Escitalopram, Oral Tablet

Medically reviewed by Creighton University, Center for Drug Information and Evidence-Based Practice on May 17, 2017Written by University of Illinois-Chicago, Drug Information Group

Important warnings

FDA warning: Suicide

  • This drug has a black box warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients about drug effects that may be dangerous.
  • Suicide warning. Escitalopram, like many antidepressants, can increase the risk of suicidal thinking and behavior when you take it to treat depression or other psychiatric disorders. This risk is higher in children, teenagers, and young adults, especially within the first few months of treatment or when the dose is changed. You, family members, caregivers, and your doctor should pay attention to any unusual changes in mood, behaviors, thoughts, or feelings.
  • Serotonin syndrome: A serious condition called serotonin syndrome may occur when you take this drug. It occurs when dangerously high levels of a natural brain chemical are present. It occurs when your levels of a natural brain chemical called serotonin are dangerously high. It’s most likely to occur if you take this drug with other drugs that increase your levels of serotonin. Serotonin syndrome causes symptoms like irritability, agitation, confusion, hallucinations, rigid muscles, tremors, and seizures. If you have this, seek emergency medical care right away.
  • Stopping the drug quickly: If you stop taking this drug too quickly, you may experience withdrawal side effects like irritability, agitation, anxiety, high or low mood, feeling restless, changes in sleep habits, headache, sweating, nausea, dizziness, electric shock-like sensations, shaking, and confusion. Don’t stop taking escitalopram without speaking with your doctor first. He or she will lower your dose slowly to prevent these withdrawal side effects.
  • Bleeding: Using escitalopram can increase your risk of bleeding if you also take aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), warfarin, or other anticoagulants. Speak with your doctor or pharmacist if you notice any bleeding or unusual bruising.

What is escitalopram?

Escitalopram oral tablet is a prescription drug that’s available as the brand-name drug Lexapro. It’s also available as a generic drug. Generic drugs usually cost less. In some cases, they may not be available in every strength or form as the brand-name version. Talk to your doctor to see if the generic version will work for you. Escitalopram is also available as an oral solution.

Why it's used

This drug is used to treat depression and generalized anxiety disorder. It may be used as part of a combination therapy. This means you may need to take it with other medications.

How it works

This drug belongs to the class of drugs called selective serotonin reuptake inhibitors (SSRIs). A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions. Escitalopram increases the amount of a natural substance in your brain called serotonin. This substance helps maintain mental balance.

Escitalopram side effects

Escitalopram oral tablet may cause sleepiness and tiredness. It can also cause other side effects.

More common side effects

The more common adult side effects for this drug are slightly different from the more common side effects for children.

  • More common adult side effects can include:
    • nausea
    • sleepiness
    • weakness
    • dizziness
    • anxiousness
    • trouble sleeping
    • sexual problems
    • sweating
    • shaking
    • lack of hunger
    • dry mouth
    • constipation
    • infection
    • yawning
  • More common children’s side effects can include:
    • increased thirst
    • abnormal increase in muscle movement or agitation
    • unexpected nosebleeds
    • difficult urination
    • heavy menstrual periods
    • possible slowed growth rate and weight change
    • nausea
    • sleepiness
    • weakness
    • dizziness
    • anxiousness
    • trouble sleeping
    • sexual problems
    • sweating
    • shaking
    • lack of hunger
    • dry mouth
    • constipation
    • infection
    • yawning

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • Severe allergic reactions. Symptoms can include:
    • trouble breathing
    • swelling of your face, tongue, eyes, or mouth
    • rash, itchy welts (hives), or blisters (alone or with fever or joint pain)
  • Seizures or convulsions
  • Suicidal thoughts and behaviors
  • Serotonin syndrome. Symptoms can include:
    • agitation, hallucinations, coma, or other changes in mental status
    • coordination problems or muscle twitching (overactive reflexes)
    • racing heartbeat
    • high or low blood pressure
    • sweating or fever
    • nausea, vomiting, or diarrhea
    • muscle rigidity
  • Low sodium levels in your blood. Symptoms can include:
    • headache
    • confusion
    • difficulty concentrating
    • thinking or memory problems
    • weakness
    • unsteadiness (which can lead to falls)
    • seizures
  • Manic episodes. Symptoms can include:
    • greatly increased energy
    • severe trouble sleeping
    • racing thoughts
    • reckless behavior
    • unusually grand ideas
    • excessive happiness or irritability
    • excessive talking or speech that is faster than usual
  • Changes in appetite or weight
  • Visual problems. Symptoms can include:
    • eye pain
    • changes in vision, such as blurred vision or double vision
    • swelling or redness in or around your eyes

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

Escitalopram may interact with other medications

Escitalopram oral tablet can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Examples of drugs that can cause interactions with promethazine are listed below.

