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Overview brief

Escitalopram capsule, commonly known by the brand name Lexapro, is an SSRI antidepressant that increases serotonin activity in the brain. In Australian clinical practice it is widely used to treat major depressive disorder and generalised anxiety disorder in adults and can be considered for other anxiety-related conditions when appropriate.

For options if escitalopram is unsuitable, jump to Other Medications and Similar Medicines. For safety checks and follow-up after you begin treatment, see System monitoring and Safety Protocols.

• Lexapro, the trade name for escitalopram is the medicinal active ingredient
• Common tablet strengths in Australia: 5 mg, 10 mg, 20 mg film-coated tablets
• Primary telltale signs: depression and generalised anxiety disorder; may also be used for other anxiety disorders per clinician judgement

Plan before you begin escitalopram

Tell your prescriber and pharmacist about all current medicines and supplements, and your medical history, before the first dose. Include prescription drugs, over-the-counter products, vitamins and herbal remedies.

Important conditions to mention:

• Family history of bipolar illness or mania
• Cardiac disease or a history of arrhythmias, including long QT or sudden cardiac death in relatives
• Reduced hepatic function or reduced renal function
• Previous or current suicidal thoughts or self-harm behaviour
• Seizure disorder or a record of convulsions.
• Planned or recent electroconvulsive therapy
• Low sodium (hyponatraemia) or risk factors for it
• Factors that contribute to angle-closure glaucoma risk
• Diabetes, commonly known as diabetes mellitus
• Known allergy to escitalopram, citalopram or any tablet ingredient
• Plan for pregnancy, current pregnancy or breastfeeding

If you are unsure about real time communication in actions enable quick problem solving., consult Communication along with the back and forth between people and examine the data your full medicines list with your treating clinician.

How should escitalopram be taken correctly?

• Take once daily at approximately the same time each day. Choose morning or evening based on how it affects you.
• Swallow tablets whole with a glass of water. Taking with food may reduce nausea but is not required.
• Therapeutic effects may begin within 1 to 2 weeks for some people, but a fuller response typically develops by 4 to 6 weeks.
• Typical starting dose for adults is 10 mg daily, adjusted by your prescriber for effect and tolerability; lower starting doses may be used for some patients.
• Use in children and adolescents should be directed by a specialist or paediatrician.
• Abruptly stopping escitalopram can cause withdrawal-like symptoms; taper gradually under medical supervision.
• In the event of overdosing, call 000, go to the nearest emergency department, or ring the Poisons Information Centre on 13 11 26.

Scan the file what to do if you miss a medication dose in the patient facts and figures. Missed daily dose. For ongoing checks while on treatment, visit Environmental monitoring Protocols and Cautionary measures.

Untaken dose

If you fail to take a dose, take it as soon as you remember, unless the next dose is due within about four hours. If it is close to the next dose, skip the missed tablet and continue your regular regimen. Do not join a duo to catch up.

If you frequently miss doses, consider alarms, pill boxes or discussing once-daily timing strategies or other therapeutic options with your health care provider. See Choice contingency options in the options list.

Supervisory monitoring and safety guidelines

Regular clinical reviews are recommended so your prescriber can assess benefit, unintended effects and dosing. Oversight frequency will depend on your situation.

• Observe mood and behavior closely during the first weeks and after dose changes. Report worsening depression, agitation, increased anxiety, new insomnia, restlessness, or suicidal thoughts immediately.
• Do not stop long-term treatment without medical advice; a gradual taper reduces discontinuation effects.
• Drowsiness, dizziness or slowed reaction times can occur; avoid driving or heavy machinery until you know how escitalopram affects you.
• Avoid excessive alcohol while taking escitalopram because it may increase sedation and impair judgment.
• Concomitant use of NSAIDs, aspirin or anticoagulants increases bleeding risk; consult your clinician before combining these.
• Older adults should be monitored for low sodium (symptoms include confusion, pain in the head, weakness) and for falls.
• Be alert for signs of serotonin syndrome: high temperature, sweating, tremor, agitation, muscle stiffness, diarrhoea. Seek urgent medical care if suspected.
• Simple measures can alleviate dry mouth (sipping water, sugar-free gum). Discuss persistent problems with your pharmacist or GP.

