Lexapro is thought to improve mood by increasing levels of the neurotransmitter in the brain called serotonin.
Although generally safe to take, Lexapro does have a boxed warning, the most serious warning from the Food and Drug Administration (FDA), for the risk of suicidal thinking and behavior in children, adolescents, and young adults. Taking antidepressants for major depressive disorder and other disorders can increase this risk in these patients. However, Lexapro is not approved for use in children less than 12 years of age.
What Is Lexapro Used For?
The FDA approved Lexapro to treat:
Brand Name(s): Lexapro
Administration Route(s): Oral
Drug Availability: Prescription
Therapeutic Classification: Antidepressant
Available Generically: Yes
Controlled Substance: N/A
Active Ingredient: Escitalopram
Dosage Form(s): Tablet, solution
Acute and maintenance treatment of major depressive disorder in adults and children aged 12 to 17 years old Acute treatment of generalized anxiety disorder in adults
Lexapro and its generic version are generally preferred over other antidepressants due to their fast-acting effects and affordability.
How to Take Lexapro
Follow your healthcare provider’s direction when taking this medication.
Take Lexapro and its generic form once daily in the morning or the evening. If you have trouble sleeping, then it is recommended to take this medication in the morning.
You can take this medication with or without food. The pills appear as round, film-coated tablets containing escitalopram oxalate and come in strengths of 5 mg, 10 mg, and 20 mg. The generic form is also available in a solution form for those who may have issues with swallowing tablets.
Using Lexapro with blood thinner medications requires extra monitoring by a healthcare provider because of the potential increase in the platelet effects of these medications.
When stopping Lexapro, your healthcare provider will often gradually lower your dosing over time to prevent withdrawal or rebound symptoms. Abruptly stopping Lexapro treatment can cause symptoms such as:
Dysphoric mood Irritability Agitation Dizziness Sensory disturbances Anxiety Confusion Headache Fatigue Emotional lability (rapid changes in mood) Insomnia Hypomania
Storage
Store this prescription medication at room temperature (77 F). If you plan to travel on an airplane or out of the country, carry the original package the medication came in and have your prescription with you at all times.
Make sure to keep Lexapro away from light and moisture. Avoid leaving this medication in the refrigerator or the car for long periods of time, and store it away from the bathroom area or anywhere there is high humidity or moisture.
Off-Label Uses
There are several off-label uses for Lexapro. Off-label use means a healthcare provider prescribes a medication for a different medical condition than the FDA has approved.
Off-label uses of Lexapro include:
Social anxiety disorder Obsessive-compulsive disorder Panic disorder Post-traumatic stress disorder (PTSD) Premenstrual dysphoric disorder Hot flashes due to menopause Agitation due to Alzheimer’s disease and other types of dementia
What Are the Side Effects of Lexapro?
This is not a complete list of side effects and others may occur. A medical professional can advise you on side effects. If you experience other effects, contact your pharmacist or a medical professional. You may report side effects to the FDA at www.fda.gov/medwatch or 1-800-FDA-1088.
Lexapro is considered a safe medication, but it can cause side effects. Having other medical conditions or taking certain medications with Lexapro can increase your chances of having side effects. Let your healthcare provider know if you are sensitive to the side effects of SSRIs. They may start you at a lower dose and gradually increase it over time.
Common Side Effects
The common side effects of Lexapro may go away after a few months of using this medication. However, it is always best to speak with your healthcare provider before taking this medication to discuss the degree of some of the side effects associated with Lexapro.
Common side effects of taking Lexapro or escitalopram include:
Insomnia Ejaculation problems Diarrhea Nausea Sweating Fatigue Low sex drive (decreased libido)
Severe Side Effects
Although rare, this medication can cause severe or even life-threatening side effects.
You should seek immediate medical attention if you begin to experience these side effects:
Worsening Symptoms
Contact your healthcare provider if you have a possible worsening of depression, anxiety, or the lack of improvement of your original symptoms.
Serotonin Syndrome
Serotonin syndrome is presented with the effects of a rapid heartbeat, confusion, sweating, muscle twitching, irregular body temperature, and a sense of uncomfortableness.
The risk of serotonin syndrome is low if you are taking Lexapro on its own. However, combining Lexapro with other medications that raise serotonin, like monoamine oxidase inhibitors (MAOIs), increases this risk.
Suicidal Thoughts
This medication is known to trigger suicidal thoughts, especially in younger people. If you begin to have thoughts of hurting yourself in any way, seek immediate medical help. Help is always available through the National Suicide Prevention Lifeline at 1-800-273-8255.