Blood thinners

Escitalopram can thin your blood a little. If you take escitalopram with blood thinners, your risk of bleeding is increased. Examples of blood thinning drugs include:

  • warfarin
  • nonsteroidal anti-inflammatory drugs:
    • diclofenac
    • etodolac
    • ibuprofen
    • indomethacin
    • ketorolac
    • meloxicam
    • naproxen
  • apixaban
  • dabigatran
  • edoxaban
  • rivaroxaban

Migraine drugs

Certain migraine drugs called triptans may work similarly to escitalopram. Taking them with escitalopram could increase your risk of side effects. Examples of migraine drugs include:

  • almotriptan
  • eletriptan
  • frovatriptan
  • naratriptan
  • rizatriptan
  • sumatriptan
  • zolmitriptan

Psychiatric drugs

Certain psychiatric drugs may work similarly to escitalopram. Taking them together may increase your risk of side effects. Examples of these drugs include:

  • Monoamine oxidase inhibitors (MAOIs). Don’t take an MAOI with escitalopram or within 2 weeks of stopping escitalopram unless your doctor tells you. Don’t start escitalopram if you stopped taking an MAOI in the last 2 weeks unless directed to do so by your doctor. Taking them within 2 weeks of each other increases your risk of serotonin syndrome. Examples of these drugs include:
    • isocarboxazid
    • phenelzine
    • tranylcypromine
  • Pimozide (an antipsychotic drug). Do not take escitalopram if you also take pimozide.
  • Antidepressant drugs. Examples of these drugs include:
    • citalopram
    • fluoxetine
    • fluvoxamine
    • paroxetine
    • sertraline
  • Drugs that affect the central nervous system. Examples of these drugs include:
    • benzodiazepines
    • gabapentin
    • sleeping pills, such as estazolam, temazepam, triazolam, and zolpidem

Drugs to reduce stomach acid

Taking these drugs with escitalopram may increase levels of escitalopram in your body and increase your risk of side effects. An example of these drugs includes:

  • cimetidine

Water pills

Certain water pills can decrease sodium levels in your body. Escitalopram may also decrease sodium. Taking water pills with these drugs may increase your risk of low sodium levels. Examples of these drugs include:

  • furosemide
  • torsemide
  • hydrochlorothiazide
  • spironolactone

Serotonergic drugs

Taking these drugs with escitalopram may increase your risk of serotonin syndrome, which can be fatal. If you take any of these drugs, your doctor will start you on a lowered dosage of escitalopram and monitor you for signs of serotonin syndrome. Symptoms can include agitation, sweating, muscle twitches, and confusion. Serotonergic drugs include:

  • selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine and sertraline
  • serotonin-norepinephrine reuptake inhibitors (SSNRIs) such as duloxetine and venlafaxine
  • tricyclic antidepressants (TCAs) such as amitriptyline and clomipramine
  • the opioids fentanyl and tramadol
  • the anxiolytic buspirone
  • triptans
  • lithium
  • tryptophan
  • St. John’s wort
  • amphetamines

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

Escitalopram warnings

Escitalopram oral tablet comes with several warnings.

Allergies

Escitalopram can cause a severe allergic reaction. Symptoms can include:

  • trouble breathing
  • swelling of your face, tongue, eyes, or mouth
  • rash, itchy welts (hives), or blisters, with or without fever or joint pain

If you have an allergic reaction, call your doctor or local poison control center right away. If your symptoms are severe, call 911 or go to the nearest emergency room.

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

Alcohol interaction

Drinking alcohol while taking escitalopram can increase your risk of sleepiness or dizziness. If you drink alcohol, talk to your doctor.

Warnings for people with certain health conditions

People with a history of suicidal thoughts or behaviors: This drug can increase the risk of suicidal thoughts and behavior. This risk is higher in children, teenagers, and young adults. Tell your doctor if you have a history of suicidal thoughts or behaviors.

People with glaucoma: This drug may dilate your pupils (make them wider), which may trigger a glaucoma attack. Tell your doctor if you have glaucoma before taking this drug.

People with bipolar disorder: Let your doctor know if you have a history of bipolar disorder. If you have a history of bipolar disorder, taking this drug alone may trigger a mixed or manic episode.

People with seizure disorders: This drug may cause seizures. If you have ever had a seizure, notify your doctor before taking this drug. Taking this drug can increase your risk of having more seizures.

People with heart problems: Taking this drug may cause a prolonged QT interval. This is a heart rhythm issue that may cause your heartbeat to be abnormal. Your risk for QT interval prolongation is greater if you have heart disease. Talk to your doctor before taking this drug.

Warnings for other groups

For pregnant women: Escitalopram is a category C pregnancy drug. That means two things:

  1. Research in animals has shown adverse effects to the fetus when the mother takes the drug.
  2. There haven’t been enough studies done in humans to be certain how the drug might affect the fetus.

Talk to your doctor if you’re pregnant or planning to become pregnant. This drug should be used only if the potential benefit justifies the potential risk to the fetus.

For women who are breastfeeding: Escitalopram may pass into breast milk and may cause side effects in a child who is breastfed. Talk to your doctor if you breastfeed your child. You may need to decide whether to stop breastfeeding or stop taking this medication.

For seniors: Seniors are more likely to have lowered sodium levels. Because this drug can decrease sodium levels, seniors may be at even higher risk for low sodium levels.

