Escitalopram

LEXAPRO

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Pronunciation: es-sye-TAL-oe-pram (LEX-a-proe)

Escitalopram ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Escitalopram ballicule

Escitalopram LEXAPRO mascot mnemonic cartoon — Visual mnemonic: Escitalopram mascot
**“Lexus Pram”**
Pram is the British word for baby carriage
Blue cloud → serotonin reuptake inhibitor (SRI)

What it isSSRI, the active S-enantiomer of citalopram; depression and generalized anxiety.

Why this oneMinimal CYP inhibition and little activating or sedating burden make it a common first choice when tolerability matters.

What limits itQT prolongation is dose-related; use lower ceilings in older adults or hepatic impairment. Watch for hyponatremia.

Escitalopram molecular structure (skeletal formula) — Molecular structure: Escitalopram

FDA-approved for

depression (2002)
GAD (2003)

Off-label

panic disorder
PMDD

FDA label

Read the full label on DailyMed ↗

BOXED WARNING Antidepressants increased risk of suicidal thoughts and behaviors in pediatric and young adult patients; monitor closely.

FDA dosing	Population	Start	Target	Max
Major depressive disorder	Adults	10 mg QD	10 mg QD	20 mg QD
Major depressive disorder	Peds >=12 y	10 mg QD	10 mg QD	20 mg QD
Generalized anxiety disorder	Adults	10 mg QD	10 mg QD	20 mg QD

Titration Increase at intervals of no less than 1 week (no less than 3 weeks in pediatrics)

Renal Undefined

Hepatic 10 mg once daily

Instructions

Administer once daily, morning or evening, with or without food
When discontinuing, reduce dose gradually
Elderly: recommended dosage 10 mg once daily

Available strengths

tab 5, 10, 20 mg
sol 5 mg/5 mL
cap 15 mg

Contraindications

MAOIs (concurrently or within 14 days) due to risk of serotonin syndrome
Concomitant pimozide

Cautions

Serotonin syndrome
Discontinuation syndrome
Seizures (caution with history)
Activation of mania/hypomania (screen for bipolar disorder)
Hyponatremia/SIADH
Increased bleeding risk (NSAIDs, aspirin, warfarin)
Angle-closure glaucoma
Sexual dysfunction

Adverse reactions

Insomnia
Ejaculation disorder
Nausea
Increased sweating
Fatigue
Somnolence
Decreased libido
Anorgasmia

Pregnancy SSRI; late-pregnancy use may cause PPHN and poor neonatal adaptation; no established increase in birth defects

Lactation Undefined

Cost

Escitalopram (LEXAPRO)

What pharmacies pay · NADAC 9/30/26

Strength		#/mo	generic $	CostPlus
5 mg	tab	30 qd	$1.25/mo	offered
10 mg	tab	30 qd	$1.18/mo	offered
20 mg	tab	30 qd	$1.89/mo	offered
5 mg/5 mL	sol	per unit	$0.14/mL	offered

Generic entry2007

⚠ BOXED WARNING

Suicidal thoughts and behaviors in patients under 25

Classes and tags

Clinical profile

Therapeutic safety burden2 / 4

Overdose danger2 / 4

Weight-gain liability1 / 4

Sedation liability1 / 4

QT / Torsades1 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk1 / 4

Legacy pregnancy categoryC

Defining liabilitySexual/GI effects, hyponatremia, discontinuation and serotonin toxicity; overdose danger varies substantially by agent.

Serotonin and MAOI

Provisional washout figures

SRI significance3 / 4

MAO-A inhibition0 / 4

Serotonin release0 / 4

Elevating mechanismSRI

Non-elevating actionNone recorded

Exposure dependenceTherapeutic exposure; severe toxicity requires meaningful MAO-A inhibition

Washout BEFORE an MAOI14 days

Evidence confidenceHigh

InterpretationClinically significant SRI. A second SRI generally represents therapeutic duplication/additive adverse effects, not the classic life-threatening interaction.

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Memory aids: interaction avatars

CYP2C19 substrate

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