Long-Term Side Effects
There currently is minimal evidence of negative side effects with long-term use of Lexapro. However, it is important to check in with your healthcare provider regularly to ensure that it is working as it should.
Dosage: How Much Lexapro Should I Take?
Modifications
Your healthcare provider may modify your treatment or dose under certain circumstances.
If you experience a serious side effect, you or your provider may send a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting Program or by phone (800-332-1088).
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
For oral dosage forms (solution or tablets): For depression: Adults and children 12 years of age and older—10 milligrams (mg) once a day, taken either in the morning or evening. Your doctor may adjust your dose as needed. However, the dose is usually not more than 20 mg per day. Older adults—10 mg once a day, taken either in the morning or evening. Children younger than 12 years of age—Use and dose must be determined by your doctor. For generalized anxiety disorder: Adults—At first, 10 milligrams (mg) once a day, taken either in the morning or evening. Your doctor may adjust your dose as needed. However, the dose is usually not more than 20 mg per day. Older adults—10 mg once a day, taken either in the morning or evening. Children—Use and dose must be determined by your doctor.
Pregnancy
SSRI use has been extensively studied in people who are pregnant and continues to be monitored. There are documented risks to SSRI use during pregnancy, but there are also risks for leaving psychiatric conditions untreated during pregnancy.
Pregnant people should only take Lexapro if the potential benefits of the medication outweigh the potential risk to the baby. If you are taking Lexapro, or any SSRI, while pregnant, you should enroll in the National Pregnancy Registry for Antidepressants (NPRAD). NPRAD evaluates the safety of these medications during pregnancy.
Talk to your healthcare provider if you are pregnant or plan on becoming pregnant.
Breastfeeding
Lexapro can be passed to infants through breast milk. The decision to take this medication while breastfeeding will be under the discretion of you and your healthcare provider based on risk vs. benefit.
Older Adults
Adults aged 65 years and older are more likely to have low sodium levels in the blood while taking Lexapro. Lexapro dosing may be lower for this population in comparison to younger patients.
Side Effects
People who are sensitive to the side effects of SSRIs may start at a lower dose (5 mg) and slowly increase their dose (5 mg at a time) until the target dose is reached.
Missed Dose
If you miss a dose, take it as soon as you think about it. If it is almost time for your next dose, skip the missed dose and continue your regular intake schedule. Do not take extra doses or multiple doses at the same time.
Overdose: What Happens If I Take Too Much Lexapro?
Overdose symptoms of Lexapro may include confusion, nausea, and abnormal heart rates and rhythms. This has a greater chance of happening when Lexapro is used in combination with other medications that increase your serotonin levels, or if you take it more often than prescribed.
Precautions
What Are Reasons I Shouldn’t Take Lexapro?
Lexapro is a well-tolerated medication that usually doesn’t have major issues. However, there may be reasons that you should not be taking this medication.
If someone collapses or isn’t breathing after taking Lexapro, call 911 immediately.
Do not take escitalopram with a monoamine oxidase (MAO) inhibitor (eg, isocarboxazid [Marplan®], linezolid (Zyvox®), methylene blue injection, phenelzine [Nardil®], selegiline [Eldepryl®], tranylcypromine [Parnate®]). Do not start taking escitalopram during the 14 days after you stop a MAO inhibitor. Wait 14 days after stopping escitalopram before you start taking a MAO inhibitor. If you take them together or do not wait the proper amount of time, you may develop confusion, agitation, restlessness, stomach or bowel symptoms, a sudden high body temperature, an extremely high blood pressure, or severe seizures.
Do not take escitalopram with pimozide (Orap®). Using these medicines together can cause very serious heart problems.
Escitalopram may cause some teenagers and young adults to be agitated, irritable, or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. Some people may have trouble sleeping, get upset easily, have a big increase in energy, or start to act reckless. If you or your caregiver notice any of these unwanted effects, tell your doctor right away. Let the doctor know if you or anyone in your family has bipolar disorder (manic-depressive) or has tried to commit suicide.
Escitalopram may cause a serious condition called serotonin syndrome if taken together with some medicines. Do not use escitalopram with buspirone (Buspar®), fentanyl (Abstral®, Duragesic®), lithium (Eskalith®, Lithobid®), tryptophan, St. John’s wort, amphetamines, or some pain or migraine medicines (eg, rizatriptan, sumatriptan, tramadol, Frova®, Imitrex®, Maxalt®, Relpax®, Ultram®, Zomig®). Check with your doctor first before taking any other medicines with escitalopram.