For children: Children who take drugs like escitalopram may have a decreased appetite and weight loss.

When to call the doctor

Call your doctor if your mood changes suddenly. Call your doctor right away or call 911 in an emergency if you have any of the following symptoms, especially if they are new, worse, or worry you:

  • attempts to commit suicide
  • acting on dangerous impulses
  • acting aggressive or violent
  • thoughts about suicide or dying
  • new or worse depression
  • new or worse anxiety or panic attacks
  • feeling agitated, restless, angry, or irritable
  • trouble sleeping
  • an increase in activity or talking more than what is normal for you

How to take escitalopram

All possible dosages and drug forms in addition to escitalopram oral tablet may not be included here. Your dosage, drug form, and how often you take the drug will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

Forms and strengths

Brand: Lexapro

  • Form: Oral tablet
    • Strengths: 5 mg, 10 mg, 20 mg
  • Form: Liquid oral solution
    • Strengths: 5 mg/5mL

Generic: escitalopram

  • Form: Oral tablet
    • Strengths: 5 mg, 10 mg, 20 mg
  • Form: Liquid oral solution
    • Strengths: 5 mg/5mL

Dosage for major depressive disorder

Adult Dosage (ages 18 years–64 years)

The usual dose is 10–20 mg, taken once per day.

Child Dosage (ages 12–17 years)

Usual dose: 10 to 20 mg once per day.

Child Dosage (ages 0–11 years)

It hasn’t been confirmed that this drug is safe and effective in people younger than 12 years.

Senior dosage (ages 65 years and older)

  • The liver of older adults may not work as well as it used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This increases your risk of side effects.
  • Your doctor may start you on a lowered dose or a different medication schedule. This can help keep levels of this drug from building up too much in your body.
  • The recommended dose is 10 mg, taken once per day.

Special considerations

Liver problems: If you have liver problems, the recommended dose is 10 mg, taken once per day.

Dosage for generalized anxiety disorder

Brand: Lexapro

  • Form: Oral tablet
    • Strengths: 5 mg, 10 mg, 20 mg
  • Form: Liquid oral solution
    • Strengths: 5 mg/5mL

Generic: escitalopram

  • Form: Oral tablet
    • Strengths: 5 mg, 10 mg, 20 mg
  • Form: Liquid oral solution
    • Strengths: 5 mg/5mL

Adult Dosage (ages 18 years–64 years)

The usual dose is 10–20 mg, taken once per day.

Child Dosage (ages 0–17 years)

It is unknown if this drug is safe and effective to treat generalized anxiety disorder in children younger than 18 years.

Senior dosage (ages 65 years and older)

  • The liver of older adults may not work as well as it used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This increases your risk of side effects.
  • Your doctor may start you on a lowered dose or a different medication schedule. This can help keep levels of this drug from building up too much in your body.
  • The recommended dose is 10 mg, taken once per day.

Special considerations

Liver problems: If you have liver problems, the recommended dose is 10 mg, taken once per day.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.

Take as directed

Escitalopram oral tablet is used for long-term treatment. It comes with risks if you don’t take it as prescribed.

If you stop taking the drug suddenly or don’t take it at all: You may experience withdrawal symptoms if you stop taking escitalopram rapidly. If you need to stop taking it, the dose should gradually be reduced. Never stop taking escitalopram on your own before speaking to your doctor.

If you miss doses or don’t take the drug on schedule: Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.

If you take too much: You could have dangerous levels of the drug in your body. Symptoms of an overdose of this drug can include:

  • dizziness
  • low blood pressure
  • sleep problems
  • nausea, vomiting
  • fast heart rate
  • seizures, and coma

If you think you’ve taken too much of this drug, call your doctor or local poison control center. If your symptoms are severe, call 911 or go to the nearest emergency room right away.

What to do if you miss a dose: Take your dose as soon as you remember. But if you remember just a few hours before your next scheduled dose, take only one dose. Never try to catch up by taking two doses at once. This could result in dangerous side effects.

How to tell if the drug is working: You should experience improvement in your conditions. However, you may not notice any difference in your condition for the first several weeks. It takes time for escitalopram to begin to work well. Sometimes this can take up to 2 months.

Important considerations for taking escitalopram

Keep these considerations in mind if your doctor prescribes escitalopram oral tablet for you.

General

  • You can take this drug with or without food. Taking it with food may help to reduce upset stomach.
  • You can cut or crush the 10-mg and 20-mg tablets. You can’t cut or crush the 5-mg tablets.

Storage

  • Store escitalopram at room temperature between 59ºF and 86°F (15ºC and 30°C). Keep it away from high temperatures.
  • Don’t store this medication in moist or damp areas, such as bathrooms.

Refills

A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When travelling with your medication:

  • Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
  • Don’t worry about airport x-ray machines. They can’t hurt your medication.
  • You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled box with you.
  • Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Clinical monitoring

Your doctor will monitor your mood. Your doctor will watch for sudden changes in mood, behaviors, thoughts, or feelings. Children will also be monitored for changes in height and weight.

Are there any alternatives?

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

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