For information on common and severe adverse events, see Unwanted adverse effects.

Residual effects

Seek rapid medical care for new onset confusion any of the following serious signs:

• Allergic reactions such as rash, hives, swelling of the face, lips or tongue
• Symptoms suggestive of serotonin syndrome (see Systematic Process monitoring and Protective guidelines)
• Seizure phenomena or new convulsions
• Hallucinations or severe changes in thinking
• Sudden increase in suicidal thoughts or dramatic changes in mood
• Syncope, severe dizziness, palpitations or irregular heartbeat
• Bleeding or bruising that cannot be explained
• Acute eye pain or sudden vision changes (possible acute angle-closure glaucoma)

Broadly occurring effects that are temporary. that may settle over time include:

• Cephalalgic pain
• Nausea, stomach upset, or diarrhoea
• Changes to sleep such as insomnia or sleepiness
• Sexual adverse reactions including reduced libido or difficulty achieving orgasm
• Rising sweat production
• Mouth dryness or blurry vision
• Appetite or weight pattern changes

If you are uncertain about the severity of a symptom, contact your GP, pharmacist, or call healthdirect on 1800 022 222. For having an overdose details, see How to Take This Step by Step.

Drug the networked exchange of ideas alerts

Some combinations with escitalopram are contraindicated or require specialist oversight because of risks such as serotonin syndrome or dangerous QT prolongation. Do not mix. escitalopram with:

• MAO inhibitors (for example phenelzine, tranylcypromine, isocarboxazid, selegiline, moclobemide); follow recommended washout intervals
• Citalopram is an approved antidepressant medication (duplicate serotonin therapy)
• Pimozide medication name
• Phenothiazines such as thioridazine, chlorpromazine
• Cisapride is a drug name used in gastroenterology.
• Procarbazine (a cytotoxic medication)
• Certain appetite suppressants (for example dexfenfluramine, fenfluramine, phentermine, sibutramine)
• The medicinal herb St Johns wort (herbal product)

Medicines that need caution, dose modifications or performance monitoring include:

• Triptans for migraine (sumatriptan, rizatriptan, zolmitriptan and others)
• Linezolid medicine for infections, intravenous methylene blue (use only under specialist care if unavoidable)
• NSAIDs and aspirin (increased bleeding risk)
• Anticoagulants and antiplatelets such as warfarin and clopidogrel
• Other antidepressants, lithium, tramadol, dextromethorphan and some antipsychotics
• SNRIs like venlafaxine and desvenlafaxine (additive serotonergic effects)
• Enzyme inducers or inhibitors such as carbamazepine, cimetidine, ketoconazole, some antiretrovirals
• Certain tuberculosis medicines (isoniazid, rifampin, rifabutin)
• Amphetamine-type stimulants
• Tryptophan fortified supplements

The list is not comprehensive. Maintain an up-to-date list of all prescription medicines, non-prescription products and supplements and show this to every clinician involved in your care. For symptom help see Typical ripple effects.

Alternate medicines and similar drugs

If escitalopram is not tolerated or does not provide sufficient benefit, clinicians may switch to or consider other evidence-based pharmacological and psychological therapies.

• The remaining SSRIs are sertraline, fluoxetine, paroxetine, fluvoxamine, and citalopram.
• Within the SNRI class, you have venlafaxine, desvenlafaxine, and duloxetine.
• Non-SSRI antidepressants: mirtazapine, vortioxetine, agomelatine, bupropion (bupropion is not PBS-listed for depression in Australia)
• Older agents in select cases: tricyclics such as amitriptyline or nortriptyline; MAOIs under specialist supervision
• Psychological treatments: cognitive behavioural therapy (CBT) and other structured therapies are effective alone or as adjuncts

Price and tolerability often guide choice. Generic SSRIs and SNRIs tend to be least expensive, while newer agents like vortioxetine and agomelatine may cost more on the private in the market.

