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escitalopram
Lexapro
SSRI⚠ Unverified beta content
At a glance
- Class
- Selective serotonin reuptake inhibitor
- Black box
- ⚠ Suicidal thoughts and behaviors
- Key monitoring
- Suicidality / mood / behavior
- Usual adult dose
- MDD / GAD: 10–20 mg/day
- Call provider / escalate if
- Thoughts of suicide or self-harm, or worsening mood • Fainting, palpitations, irregular heartbeat • Serotonin syndrome signs (agitation, fever, sweating, tremor, stiffness, diarrhea)
Built-in explanation — generated offline from this app’s structured data (no AI, no network). Still unverified beta content.
What it is
- escitalopram (Lexapro) — selective serotonin reuptake inhibitor.
- Used for: Major depressive disorder; Generalized anxiety disorder.
Usual adult dosing
- MDD / GAD: 10–20 mg/day (Start 10 mg daily; may increase to 20 mg after ≥1 week.)
- Older adults / hepatic impairment: 10 mg/day recommended
Boxed warning
- Suicidal thoughts and behaviors: antidepressants increase the risk in children, adolescents and young adults (to age 24) with major depression and other psychiatric disorders. Monitor closely, especially at start and with dose changes.
Monitor
- Suicidality / mood / behavior [Every contact; closely early & after dose changes]
Nursing priorities
- Baseline mood, suicidal ideation (ask directly), anxiety, sleep, appetite, activity level.
- Screen for history of mania/hypomania or bipolar disorder before/early in treatment.
- Assess suicidal ideation each shift/visit, especially first weeks and after dose changes; follow facility safety protocols.
- Full effect often takes 4–6 weeks; reinforce that early side effects often ease but benefit is delayed.
- Do not stop abruptly; support adherence and report missed doses/side effects.
Major interactions
- MAOIs / linezolid / methylene blue: Serotonin syndrome – contraindicated; allow washout per label (typically 14 days after MAOI).
- Other serotonergic drugs (triptans, tramadol, fentanyl, St John’s wort, other antidepressants, lithium): Increased risk of serotonin syndrome.
- Other QT-prolonging drugs (e.g., haloperidol, ondansetron, some antiarrhythmics, citalopram): Additive QT prolongation.
Key teaching
- Take it every day, even when you feel better. It can take 4–6 weeks to feel the full effect.
- Do not stop suddenly – talk to your provider first; stopping fast can cause dizziness, “brain zaps,” nausea, and irritability.
- Tell your care team right away about new or worse thoughts of hurting yourself, agitation, or unusual changes in mood or behavior.
Optional: AI explanation
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Boxed warning
- Suicidal thoughts and behaviors: antidepressants increase the risk in children, adolescents and young adults (to age 24) with major depression and other psychiatric disorders. Monitor closely, especially at start and with dose changes.
Other serious warnings
- Serotonin syndrome
- Dose-related QT prolongation (less than citalopram; caution with risk factors)
- Bleeding risk
- Hyponatremia/SIADH
- Activation of mania
- Discontinuation syndrome
Sources: FDA label (DailyMed): LEXAPRO (ESCITALOPRAM) TABLET, FILM COATED LEXAP
- Suicidality / mood / behaviorWhen: Every contact; closely early & after dose changes
- ECG / QTcWhen: Baseline if risk factorsIf risk factors; correct K/Mg first
- SodiumWhen: If at risk or symptomatic
Sources: FDA label (DailyMed): LEXAPRO (ESCITALOPRAM) TABLET, FILM COATED LEXAP
Assessment
- Baseline mood, suicidal ideation (ask directly), anxiety, sleep, appetite, activity level.
- Screen for history of mania/hypomania or bipolar disorder before/early in treatment.
- Medication/supplement list for serotonergic drugs, anticoagulants, NSAIDs.
- Baseline sodium if older adult, on diuretics, or history of hyponatremia.
- Cardiac history, family history of long QT, current QT-prolonging drugs, potassium/magnesium status.
