TaperCommunityescitalopram
Boxed Warning
Suicidality risk in children, adolescents, and young adults under 25 during initial treatment.
Escitalopram is the therapeutically active S-enantiomer of citalopram, an SSRI used for the treatment of major depressive disorder and generalized anxiety disorder. It is considered one of the most selective SSRIs available.
5mg, 10mg, 20mg
Tablets: 5mg, 10mg, 20mg; Oral solution: 1mg/mL
Category C (risk cannot be ruled out)
Selective serotonin reuptake inhibitor (SSRI) that binds with high affinity to the serotonin transporter (SERT), blocking reuptake of serotonin into the presynaptic neuron and increasing serotonergic neurotransmission.
Hyperbolic taper recommended. Liquid formulation (1mg/mL) available for precise final cuts below 5mg.
Reduce by proportionally smaller amounts at lower doses. Final reductions (2.5mg → 0) are often the hardest. Consider liquid formulation for cuts below 2.5mg.
Evidence-based phased reduction schedule. Always taper under medical supervision.
| Phase | Duration | Notes |
|---|---|---|
| Initial reductions | ~4 weeks | Larger dose steps are generally better tolerated early on. Your prescriber will determine appropriate increments. |
| Middle reductions | 4-6 weeks | Smaller dose changes become important. Liquid formulation may help with precision at lower doses. |
| Final reductions | 8-12 weeks | The lowest doses often require the slowest, most gradual approach. Discuss liquid formulation with your prescriber. |
1-3 days after dose reduction
4-7 days
2-4 weeks for most symptoms
Brain zaps and emotional blunting may persist 1-3 months in some cases
Practical insights shared by members tapering Lexapro. Not medical advice — always consult your prescriber.
Toxicity
Serotonin syndrome at high doses or in combination with serotonergic agents. QT prolongation rare but dose-dependent.
Pharmacokinetics
Rapidly absorbed after oral administration, Tmax ~5 hours, bioavailability ~80%, unaffected by food.
~12 L/kg
Hepatic via CYP3A4 and CYP2C19 to S-demethylcitalopram (S-DCT) and S-didemethylcitalopram (S-DDCT), both with minimal pharmacological activity.
Renal (~8% excreted unchanged) and hepatic metabolism.
~56%
~600 mL/min (oral clearance)
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