Escitalopram Dosage

The information at Drugs.com is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist.

Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Anxiety

10 mg orally once a day in the morning or evening with or without food.

The dose may be increased to 20 mg, after a minimum of one week.

Escitalopram (10 to 20 mg orally daily) has been shown to be well tolerated and effective in the treatment of generalized anxiety disorder for up to 6 months.

Usual Adult Dose for Depression

10 mg orally once a day in the morning or evening with or without food.

The dose may be increased to 20 mg, after a minimum of three weeks.

Usual Pediatric Dose for Depression

12 to 17 years:

10 mg orally once a day in the morning or evening with or without food.

The dose may be increased to 20 mg, after a minimum of three weeks.

Renal Dose Adjustments

CrCl greater than 25 mL/min: no adjustment recommended.
CrCl less than or equal to 25 mL/min: use with caution.

Liver Dose Adjustments

10 mg per day is the recommended dose in patients with hepatic impairment.

Precautions

Children, adolescents, and young adults (18 to 24 years of age) with major depressive disorder and other psychiatric disorders may be at an increased risk of suicidal thinking and suicidality with antidepressant use, particularly during the first few months of treatment. Medical evidence has not shown this increased risk to exist in adults older than 24 years of age, but adults 65 years of age and older taking antidepressants appear to have a decreased risk of suicidality. The results of a meta-analysis indicate an overall favorable risk to benefit profile for the use of antidepressants (i.e., selective serotonin and/or norepinephrine reuptake inhibitors) in the treatment of pediatric patients (less than 19 years old) with major depressive disorders (MDD), obsessive-compulsive disorder (OCD), or non OCD anxiety disorders. Although this study also reports an overall increased risk of suicidal ideation/suicide attempt associated with the use of antidepressants in pediatric patients, the risk may be less than originally estimated. Additional prospective studies are warranted in order to confirm these findings.

Escitalopram is the active enantiomer of citalopram. Controlled clinical trials on children and adolescents treated with citalopram have reported that suicide attempts have occurred more often by citalopram treated patients than by placebo treated patients. These trials also reported 16 cases of adolescent self harm. The FDA reports antidepressants may increase suicidal thoughts and actions in approximately 1 out of 50 pediatric patients (18 years and younger).

Worsening of depression and/or increased suicidal thinking or behavior may always be a possibility in patients treated with antidepressant medications, particularly those being treated for depression. Anxiety, agitation, panic attacks, insomnia, irritability, hostility, impulsivity, akathisia (severe restlessness), hypomania, and mania have been reported in patients being treated with antidepressants for major depressive disorder as well as for other indications, both psychiatric and nonpsychiatric. It is unknown if these symptoms are a precursor to either worsening of depression or the emergence of suicidal impulses; however, there is concern that patients who experience one or more of these symptoms may be at increased risk for worsening depression or suicidality. Although the FDA has not concluded that antidepressant drugs cause worsening depression or suicidality, health care providers should be aware that worsening of symptoms could be due to the underlying disease or might be a result of drug therapy.

Health care providers should carefully monitor patients receiving antidepressants for possible and/or persistent worsening of depression or emergent suicidality, especially at the beginning of therapy or when the dose either increases or decreases. If symptoms are severe, abrupt in onset, or were not part of the patient's presenting symptoms, the health care provider will need to determine what intervention, including discontinuing or modifying the current drug therapy, is indicated. Prescriptions should be written for small quantities of drug to reduce the risk of an attempt to overdose. Health care providers should instruct patients, their families and their caregivers to be alert for the emergence of agitation, irritability, and the other symptoms described above, as well as the emergence of suicidality and worsening depression, and to report such symptoms immediately to their health care provider.

Because antidepressants are believed to have the potential for inducing manic episodes in patients with bipolar disorder, there is a concern about using antidepressants alone in this population. Therefore, patients should be adequately screened to determine if they are at risk for bipolar disorder before initiating antidepressant treatment so that they can be appropriately monitored during treatment. Such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression.

The use of escitalopram is considered contraindicated in patients concomitantly receiving pimozide or monoamine oxidase inhibitors (MAOIs). The development of a potentially life-threatening serotonin syndrome may occur with use of escitalopram, especially with concomitant use of serotonergic drugs (including triptans) and drugs which impair metabolism of serotonin. Caution and close monitoring is recommended, especially during initiation of treatment or dose increases, in any patient in whom the concomitant use of escitalopram with a 5- hydroxytryptamine receptor agonist (triptan) is clinically necessary. The concomitant use of escitalopram and serotonin precursors (such as tryptophan) is not advised.

Escitalopram should not be used within 14 days of discontinuing treatment with an MAOI and at least 14 days should elapse after discontinuing escitalopram before starting an MAOI.

The concomitant administration with linezolid (a reversible nonselective MAOI) has been associated with serotonin syndrome.

Upon discontinuation of SSRI antidepressant therapy, symptoms of withdrawal (such as dizziness, lethargy, paresthesia, nausea, vivid dreams, irritability, and lowered mood) and adverse effects (such as dysphoric mood, irritability, agitation, dizziness, sensory disturbances, anxiety, confusion, headache, lethargy, emotional lability, insomnia, and hypomania) have been reported. Sensory disturbances have included paresthesias such as electric shock sensations and tinnitus. Patients should be monitored for symptoms when discontinuing treatment. A gradual reduction in dosage rather than abrupt discontinuation of therapy is recommended when possible. If intolerable symptoms occur following discontinuation of therapy, then resumption of the previous dose may be considered. Subsequently, discontinuation of therapy may be retried at a more gradual rate.

Bleeding episodes have been reported in patients treated with psychotropic drugs that interfere with serotonin reuptake. Subsequent epidemiological studies have reported an association between the use of psychotropic drugs that interfere with serotonin reuptake and the occurrence of upper gastrointestinal bleeding. Two studies have also reported that concurrent use of a nonsteroidal anti-inflammatory drug or aspirin potentiated the risk of bleeding. These studies focused on upper gastrointestinal bleeding. However, there is reason to believe that bleeding at other sites may be similarly potentiated. Patients should be warned about the risk of bleeding from concurrent use of paroxetine and NSAIDS, aspirin, or other drugs that affect coagulation.

Hyponatremia and the syndrome of inappropriate antidiuretic hormone (SIADH) secretion have been reported in patients receiving escitalopram.

Escitalopram should be used cautiously in patients with a seizure disorder.

Dialysis

Caution is recommended in patients with severe renal dysfunction.

Other Comments

Escitalopram may be administered with or without food.

Use of escitalopram for extended periods of time should be periodically reevaluated for long-term usefulness in each individual patient.

It is generally agreed that acute episodes of depression require several months or longer of sustained pharmacological therapy beyond the response to the acute episode. Systematic evaluation of continuing escitalopram 10 or 20 mg per day for periods up to 36 weeks in patients with major depressive disorder (who responded while taking escitalopram during an 8 week treatment phase) demonstrated a benefit to this maintenance treatment. Patients should be periodically reassessed to determine the need for maintenance and the appropriate dose for such treatment.

Efficacy in the treatment of generalized anxiety disorder has been demonstrated for up to 6 months.

Hide
(web1)