Cipralex/Lexapro)

Pharmacokinetics of Escitalopram

Escitalopram: Cytochrome P450 Metabolism

Substrate of (Metabolized by) 2C19, 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

Dosing for Escitalopram

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
  • Escitalopram comes in

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]

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