Escitalopram
SSRI, S-enantiomer of citalopram (Lundbeck Lexapro/Cipralex). First-line Rx for MDD + anxiety disorders. Cipriani 2018 meta-analysis: top-3 efficacy.
Related comparisons
Escitalopram vs FluoxetineWHAT IS ESCITALOPRAM?
Detailed overview
Escitalopram is the active S-enantiomer of citalopram (R-enantiomer is pharmacologically inactive and may slightly interfere). Developed by Lundbeck (Lexapro FDA 2002), one of the cleanest SERT-selective SSRIs. Per Cipriani 2018 Lancet (PMID 29477251) network meta-analysis, top-3 of 21 antidepressants for efficacy-tolerability ratio (alongside vortioxetine, mirtazapine). Lader 2004 (PMID 15125014) trial showed MDD superiority over citalopram at 8 weeks. Generally better tolerability than citalopram, with lower QTc-prolongation risk (FDA 2011 warning for citalopram > 40 mg/day, escitalopram > 20 mg/day).
ATC code
N06AB10
Prescription
Prescription only (Rx)
Mechanism
Selective serotonin reuptake inhibitor (SSRI), SERT target
Half-life
27-32 h (once-daily dosing)
Onset
2-6 weeks (full antidepressant response)
Data console
Lab data
Safety
Side effects, stop signs, contraindications
Side effects · 8
- Increased risk of suicidal thoughts and behavior in patients under 25, especially at treatment start and dose changes (FDA boxed warning); close monitoring required.
- Serotonin syndrome (agitation, hyperthermia, myoclonus, tachycardia, diarrhea), especially combined with other serotonergic drugs; can be life-threatening.
- Discontinuation syndrome on abrupt stopping: dizziness, headache, irritability, 'electric shock' sensations, sleep disturbance; requires slow tapering.
- Sexual dysfunction (reduced libido, delayed orgasm, erectile dysfunction) common (about 10–20%) and may persist.
- Gastrointestinal effects: nausea (10–15%), diarrhea, dry mouth, decreased appetite; usually in the first weeks.
- Dose-dependent QT prolongation (> 20 mg/day not recommended) with risk of torsades de pointes; insomnia, headache, sweating also common.
- Hyponatremia / SIADH, especially in the elderly and with diuretics; fatigue, confusion, seizures may be warning signs.
- Increased bleeding risk (with NSAIDs, aspirin, anticoagulants) and induction of mania/hypomania in those with bipolar predisposition.
Contraindications · 3
- MAOi within 14 days (serotonin syndrome)
- Concurrent pimozide (QT prolongation)
- Congenital long-QT syndrome
Related Pharmaceuticals
Same therapeutic category
Studies
Related research and clinical findings
Comparative efficacy of 21 antidepressants for MDD
Cipriani A, Furukawa TA, Salanti G et al.
[Escitalopram: a selective inhibitor and allosteric modulator of the serotonin transporter].
Mnie-Filali O, El Mansari M, Scarna H, Haddjeri N
Escitalopram.
Aronson S, Delgado P
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The information here is for educational and scientific purposes only. Medication use requires medical consultation and a prescription. The indications, dose ranges, and side effects listed here do NOT replace the official Summary of Product Characteristics (SmPC) or consultation with a physician. Do not start or stop any medication on your own. In an emergency, call your local emergency number.