Do not suddenly stop taking this medicine without checking first with your doctor. Your doctor may want you to gradually reduce the amount you are taking before stopping it completely. This will decrease the chance of having withdrawal symptoms such as increased anxiety, burning or tingling feelings, confusion, dizziness, headache, irritability, nausea, trouble sleeping, or unusual tiredness or weakness.
This medicine may increase your risk for bleeding problems. Make sure your doctor knows if you are also taking other medicines that thin the blood, including aspirin, NSAIDs (eg, diclofenac, ibuprofen, naproxen, Advil®, Aleve®, Celebrex®, Voltaren®), or warfarin (Coumadin®, Jantoven®).
This medicine may cause hyponatremia (low sodium in the blood). This is more common in elderly patients, those who are taking diuretic medicines for high blood pressure, or those who have decreased amounts of fluid in the body due to severe diarrhea or vomiting. Check with your doctor right away if you have confusion, headache, memory problems, trouble concentrating, weakness, or unsteadiness.
This medicine may cause some people to become drowsy, have trouble with thinking or controlling body movements. Make sure you know how you react to escitalopram before you drive, use machines, or do anything else that could be dangerous if you are not alert or well-coordinated.
The use of alcohol is not recommended in patients who are taking escitalopram.
Check with your doctor right away if you have decreased interest in sexual intercourse, delayed or inability to have an orgasm in women, inability to have or keep an erection in men, or loss in sexual ability, desire, drive, or performance. These could be symptoms of sexual dysfunction.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal (eg, St. John’s wort) or vitamin supplements.
Do not take Lexapro if you have had any signs of an allergic reaction (e.g., hives, itching, swelling) to it. In this case, let your healthcare provider know so that an alternative can be prescribed to you.
What Other Medications Interact With Lexapro?
Certain medications can increase the risk of serotonin syndrome when used with Lexapro:
MAOIs: This is another class of antidepressants. Your healthcare provider may switch your MAOIs to other antidepressants and wait a minimum of 14 days before starting you on Lexapro. Duragesic (fentanyl): Fentanyl is a strong pain medication that can increase serotonin levels in the body. Ultram (tramadol): Tramadol is a pain medication that, when used in combination with Lexapro, may increase the risk of serotonin syndrome or irregular heart rhythms. Trazodone: Trazodone is an antidepressant that can affect the amount of serotonin in the body. Combined with another antidepressant, Lexapro and this medication could cause serotonin syndrome or dangerous levels of serotonin in the body. Seroquel (quetiapine): Seroquel is a medication used to treat psychotic disorders. When combined with Lexapro, it may affect heart function. This side effect is rare but can be potentially life-threatening. Wellbutrin (bupropion): Wellbutrin is also an antidepressant medication. Although rare, it may increase the risk of seizures when used in combination with Lexapro. Triptans (e. g. , almotriptan, eletriptan, lasmiditan, etc. ): Triptans are drugs used to treat migraines by stimulating serotonin receptors in the brain.
What Medications Are Similar?
Numerous classes of medications are available to help treat depression.
Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)
SNRIs work similarly to SSRIs, but also inhibit the reuptake of another neurotransmitter, norepinephrine. SNRI medications include:
Cymbalta (duloxetine) Effexor (venlafaxine) Pristiq (desvenlafaxine)
Tricyclic Antidepressants (TCAs)
TCAs not only block the reuptake of serotonin and norepinephrine, but also acetylcholine.
TCA medications include:
Elavil (amitriptyline) Pamelor (nortriptyline) Anafranil (clomipramine)
MAOIs
MAOIs inhibit the enzyme monoamine oxidase, allowing for more mood-stabilizing neurotransmitters.
MAOI medications include:
Emsam (selegiline) Nardil (phenelzine) Marplan (isocarboxazid)
Atypical Antidepressants
Atypical antidepressants have a range of effects on serotonin, norepinephrine, and dopamine.
Atypical antidepressant medications include:
Oleptro (trazodone) Remeron (mirtazapine) Wellbutrin (bupropion)
How Can I Stay Healthy While Taking Lexapro?
Always prioritize your health while taking antidepressants. Although Lexapro is an effective therapy, managing depression in other ways is just as important.
In addition to taking medication, you can work to improve your mood by:
Exercising regularlyEating healthyGetting enough sleepStaying hydrated
