Escitalopram

SSRI·Psychiatry - Antidepressants

Major Depressive Disorder, Generalized Anxiety Disorder, Social Anxiety, OCD

PBSSSRILexapro, Lexam10 mg tabletS4+1

Max Dose

20 mg/day

Half-life

30 h

QTc Risk

DOSE-DEP

Elderly Max

10 mg/day

Rapid Summary

Overview

The S-enantiomer of citalopram. The most highly selective SSRI available. Exceptional tolerability and efficacy, but carries a strict, dose-dependent risk of QTc prolongation.

Maximum Dose

Max 20 mg/day (Adults) • Max 10 mg/day (Elderly >65 yrs).

Clinical Focus

Do not exceed 10mg in the elderly due to severe QTc and hyponatremia risks.

Bottom Line

Escitalopram is the most selective SSRI with strong efficacy for depression and generalised anxiety disorder, but prolongs QTc dose-dependently (max 20 mg/day) and has the same SSRI class risks.

Formulation & Access

Brand Names

Lexapro, Lexam

Oral Routes

Tablets (10 mg, 20 mg). Oral drops (10 mg/mL).

Prescribing & PBS

Unrestricted General Benefit (S4).

Indications & Use

Primary

PBSTGA

Major Depressive Disorder, Generalized Anxiety Disorder, Social Anxiety, OCD.

Clinical Place

Arguably the most 'tolerable' SSRI. Often chosen for patients highly sensitive to the side effects of other antidepressants.

Quick reference

Class & Role

SSRI — The S-enantiomer of citalopram.

Route / Formulation

Tablets (10 mg, 20 mg). Oral drops (10 mg/mL). (Lexapro, Lexam)

Usual Dose & Max

Start PO 10 mg OD. May increase to Max 20 mg/day after 2-4 weeks.

Key Indication Doses

Depression / Anxiety: Start PO 10 mg OD. May increase to Max 20 mg/day after 2-4 weeks. Elderly / Hepatic Impairment: Max PO 10 mg OD.

Best Uses

Escitalopram is the most selective SSRI with strong efficacy for depression and generalised anxiety disorder, but prolongs QTc dose-dependently (max 20 mg/day) and has the same SSRI class risks.

Avoid / Cautions

Concurrent MAOI use. Baseline QTc > 500 ms. Pregnancy Category C.

Key Risks

Cardiovascular: Dose-dependent QTc prolongation. Can lead to fatal Torsades de Pointes if combined with other agents or in hypokalemia. Metabolic: Hyponatremia (SIADH) in the elderly. Gastrointestinal: Nausea (usually milder than Sertraline/Fluoxetine). Endocrine/GU: Sexual dysfunction.

Key Interactions

Avoid mixing with other QTc prolonging drugs (e.g., Amiodarone, Haloperidol, Sotalol). Omeprazole inhibits CYP2C19, significantly increasing Escitalopram levels and QTc risk. Max Escitalopram dose is 10mg if on Omeprazole. NSAIDs (Bleeding risk).

Monitoring

Baseline ECG to check QTc before escalating to 20 mg, especially in females > 65 years. Check U&E (sodium) at 2-4 weeks in the elderly.

Clinical Pearl

For patients over 65, the liver cannot clear the drug fast enough. 10mg in an 80-year-old gives the same blood levels as 20mg in a 30-year-old. Pushing to 20mg in the elderly provides zero extra mood benefit but massively risks a fatal cardiac arrhythmia.

Access

Lexapro, Lexam10 mg tablet

Brand: Lexapro, Lexam
Formulation: Tablets (10 mg, 20 mg)

Escitalopram

SSRI·Psychiatry - Antidepressants

Major Depressive Disorder, Generalized Anxiety Disorder, Social Anxiety, OCD

PBSSSRILexapro, Lexam10 mg tabletS4+1

Max Dose

20 mg/day

Half-life

30 h

QTc Risk

DOSE-DEP

Elderly Max

10 mg/day

Rapid Summary

Overview

The S-enantiomer of citalopram. The most highly selective SSRI available. Exceptional tolerability and efficacy, but carries a strict, dose-dependent risk of QTc prolongation.

Maximum Dose

Max 20 mg/day (Adults) • Max 10 mg/day (Elderly >65 yrs).

Clinical Focus

Do not exceed 10mg in the elderly due to severe QTc and hyponatremia risks.

Bottom Line

Escitalopram is the most selective SSRI with strong efficacy for depression and generalised anxiety disorder, but prolongs QTc dose-dependently (max 20 mg/day) and has the same SSRI class risks.

Formulation & Access

Brand Names

Lexapro, Lexam

Oral Routes

Tablets (10 mg, 20 mg). Oral drops (10 mg/mL).

Prescribing & PBS

Unrestricted General Benefit (S4).

Indications & Use

Primary

PBSTGA

Major Depressive Disorder, Generalized Anxiety Disorder, Social Anxiety, OCD.

Clinical Place

Arguably the most 'tolerable' SSRI. Often chosen for patients highly sensitive to the side effects of other antidepressants.

Quick reference

Class & Role

SSRI — The S-enantiomer of citalopram.

Route / Formulation

Tablets (10 mg, 20 mg). Oral drops (10 mg/mL). (Lexapro, Lexam)

Usual Dose & Max

Start PO 10 mg OD. May increase to Max 20 mg/day after 2-4 weeks.

Key Indication Doses

Depression / Anxiety: Start PO 10 mg OD. May increase to Max 20 mg/day after 2-4 weeks. Elderly / Hepatic Impairment: Max PO 10 mg OD.

Best Uses

Escitalopram is the most selective SSRI with strong efficacy for depression and generalised anxiety disorder, but prolongs QTc dose-dependently (max 20 mg/day) and has the same SSRI class risks.

Avoid / Cautions

Concurrent MAOI use. Baseline QTc > 500 ms. Pregnancy Category C.

Key Risks

Key Interactions

Monitoring

Baseline ECG to check QTc before escalating to 20 mg, especially in females > 65 years. Check U&E (sodium) at 2-4 weeks in the elderly.

Clinical Pearl

Access

Lexapro, Lexam10 mg tablet

Brand: Lexapro, Lexam
Formulation: Tablets (10 mg, 20 mg)