Lexapro (escitalopram oxalate) is a selective serotonin reuptake inhibitor (SSRI) approved by the FDA for the treatment of major depressive disorder (MDD) and generalized anxiety disorder (GAD) in adults and adolescents. As one of the most widely prescribed antidepressants globally, Lexapro demonstrates high selectivity for the serotonin transporter, resulting in efficacy with a generally favorable side effect profile. Its well-established pharmacokinetics and clinical evidence support its use as a first-line pharmacological intervention for mood and anxiety disorders.

Features

• Contains escitalopram oxalate as the active pharmaceutical ingredient
• Available in 5 mg, 10 mg, and 20 mg film-coated tablets
• Also supplied as an oral solution (5 mg/5 mL)
• Exhibits high selectivity for serotonin reuptake inhibition
• Minimal effect on norepinephrine and dopamine transporters
• Linear pharmacokinetics with dose proportionality
• Mean elimination half-life of 27–32 hours
• Steady-state plasma concentrations achieved within one week
• Primarily metabolized by CYP2C19, CYP3A4, and CYP2D6 liver enzymes

Benefits

• Demonstrated efficacy in reducing symptoms of major depressive disorder
• Effective management of generalized anxiety disorder symptoms
• Generally well-tolerated side effect profile compared to older antidepressants
• Once-daily dosing regimen supports treatment adherence
• Lower potential for drug interactions than some other SSRIs
• Established safety profile across diverse patient populations

Common use

Lexapro is primarily indicated for the treatment of major depressive disorder (MDD) in adults and adolescents aged 12–17 years, and for generalized anxiety disorder (GAD) in adults. Clinical studies have demonstrated its effectiveness in improving mood, reducing anxiety symptoms, and enhancing overall functioning. Healthcare providers may also prescribe Lexapro off-label for other anxiety disorders, including social anxiety disorder, panic disorder, and obsessive-compulsive disorder, though these uses are not FDA-approved. Treatment response typically becomes evident within 1–2 weeks, with full therapeutic effects manifesting after 4–6 weeks of consistent dosing.

Dosage and direction

The recommended starting dosage for Lexapro is 10 mg once daily for both major depressive disorder and generalized anxiety disorder in adults. Based on individual patient response and tolerability, the dosage may be increased to a maximum of 20 mg daily after a minimum of one week. For adolescents aged 12–17 years with MDD, the recommended starting dose is 10 mg once daily, with possible increase to 20 mg daily after three weeks. For elderly patients or those with hepatic impairment, the recommended starting dose is 5 mg daily, with a maximum dose of 10 mg daily. Lexapro may be taken with or without food, preferably at the same time each day to maintain consistent plasma concentrations. Dosage adjustments should be made under medical supervision, and treatment should not be discontinued abruptly.

Precautions

Patients should be monitored closely for clinical worsening, suicide risk, and unusual changes in behavior, particularly during the initial months of therapy and during dosage adjustments. Lexapro may cause activation of mania/hypomania in patients with bipolar disorder; therefore, screening for bipolar disorder is recommended before initiation. Use with caution in patients with a history of seizures. SSRI treatment may impact bone density; periodic monitoring may be warranted in at-risk populations. Lexapro can cause hyponatremia, particularly in elderly patients, those taking diuretics, or those who are volume-depleted. Caution is advised when prescribing to patients with conditions that affect metabolism or hemodynamic response. Patients should be advised that Lexapro may impair judgment, thinking, or motor skills, and should exercise caution when operating machinery or driving until they know how the medication affects them.

Contraindications

Lexapro is contraindicated in patients taking monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOI treatment due to the risk of serotonin syndrome. Concomitant use with pimozide is contraindicated due to the potential for QT prolongation. Lexapro is contraindicated in patients with known hypersensitivity to escitalopram, citalopram, or any component of the formulation. The use of Lexapro is contraindicated in patients taking linezolid or intravenous methylene blue due to serotonin syndrome risk. Patients with congenital long QT syndrome or known QT prolongation should avoid Lexapro treatment.