Interventions
- Assess suicidal ideation each shift/visit, especially first weeks and after dose changes; follow facility safety protocols.
- Full effect often takes 4–6 weeks; reinforce that early side effects often ease but benefit is delayed.
- Do not stop abruptly; support adherence and report missed doses/side effects.
- Monitor for activation (agitation, insomnia, restlessness/akathisia, new mania).
- Consider ECG when QT risk factors are present (bradycardia, hypokalemia/hypomagnesemia, congenital long QT, other QT drugs).
Sources: General nursing drug reference conventions (e.g., Davis Drug Guide / L
- Thoughts of suicide or self-harm, or worsening mood
- Fainting, palpitations, irregular heartbeat
- Serotonin syndrome signs (agitation, fever, sweating, tremor, stiffness, diarrhea)
- Unusual bleeding
- Confusion/weakness (low sodium)
- Manic symptoms
Sources: FDA label (DailyMed): LEXAPRO (ESCITALOPRAM) TABLET, FILM COATED LEXAP · General nursing drug reference conventions (e.g., Davis Drug Guide / L
- Nausea
- Insomnia or somnolence
- Ejaculation disorder / decreased libido / anorgasmia
- Fatigue
- Dry mouth
- Sweating
- Diarrhea / constipation
Sources: FDA label (DailyMed): LEXAPRO (ESCITALOPRAM) TABLET, FILM COATED LEXAP
- MAOIs / linezolid / methylene blue MajorSerotonin syndrome – contraindicated; allow washout per label (typically 14 days after MAOI).
- Other serotonergic drugs (triptans, tramadol, fentanyl, St John’s wort, other antidepressants, lithium) MajorIncreased risk of serotonin syndrome.
- NSAIDs, aspirin, anticoagulants, antiplateletsIncreased bleeding risk (GI bleed).
- Diuretics, other hyponatremia-causing drugsAdded risk of hyponatremia/SIADH, especially in older adults.
- Other QT-prolonging drugs (e.g., haloperidol, ondansetron, some antiarrhythmics, citalopram) MajorAdditive QT prolongation.
- Cimetidine, omeprazole (CYP2C19 inhibitors)May raise escitalopram levels.
Sources: FDA label (DailyMed): LEXAPRO (ESCITALOPRAM) TABLET, FILM COATED LEXAP
- Take it every day, even when you feel better. It can take 4–6 weeks to feel the full effect.
- Do not stop suddenly – talk to your provider first; stopping fast can cause dizziness, “brain zaps,” nausea, and irritability.
- Tell your care team right away about new or worse thoughts of hurting yourself, agitation, or unusual changes in mood or behavior.
- Check with a pharmacist/provider before taking other medicines, herbal products (like St John’s wort), or NSAIDs such as ibuprofen.
- Avoid alcohol or limit it; it can make side effects and depression worse.
Sources: General nursing drug reference conventions (e.g., Davis Drug Guide / L
Indications
- Major depressive disorder
- Generalized anxiety disorder
Dosing
- MDD / GAD: 10–20 mg/dayStart 10 mg daily; may increase to 20 mg after ≥1 week.
- Older adults / hepatic impairment: 10 mg/day recommended
Sources: FDA label (DailyMed): LEXAPRO (ESCITALOPRAM) TABLET, FILM COATED LEXAP
Prescriber-oriented details; limited in this beta.
hepatic Adjustment
- 10 mg/day in hepatic impairment (per label).
geriatric
- 10 mg/day recommended for older adults.
Sources: FDA label (DailyMed): LEXAPRO (ESCITALOPRAM) TABLET, FILM COATED LEXAP
- Verified
- No – unverified beta
- Last reviewed
- 2026-10-29 (drafted; not clinician-reviewed)
- FDA label (DailyMed): LEXAPRO (ESCITALOPRAM) TABLET, FILM COATED LEXAPRO (ESCITALOPRAM) SOLUTION [ALLERGAN, INC.]
- General nursing drug reference conventions (e.g., Davis Drug Guide / Lexicomp nursing) - summarized from standard practice; NOT line-by-line verified