Lexapro
escitalopram
Boxed Warning
Suicidality risk in children, adolescents, and young adults under 25 during initial treatment.
Overview
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)
Mechanism of Action
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.
Taper Notes
Hyperbolic taper recommended. Liquid formulation (1mg/mL) available for precise final cuts below 5mg.
Maudsley Deprescribing Guidance
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.
Common Withdrawal Symptoms
Interactions & Safety
Drug Interactions
- MAOIs — contraindicated (risk of serotonin syndrome)
- CYP2C19 inhibitors (e.g., omeprazole) may increase escitalopram levels
- Serotonergic drugs (triptans, tramadol, St. John's Wort) increase serotonin syndrome risk
Food Interactions
- Grapefruit juice may increase levels via CYP3A4 inhibition
- No significant food effect on absorption
Contraindications
- MAOIs within 14 days
- Pimozide
- Known hypersensitivity to escitalopram or citalopram
Toxicity
Serotonin syndrome at high doses or in combination with serotonergic agents. QT prolongation rare but dose-dependent.
Pharmacokinetics
ADME Profile
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)
Need a clinician who understands tapering?
Browse our map of deprescribing-informed providers worldwide.