Possible side effect

Common side effects (occurring in >5% of patients) include nausea, insomnia, ejaculation disorder, fatigue, drowsiness, increased sweating, and decreased libido. Less frequent side effects (1–5% incidence) include diarrhea, constipation, indigestion, vomiting, yawning, arthralgia, myalgia, rhinitis, sinusitis, and flu-like symptoms. Sexual side effects may include anorgasmia, erectile dysfunction, and decreased libido in both men and women. Rare but serious adverse effects may include serotonin syndrome, abnormal bleeding, angle-closure glaucoma, hyponatremia, manic episodes, seizures, and QT interval prolongation. Most side effects are dose-dependent and often diminish with continued treatment.

Drug interaction

Lexapro has significant interactions with MAO inhibitors, potentially causing serotonin syndrome. Strong inhibitors of CYP2C19 (e.g., fluconazole, omeprazole) may increase escitalopram concentrations. Concomitant use with other serotonergic drugs (triptans, tramadol, tryptophan, St. John’s wort) may increase serotonin syndrome risk. Lexapro may increase bleeding risk when used with NSAIDs, aspirin, warfarin, or other anticoagulants. Concurrent use with drugs that prolong QT interval (antiarrhythmics, antipsychotics, antibiotics) may increase arrhythmia risk. Lexapro may alter concentrations of drugs metabolized by CYP2D6 (e.g., metoprolol, risperidone). Carbamazepine may decrease escitalopram concentrations through CYP3A4 induction.

Missed dose

If a dose of Lexapro is missed, it should be taken as soon as remembered unless it is close to the time for the next scheduled dose. In that case, the missed dose should be skipped, and the regular dosing schedule resumed. Patients should not take a double dose to make up for a missed one. Maintaining consistent dosing is important for stable therapeutic effects, but occasional missed doses are unlikely to significantly impact treatment efficacy. Patients should contact their healthcare provider if multiple doses are missed or if they have questions about dosing.

Overdose

Lexapro overdose may manifest as dizziness, sweating, nausea, vomiting, tremor, drowsiness, sinus tachycardia, amnesia, confusion, coma, convulsions, and ECG changes including QT prolongation. In cases of massive overdose, serotonin syndrome may occur, characterized by mental status changes, autonomic instability, neuromuscular symptoms, and gastrointestinal symptoms. Fatalities have been reported primarily with mixed overdoses involving multiple drugs. There is no specific antidote for Lexapro overdose. Treatment should consist of supportive measures and symptomatic care. Gastric lavage with airway protection may be considered if performed soon after ingestion. Activated charcoal may be administered. ECG monitoring is recommended for at least 24 hours in cases of significant overdose.

Storage

Store Lexapro tablets and oral solution at room temperature (20–25°C or 68–77°F), with excursions permitted between 15–30°C (59–86°F). Keep the medication in its original container, tightly closed, and protected from light and moisture. Do not store in bathroom areas where moisture levels may be high. Keep out of reach of children and pets. Properly discard any unused medication after the expiration date or when treatment is discontinued. The oral solution should be used within 90 days after first opening the bottle.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Lexapro is a prescription medication that should be used only under the supervision of a qualified healthcare professional. Individual response to treatment may vary, and only a healthcare provider can determine the appropriate treatment based on a patient’s specific medical condition, history, and current medications. Patients should not adjust their dosage or discontinue treatment without consulting their healthcare provider. The complete prescribing information should be reviewed before initiating therapy.

Reviews

Clinical trials and post-marketing surveillance demonstrate that Lexapro is generally well-tolerated and effective for its indicated conditions. In randomized controlled trials, Lexapro showed significant improvement in depression and anxiety ratings compared to placebo. Many patients report improved mood, reduced anxiety, and better overall functioning. However, individual experiences vary, and some patients may not respond adequately or may experience bothersome side effects. Long-term studies support the maintenance of efficacy with continued treatment. Patient satisfaction surveys indicate that many appreciate the once-daily dosing and relatively mild side effect profile compared to other antidepressants. Healthcare providers often consider Lexapro a first-line option due to its established efficacy and safety profile.