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 pharmacokinetic profile and clinical evidence support its use as a first-line pharmacological intervention for mood and anxiety disorders.

Features

• Active ingredient: Escitalopram oxalate
• Drug class: Selective serotonin reuptake inhibitor (SSRI)
• Available formulations: Film-coated tablets (5 mg, 10 mg, 20 mg) and oral solution (5 mg/5 mL)
• High affinity for serotonin transporter with minimal effect on other neurotransmitter systems
• FDA-approved for major depressive disorder and generalized anxiety disorder
• Once-daily dosing regimen

Benefits

• Effectively reduces symptoms of depression, including low mood, anhedonia, and fatigue
• Demonstrates significant anxiolytic properties for generalized anxiety disorder
• Generally well-tolerated with lower incidence of certain side effects compared to older antidepressants
• Minimal drug-drug interactions due to selective mechanism of action
• Suitable for long-term maintenance therapy in chronic mood disorders
• Rapid onset of therapeutic effect typically within 2-4 weeks of initiation

Common use

Lexapro is primarily indicated for the treatment of major depressive disorder in adults and adolescents aged 12-17 years, as well as generalized anxiety disorder in adults. It is frequently prescribed as first-line pharmacotherapy due to its established efficacy and safety profile. Clinicians may also use Lexapro off-label for other anxiety spectrum disorders, including social anxiety disorder, panic disorder, and obsessive-compulsive disorder, though supporting evidence varies across these conditions.

Dosage and direction

Adults (MDD and GAD): Initiate treatment with 10 mg once daily, with or without food. Based on clinical response, dosage may be increased to 20 mg daily after a minimum of one week. Maintenance therapy typically continues at the lowest effective dose.

Geriatric patients: Recommended starting dose is 10 mg daily, with careful titration based on tolerance.

Adolescents (12-17 years, MDD only): Initiate with 10 mg once daily, with possible increase to 20 mg daily after three weeks if inadequate response.

Dosage adjustments are necessary in patients with hepatic impairment, with maximum recommended dose of 10 mg daily. Tablets should be swallowed whole with water; the oral solution should be measured using the provided dosing device.

Precautions

Lexapro should be used with caution in patients with a history of mania/hypomania, seizure disorders, or bleeding tendencies. SSRIs may impair platelet aggregation and increase bleeding risk, particularly when combined with NSAIDs, aspirin, or other anticoagulants. Caution is advised in patients with narrow-angle glaucoma due to potential pupillary dilation. Regular monitoring for emergence of anxiety, insomnia, panic attacks, agitation, or unusual changes in behavior is recommended, especially during initial treatment phases. Abrupt discontinuation should be avoided due to potential withdrawal symptoms.

Contraindications

Lexapro is contraindicated in patients taking monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOI therapy due to risk of serotonin syndrome. Concurrent use with pimozide is contraindicated due to potential QT prolongation. Hypersensitivity to escitalopram or any component of the formulation prohibits use. Additional contraindications include patients with uncontrolled narrow-angle glaucoma and those with severe hepatic impairment.

Possible side effects

Common (≥5%): Nausea, insomnia, ejaculation disorder, fatigue, drowsiness, increased sweating

Less common (1-5%): Diarrhea, constipation, dizziness, libido decreased, anorexia, anxiety, agitation

Rare (<1%): Serotonin syndrome, hyponatremia, abnormal bleeding, angle-closure glaucoma, QT prolongation

Sexual dysfunction including decreased libido, erectile dysfunction, and anorgasmia may occur. Most side effects are dose-dependent and often diminish with continued therapy. Patients should report any unusual or severe symptoms promptly.

Drug interaction

Significant interactions: MAOIs (risk of serotonin syndrome), serotonergic drugs (tramadol, triptans, linezolid), drugs that prolong QT interval (antiarrhythmics, antipsychotics), NSAIDs/aspirin/warfarin (increased bleeding risk)

Moderate interactions: CYP2C19 inhibitors (omeprazole, cimetidine), CYP3A4 inhibitors (ketoconazole)

Minor interactions: Alcohol (may enhance CNS depression)

Lexapro is primarily metabolized by CYP2C19 and CYP3A4 enzymes. Dose adjustment may be necessary when co-administered with strong inhibitors of these enzymes. Healthcare providers should conduct thorough medication reconciliation before initiation.

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is接近 the time for the next scheduled dose. In that case, the missed dose should be skipped and the regular dosing schedule resumed. Doubling doses to make up for a missed dose is not recommended. Patients should maintain consistent dosing times to ensure stable plasma concentrations.

Overdose

Symptoms of Lexapro overdose may include dizziness, sweating, nausea, vomiting, tremor, drowsiness, sinus tachycardia, and in severe cases, seizures, coma, or ECG changes including QT prolongation. There is no specific antidote for escitalopram overdose. Management consists of supportive care and symptomatic treatment. Gastric lavage may be considered if presented early after ingestion. Activated charcoal may be administered. ECG monitoring is recommended for at least 24 hours in significant overdose cases.

Storage

Store at room temperature (20-25°C or 68-77°F), with excursions permitted between 15-30°C (59-86°F). Keep in original container with lid tightly closed to protect from moisture and light. Keep out of reach of children and pets. Do not use beyond the expiration date printed on packaging. Oral solution should not be frozen.

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. Patients should not initiate, adjust, or discontinue medication without consulting their healthcare provider. The complete prescribing information should be reviewed before administration.

Reviews

Clinical trials demonstrate Lexapro’s efficacy with response rates of 60-70% in major depressive disorder and significant improvement in Hamilton Anxiety Rating Scale scores. Many patients report improved mood, reduced anxiety, and enhanced quality of life. Some users note initial side effects that often diminish over time. Healthcare professionals frequently cite its favorable side effect profile and once-daily dosing as advantages in long-term management of mood disorders. Real-world evidence supports its position as a well-tolerated and effective SSRI option.