Escitalopram
SSRI, S-enantiomer of citalopram (Lundbeck Lexapro/Cipralex). First-line Rx for MDD + anxiety disorders. Cipriani 2018 meta-analysis: top-3 efficacy.
WHAT 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).
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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Educational drug info from official sources (PubMed, FDA, EMA). Does NOT replace medical consultation or the SmPC. Talk to your doctor!
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.