Escitalopram

Escitalopram is a potent and highly selective selective serotonin reuptake inhibitor (SSRI). It inhibits the reuptake of serotonin (5-HT) at the presynaptic neuronal membrane, leading to an increase in the concentration of serotonin in the synaptic cleft. This potentiation of serotonergic neurotransmission is believed to be the primary mechanism responsible for its antidepressant and anxiolytic effects.

Adult

Initial: 10 mg orally once daily. May increase to 20 mg once daily after at least one week based on clinical response. For panic disorder, an initial dose of 5 mg once daily for the first week, then 10 mg once daily, may be considered to mitigate initial anxiety.

Pediatric

Not generally recommended for patients <12 years. For adolescents (12-17 years) with MDD: 10 mg orally once daily; maximum 20 mg/day.

Renal adjustment

Mild to moderate impairment (CrCl >30 mL/min): No adjustment needed. Severe impairment (CrCl <30 mL/min): Use with caution; consider lower doses or extended intervals.

Hepatic adjustment

Mild to moderate impairment (Child-Pugh A or B): Max 10 mg/day. Severe impairment (Child-Pugh C): Not recommended.

Geriatric

Initial: 5 mg orally once daily. Maximum 10 mg/day due to increased sensitivity and slower metabolism.

Max dose

20 mg/day for adults; 10 mg/day for geriatric patients and those with moderate hepatic impairment.

• Hypersensitivity to escitalopram or citalopram
• Concomitant use with MAOIs (risk of serotonin syndrome)
• Concomitant use with pimozide (risk of QTc prolongation)
• Congenital long QT syndrome or other conditions predisposing to QT prolongation
• Concurrent use with other drugs that prolong the QT interval