Escitalopram (Lexapro)

Question 1

Brand

Answer 1

Lexapro

Question 2

Class, MOA

Answer 2

SSRI (1A)

*no known secondary properties for escitalopram

Question 3

Onset

Answer 3

2-4 weeks

Question 4

S/Es, Augment

Answer 4

Same as sertraline

Question 5

Dose

Answer 5

• 10-20 mg once daily
• Start at 10, inc to 20 if needed
• 10 mg of escitalopram is comparable to 40 mg of citalopram with fewer side effects
• Rarely 30-40 mg needed

Question 6

OD

Answer 6

Same as citalopram, but rarer

Question 7

Taper

Answer 7

50% for 3 days, 50% for next 3 days, stop

Question 8

Half life

Answer 8

• 27-32 hours

* Achieves steady state plasma conc in 1 week

Question 9

CYP action

Answer 9

None

Question 10

C/I with

Answer 10

• MAOIs
• Pimozide

Allergy to citalopram and escitalopram

Question 11

Special populations

Answer 11

• Use 10 mg in hepatic pts and in elderly

* Can use in kids above 12 years

Question 12

Advantages

Answer 12

• Patients taking other meds, as it as fewer drug interactions and no CYP action
• Patients needing faster onset of action

Question 13

Disadvantages

Answer 13

More expensive than citalopram

Question 14

Of note

Answer 14

• One of the best tolerated antidepressants
• May have less sexual S/Es than other SSRIs
• Better tolerated than Citalopram
• No CYP action, so commonly used with augmenting agents as no interactions.

*Citalopram has both R and S components - R interferes with binding of S at serotonin transporters
Escitalopram has only S and no R component, so may be twice as potent as citalopram.
So 10 mg escitalopram is efficacious as 40 mg citalopram, and also has faster onset and less S/Es than citalopram.