Medication Name

Lexapro (Escitalopram)

Common Uses

Lexapro is primarily prescribed to treat major depressive disorder (MDD) and generalized anxiety disorder (GAD). It modulates serotonin levels in the brain. MDD is marked by persistent sadness, while GAD encompasses chronic worry. Both conditions show improvement with Lexapro’s serotonin reuptake inhibition.

Pharmacological Class

Lexapro is a selective serotonin reuptake inhibitor (SSRI). SSRIs enhance serotonin activity by blocking its reabsorption in the brain. Its efficacy stems from increasing serotonin’s availability, promoting mood balance.

Dosage Forms

Lexapro is available in tablet and oral solution forms. Tablets come in strengths of 5 mg, 10 mg, and 20 mg. The oral solution has a concentration of 1 mg/mL. The flexibility in forms accommodates varying patient needs and preferences.

Administration Guidelines

Take Lexapro once daily, with or without food. Consistent timing enhances its therapeutic effect. Oral solutions should be measured accurately with a dosing spoon or oral syringe. Avoid altering the form of tablets.

Dosing Schedule

The typical initial adult dose for MDD and GAD is 10 mg daily. Depending on response, it can be increased to a maximum of 20 mg daily. Pediatric dosing starts at 10 mg with careful monitoring. Adjustments are based on symptomatology and tolerability.

Mechanism of Action

Lexapro inhibits the reuptake of serotonin by neurons, increasing serotonin concentration in the synaptic cleft. This heightened availability enhances neurotransmission, addressing chemical imbalances linked to depression and anxiety.

Peak Plasma Levels

Peak plasma concentrations of Lexapro occur about 5 hours post-dose. Steady-state levels are typically reached within a week of consistent dosing. The half-life of escitalopram is approximately 27-32 hours, allowing once-daily dosing.

Metabolism and Excretion

Lexapro is metabolized in the liver primarily via the cytochrome P450 system, mainly CYP2C19, with contributions from CYP3A4 and CYP2D6. Metabolic pathways lead to inactive compounds eliminated through renal and fecal pathways.

Potential Interactions

Lexapro can interact with monoamine oxidase inhibitors (MAOIs), leading to serotonin syndrome. Concomitant use with NSAIDs or anticoagulants can increase bleeding risks. Combining with other SSRIs or SNRIs necessitates caution due to serotoninergic effects.

Side Effect Profile

Common adverse effects include nausea, insomnia, fatigue, dry mouth, and increased sweating. Sexual dysfunction and weight changes may occur. Less common effects involve vision changes and alterations in taste perception.

Contraindications

Lexapro is contraindicated in patients with known hypersensitivity to escitalopram. It’s not suitable for individuals taking MAOIs or pimozide. Patients with a history of bipolar disorder must be closely monitored due to mania risk.

Special Populations

In elderly patients, renal function should be monitored and lower doses may be required. For pregnant or breastfeeding women, weigh potential benefits against risks. Pediatric use is indicated for patients aged 12-17 for major depressive disorder.

Overdose Management

Symptoms of overdose may include dizziness, tremor, agitation, and altered mental status. Activated charcoal can be administered to reduce absorption. In severe cases, support cardiovascular and respiratory functions.

Withdrawal Symptoms

Discontinuation may lead to withdrawal symptoms like mood swings, irritability, dizziness, sensory disturbances, and sleep disruptions. Gradual dose tapering is recommended to mitigate these effects.

Patient Monitoring

Monitor patient response during initial treatment weeks for efficacy and tolerability. Regular follow-up visits help assess mood improvement and identify adverse effects. Liver function tests may be necessary with long-term use.

Storage Conditions

Store Lexapro at room temperature, away from moisture and light. Keep out of reach of children. Do not freeze the oral solution. Proper storage ensures the medication’s efficacy and safety.

Impact on Activities

Lexapro may impair cognitive and motor skills. Patients should be cautious when operating machinery or driving until they understand how Lexapro affects them. Avoid alcohol as it can exacerbate side effects.

Alternative Treatments

Alternatives include other SSRIs like fluoxetine or sertraline, and SNRIs like venlafaxine. For treatment-resistant depression, options might include tricyclic antidepressants or electroconvulsive therapy. Psychotherapy complements pharmacologic treatments.