Lexapro (Escitalopram) Indications and Dosage
- anxiety
- depression
- panic disorder †
- social phobia (social anxiety disorder) †
† non-FDA-approved indication
Lexapro (Escitalopram) Indications and Dosage
For the initial and maintenance treatment of major depression:
NOTE: Acute episodes of depression require several weeks or longer of sustained pharmacologic therapy. Initial studies have shown escitalopram to demonstrate significant antidepressant effects within 1-2 weeks. Prescribers should periodically re-evaluate the usefulness of long-term escitalopram therapy in their patients. The risk of suicide is inherent in any patient with depression, whether or not they are receiving an antidepressant. The clinician should be vigilant in assessing patients for suicidal ideation.
Oral dosage:
Adults: Initially, 10 mg PO once daily; may increase to 20 mg PO once daily after one week. A benefit of the 20 mg dose over the 10 mg dose has not been demonstrated, but side effects are dose-related. Head-to-head therapeutic interchange studies between escitalopram and citalopram are not available; however, studies have shown that the 10 mg once a day dose of escitalopram is as effective as both the 20 and 40 mg once a day titrated dose of citalopram. An unpublished study has shown that switching the next day from citalopram 20 mg/day to escitalopram 10 mg/day did not produce any new or clinically-relevant side effects. Long-term efficacy of escitalopram is extrapolated from citalopram studies showing that citalopram resulted in lower depression relapse rates compared to placebo over 24- and 72-week periods.
Elderly: 10 mg PO once daily.
Adolescents and children: Safe and effective use has not been established.
For the treatment of anxiety disorders:
- for the treatment of generalized anxiety disorder (GAD) or social phobia (social anxiety disorder) † :
NOTE: Unpublished studies have shown escitalopram to demonstrate significant anti-anxiety effects within 4 weeks. Whether the dose of escitalopram needed to induce remission is identical to the maintenance dose needed is unknown. Prescribers should periodically re-evaluate the usefulness of long-term escitalopram therapy in their patients.
Oral dosage:
Adults, including the elderly: Initially, 10 mg PO once daily; 8-week studies suggest the dose may be increased to 20 mg PO once daily after 4 weeks. Significant improvement vs. placebo was observed by week 2 (pooled data) with the 10 mg dose. Roughly twice as many patients in the active group (36%) were in remission at the end of 8 weeks vs. those in the placebo group (16%). Dose selection at the low end of the dose range may be more appropriate for certain debilitated or elderly patients.
Adolescents and children: No studies have been conducted.
- for the treatment of panic disorder † (panic attacks) with or without agoraphobia † :
NOTE: Unpublished studies have shown escitalopram to demonstrate significant anti-panic effects within 4 weeks. Whether the dose of escitalopram needed to induce remission is identical to the maintenance dose needed is unknown. Prescribers should periodically re-evaluate the usefulness of long-term escitalopram therapy in their patients.
Oral dosage:
Adults, including the elderly: Initially, 5 mg PO once daily. An unpublished, double-blind, 10-week study (n=247) suggests escitalopram can reduce the number and severity of panic attacks. Symptoms improved within 4 weeks. By the end of the study, half of escitalopram patients were completely free of attacks vs. 39% of those in the placebo group. Mean changes in the Panic and Agoraphobia Scale vs. placebo were significant at 4 weeks and continued to improve over the 10-week study period. Reductions in anxiety were also significant. Further clinical trials are needed to define the correct dose, safety and efficacy profile, and comparative use of escitalopram for panic disorders.
Adolescents and children: No studies have been conducted.
Maximum Dosage Limits:
- Adults: 20 mg/day PO.
- Elderly: 10 mg/day PO for depression; 20 mg/day PO for anxiety.
- Adolescents: Safe and effective use has not been established.
- Children: Safe and effective use has not been established.
Patients with hepatic impairment:
Escitalopram is extensively metabolized in the liver. Initiate and maintain therapy with 10 mg PO once daily in patients with hepatic impairment.
Patients with renal impairment:
CrCl >= 20 ml/min: No dosage adjustment is necessary.
CrCl < 20 ml/min: Specific guidelines for dosage adjustments in severe renal impairment are not available; however, there is potential for reduced clearance and escitalopram should be dosed cautiously.
† non-FDA-approved indication
[ Last revised: 3/8/2005 12:52:00 PM ]
Related entries
Monthly Archives
Syndicate
Allergies
