Overview

Lexapro is the brand name for escitalopram, a selective serotonin reuptake inhibitor (SSRI). It is prescribed for mood and anxiety conditions. Do not share this medicine with others, and do not change your dose unless a clinician tells you to do so.

  • Active ingredient: Escitalopram
  • Indications: Depression, generalized anxiety (and sometimes other anxiety-spectrum conditions per clinician judgment)
  • Dosage forms: 5 mg, 10 mg, 20 mg tablets; oral solution may also be available

For safety information on interactions, jump to Interactions. For urgent symptoms, see Possible side effects.

What to tell your clinician before starting

Give your health care provider a full medical and medication history. Be sure to mention the following:

  • History of seizures
  • Pregnancy, plans to become pregnant, or if you are breastfeeding
  • Any unusual or allergic reaction to escitalopram, citalopram, or other medicines, foods, dyes, or preservatives
  • Kidney or liver disease
  • Receiving or planning electroconvulsive therapy (ECT)
  • Diabetes
  • Heart disease or heart rhythm problems
  • Current or past suicidal thoughts or attempts (you or family), or rapidly changing mood
  • Bipolar disorder (you or family history)

How to take this medicine

Swallow tablets with water. You may take escitalopram with or without food; take with food if your stomach gets upset. Take it at the same time each day. Do not take it more often than prescribed, and do not stop it suddenly unless your prescriber guides you to taper.

It can take 1 to 2 weeks to notice improvement, and sometimes longer for full effect. Keep taking it even if you do not feel better right away. If you are considering stopping or adjusting your dose, discuss a gradual plan with your prescriber to reduce withdrawal symptoms. For missed doses, see Missed dose.

Pediatric use requires special caution and individualized dosing. Ask a pediatric specialist before use in children or adolescents.

Overdose: Call a poison control center or seek emergency care immediately if you think you have taken too much.

Missed dose

If you miss a dose, take it as soon as you remember. If it is less than 4 hours until your next scheduled dose, skip the missed dose and take only the next one. Do not take extra doses to make up for a missed dose.

Drug and supplement interactions

Some combinations can be dangerous. Tell your clinician about all prescription and nonprescription medicines, vitamins, and herbal products you use. Avoid alcohol if it increases drowsiness or impairs judgment.

Do not use with the following unless your prescriber explicitly instructs you

  • Monoamine oxidase inhibitors (MAOIs) such as phenelzine/Nardil, tranylcypromine/Parnate, isocarboxazid/Marplan, selegiline/Eldepryl
  • Pimozide
  • Thioridazine or other phenothiazines such as chlorpromazine, prochlorperazine, mesoridazine
  • Citalopram (risk of duplicative therapy and QT concerns)
  • Venlafaxine or other serotonergic antidepressants without medical supervision
  • Nefazodone
  • Procarbazine
  • Cisapride
  • St. Johns Wort (Hypericum)
  • Appetite suppressants such as dexfenfluramine, fenfluramine, phentermine, or sibutramine

Medicines and substances that may interact

  • NSAIDs and aspirin-like drugs (ibuprofen, naproxen) due to bleeding risk
  • Linezolid
  • Carbamazepine
  • Cimetidine
  • Metoclopramide
  • Triptans for migraine (sumatriptan, rizatriptan, zolmitriptan, naratriptan, almotriptan, eletriptan, frovatriptan)
  • Medicines that affect clotting such as warfarin, enoxaparin, dalteparin
  • Medicines for HIV/AIDS
  • Tryptophan supplements
  • Ketoconazole and other strong enzyme inhibitors
  • Amphetamine or dextroamphetamine
  • Medicines for depression, anxiety, or psychosis (other SSRIs/SNRIs, TCAs, antipsychotics)
  • Medicines for tuberculosis such as isoniazid, rifampin, rifabutin, rifapentine

This list is not complete. If you start or stop any medicine, herb, or supplement, ask your clinician or pharmacist to check for interactions. For symptoms of serotonin syndrome or unusual bleeding, see Possible side effects.

