Adult Dosing
Major depressive disorder
- Start 10 mg PO qd, may increase after 1 wk to 20 mg/day
- Max: 20 mg/day; 10 mg/day in elderly patients and hepatic impairment
Generalized anxiety disorder
- Start 10 mg PO qd, may increase after 1 wk to 20 mg/day
- Max: 20 mg/day; 10 mg/day in elderly patients and hepatic impairment
Obsessive-compulsive disorder [Non-FDA Approved]
- Start 10 mg/day PO, titrate up to 20 mg/day
- Max: 40 mg/day
Note: Taper gradually to discontinue
Pediatric Dosing
Major depressive disorder
- Safety and effectiveness in pediatric patients <12 yrs of age have not been established
Child 12-17 yrs
- Start 10 mg PO qd, may increase after 3 wks to 20 mg/day
- Max: 20 mg/day
Note: Taper gradually to discontinue
Generalized anxiety disorder
- Safety and effectiveness in pediatric patients with GAD have not been established
[Outline]
See Supplemental Patient Information
- Worsening of depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior may occur in patients with MDD, whether or not they are on antidepressant medication; this risk may persist until significant remission occurs
- Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults with MDD and other psychiatric disorders [US Black Box Warning]
- Younger patients are more prone to suicidality; suicidality risk did not increase in patients >24 yrs of age, and the risk decreased in patients >65 yrs of age [US Black Box Warning]
- Monitor and closely observe patients for clinical worsening, suicidality, or unusual changes in behavior, especially during the initial few months of drug therapy or at times of dose modifications [US Black Box Warning]
- Anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, and mania, have occurred in adults and pediatric patients treated with antidepressants
- Consider changing the therapeutic regimen or discontinuation of therapy if depression is persistently worse, or in patients experiencing emergent suicidality or abrupt onset of severe symptoms suggesting worsening of depression or suicidality, especially if these symptoms were not part of the patient's presenting symptoms
- Advise families and caregivers to monitor the patients for emergence of agitation, irritability, unusual changes in behavior, emergence of suicidality, and report such symptoms immediately to health care providers
- Escitalopram is not indicated in the treatment of bipolar disorder. Therefore, prior to starting treatment in patients with depressive symptoms, determine if the patient is at risk for bipolar disorder. Screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression
- Life-threatening serotonin syndrome or neuroleptic malignant syndrome (NMS)-like reactions may occur, particularly with co-administration of serotonergic drugs. Patients should be monitored for the emergence of serotonin syndrome or NMS-like signs and symptoms
- Discontinue concomitant use of escitalopram with serotonergic or antidopaminergic agents, including antipsychotics if serotonin syndrome occurs, and initiate supportive symptomatic treatment
- If treatment is to be discontinued or the dose reduced, gradually taper dose and monitor the patient for withdrawal symptoms (eg, abnormal skin sensations, agitation, anxiety, confusion, dizziness, dysphoric mood, irritability, emotional lability, hypomania). If significant withdrawal symptoms develop, re-institute previous dosing schedule and attempt a less rapid tapering regimen after the patient has stabilized
- Convulsion, activation of mania or hypomania, hyponatremia due to syndrome of inappropriate antidiuretic hormone secretion (SIADH) have been reported during treatment with escitalopram; caution should be exercised in such patients
- Bleeding episodes have been reported in patients treated with drugs that interfere with serotonin reuptake. Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, warfarin, and other anticoagulants may add to the risk
- Patients should be cautious while operating hazardous machinery, including automobiles because escitalopram may impair judgment, thinking, or motor skills
- Serious, sometimes fatal, reactions including hyperthermia, rigidity, myoclonus, autonomic instability with possible rapid fluctuations of vital signs, and mental status changes that include extreme agitation progressing to delirium and coma have been reported in patients receiving serotonin reuptake inhibitor (SRI) and MAOI; hence concomitant administration with an MAOI or within 14 days of discontinuation of an MAOI is not recommended
- Escitalopram is not approved for use in pediatric patients <12 yrs of age
- Use in third trimester of pregnancy has been associated with respiratory, gastrointestinal and feeding problems in the neonate
Cautions: Use cautiously in
- Severe renal impairment
- Hepatic impairment
- History of seizure disorder
- History of cardiac disease
- Concurrent diuretics
- Geriatric population
- Alcohol use
- Volume depletion
Supplemental Patient Information
- Advise patients and their caregivers to monitor for the emergence and/or worsening of symptoms, suicidal behavior and depression, especially during the early therapy and to report them promptly to the health care provider
- Advise patients and their caregivers regarding the potential for drug interactions during concomitant use of other drugs and should be asked to inform their physicians prior to taking other drugs
Pregnancy Category:C (caution in 3rd trimester)
Breastfeeding: Limited information indicates that maternal doses up to 20 mg/day produce low levels in milk and would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months. Monitor the infant for drowsiness, especially in younger, exclusively breastfed infants and when using combinations of psychotropic drugs. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 17 February 2011). As per the manufacturer's data, caution should be exercised and breastfeeding infants should be observed for adverse reactions when escitalopram is administered to a nursing woman.
Pricing data from www.DrugStore.com in U.S.A.
- Lexapro 10 MG TABS [Bottle] (FOREST)
30 mg = $129.99
90 mg = $365.97 - Lexapro 5 MG/5ML SOLN [Bottle] (FOREST)
240 5ml = $211.36
720 5ml = $605.89 - Lexapro 5 MG TABS [Bottle] (FOREST)
30 mg = $127.99
90 mg = $352.97 - Lexapro 20 MG TABS [Bottle] (FOREST)
30 mg = $135.99
90 mg = $379.97
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