For help comparing costs see Prices shown in AUD in Australia. To plan a safe switch (including MAOI washout periods) consult your prescriber and look over Continuous Compliance monitoring and Preventive care measures.

Prices denominated in AUD for Australia

There are many escitalopram products listed under the PBS. Out-of-pocket costs depend on PBS status, whether you are a concession holder, pharmacy fees and pack size. The figures below are indicative and vary by pharmacy and over time.

• Generic escitalopram 10 mg or 20 mg (28 or 30 tablets): private retail prices commonly range from about AUD 12 to 45. PBS general patient co-payments are typically around AUD 31 to 33 per item; concession card co-payments are around AUD 7 to 8.
• Brand Lexapro may carry a brand premium; a monthly supply can range about AUD 25 to 60 on the private market depending on strength and supplier.
• Smaller 5 mg tablets may cost more per tablet, though monthly totals are similar; check local pharmacy fee schedule for exact figures.

Actionable guidance:

• PBS co-payment levels and safety nets change periodically; ask your pharmacist for the current amounts.
• Electronic prescriptions are accepted across Australia and many pharmacies offer delivery or mail-order services.
• If cost is a concern, discuss generic options or therapeutic contingency options with your prescriber or pharmacist.

Access to law and regulatory systems situated within Australia.

• Scheduling: escitalopram is a Schedule 4 prescription-only medicine. You must have a prescription from an Australian-registered prescriber to obtain it.
• PBS listing and repeats: PBS eligibility and listing determine your subsidy and allowable repeats. Your prescriber sets quantity and repeats within PBS rules.
• ePrescriptions: digital prescriptions are legal nationwide; pharmacies may dispense using your prescription token or an active script list.
• Personal importation and travel: carry medications in original packaging with a copy of your prescription. The Therapeutic Goods Administration (TGA) restricts personal imports; usual practice allows limited amounts often up to a 3-month supply but check current TGA guidance before importing.
• Pharmacies must verify prescriptions and cannot legally supply escitalopram without one. Online suppliers operating in Australia are also bound by these rules.
• If escitalopram causes impairment (drowsiness, dizziness), do not drive or operate machinery and follow local road and workplace safety regulations.

For daily use guidance see The Right Way to Take and Ongoing The act of monitoring and Safety guidelines. For side-effect guidance see Untoward effects.

Mobile storage capacity can limit how much you can keep on hand.

• Place medications somewhere children cannot see or access.
• Store at room temperature, ideally between 15 to 30 degrees C (59 to 86 degrees F), in the original packaging to protect from moisture and light.
• Avoid storing in bathrooms or near sinks. Do not freeze.
• Return unused or expired drugs to a pharmacy for safe disposal.

Frequently asked questions

How long will I need to take escitalopram?

After symptoms improve, many clinicians recommend continuing treatment for several months to reduce relapse risk; duration is tailored to individual circumstances. Do not stop abruptly; discuss tapering with your prescriber involved. See Monitoring operations and Safety and precautionary practices.

Might I drink alcohol while I am on escitalopram?

An ethanol-based beverage may increase sedation and impair judgement. It is generally safest to avoid or limit alcohol while taking escitalopram. For complete details, view the documentation. Systematic Observation and tracking and Harm prevention measures.

Does escitalopram pose an addiction risk?

Lexapro is the brand name for Escitalopram is not considered addictive in the way substances of misuse are. Stopping suddenly can cause discontinuation symptoms, so plan any cessation in collaboration with your clinician.

What should I do if I become pregnant or am breastfeeding?

Do not quit the medicine abruptly. Talk with your prescriber promptly to weigh risks and benefits and to plan ongoing care for you and your baby. Relevant considerations are listed under Before the start.