May 2019 By

Escitalopram (Cipralex)

Escitalopram (Tradename: Cipralex/Lexapro) is an Selective Serotonin Reuptake Inhibitors (SSRI).

Metabolized by CYP2C19, 3A4

  • 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 older SSRI citalopram
  • A good first line choice for medically complex patients
  • May be sedating and for some even activating, so elimination of antihistamine likely

Special Populations

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

QT prolongation

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.[2][3]