What to watch for during treatment

Schedule regular follow-ups so your provider can check how you are doing and adjust your dose if needed.

  • Mood and behavior: Watch for worsening depression, new or increased suicidal thoughts, agitation, irritability, panic, restlessness, mania-like activation, or insomnia, especially when starting or changing the dose. Seek help promptly if these occur.
  • Drowsiness or dizziness: Until you know how you respond, avoid driving or operating machinery.
  • Orthostatic symptoms: Stand up slowly to reduce lightheadedness or fainting, particularly in older adults.
  • Dry mouth: Hydration, sugarless gum, or hard candy may help. Contact a clinician if severe or persistent.
  • Self-care products: Ask before using OTC cold, cough, or allergy products because some ingredients can add side effects or interact.
  • Do not stop suddenly: Taper with guidance to minimize withdrawal symptoms such as dizziness, headache, or irritability. See How to take.

Possible side effects

Seek medical advice urgently for any of the following

  • Seizures
  • Unusual bleeding or bruising
  • Allergic reactions: rash, hives, itching, swelling of face, lips, or tongue
  • Confusion, hallucinations, or loss of contact with reality
  • Feeling faint, severe lightheadedness, or falls
  • Very fast talking, racing thoughts, or behavior you cannot control (possible mania)
  • Worsening depression or suicidal thoughts

Common effects that are often mild

  • Nausea or stomach upset
  • Headache
  • Blurred vision
  • Changes in appetite
  • Increased sweating
  • Change in sex drive or sexual performance

Not all side effects are listed here. Report persistent or severe problems to your clinician. If you develop symptoms suggestive of serotonin syndrome (fever, sweating, tremor, diarrhea, confusion, muscle stiffness), seek immediate medical care.

Storage

Keep out of reach of children. Store at room temperature, 15 to 30 degrees C (59 to 86 degrees F). Discard any unused medicine after the expiration date. Ask your pharmacist about safe disposal options.

Alternatives and similar medicines, plus prices in USD

Several antidepressants may be considered if escitalopram is not suitable or not effective. The choice depends on your symptoms, side effect profile, medical history, and potential interactions. Always discuss changes with your prescriber.

Common alternatives or similar options

  • Sertraline (Zoloft) - SSRI, often used for depression and anxiety disorders
  • Fluoxetine (Prozac) - SSRI with a long half-life
  • Paroxetine (Paxil) - SSRI, can be more sedating and has higher risk of withdrawal on abrupt stop
  • Citalopram (Celexa) - SSRI related to escitalopram; watch QT prolongation at higher doses
  • Venlafaxine (Effexor XR) - SNRI; may raise blood pressure at higher doses
  • Duloxetine (Cymbalta) - SNRI; also used for certain pain conditions
  • Bupropion (Wellbutrin) - NDRI; more activating, generally less sexual side effects, avoid in seizure risk
  • Mirtazapine (Remeron) - may increase appetite and aid sleep

Typical US retail price ranges (without insurance; prices vary by pharmacy and discounts)

  • Escitalopram generic: about $6 to $25 per month for common doses with discount programs; some pharmacies offer $4 lists
  • Brand Lexapro: commonly $300 to $450 per month
  • Sertraline generic: roughly $5 to $20 per month
  • Fluoxetine generic: roughly $4 to $15 per month
  • Venlafaxine ER generic: roughly $10 to $40 per month
  • Duloxetine generic: roughly $8 to $45 per month
  • Bupropion XL generic: roughly $8 to $40 per month
  • Mirtazapine generic: roughly $6 to $25 per month

Note: Insurance copays, manufacturer coupons (for brands), and pharmacy discount cards can significantly change what you pay. Ask your pharmacist to check lower-cost equivalents. For safety rules on buying and using medicines in the US, see Legal status in the USA.