taking, titrating, and tapering Lexapro (escitalopram)

> How to Take Lexapro



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How Long & How Likely To Work, Comparisons with Other Meds | Lexapro Index | Pros & Cons, Interesting Stuff Your Doctor Didn’t Tell You
Return to the Lexapro Page

Taking & Titration Overview

One of the most important aspects of any medication is how to go about taking it. This includes:

  • how much to take (the dosage or dose)
  • when and how often to take it (dosing schedule or doses)
  • how much to start with and how to increase the dose/dosage until you’re taking the target amount (titration or titration schedule).

Although we often disagree with them, we’ll always give you the manufacturer’s recommendations from Lexapro’s full US Prescribing Information. If, for some reason, that isn’t available, we’ll use information for patients leaflets, SPCs from overseas, or whatever official sources we can find. Most doctors will give you some idea of what it will be like, and this is what every pharmacist is trained and paid to tell you.1 As “often” doesn’t mean “always”, whatever is in the PI sheet works for us a lot of the time.

We usually advocate starting at a lower dosage than recommended. One of our core philosophies is increasing the dosages as slowly as one’s condition allows, and staying at the dosage that works instead of a target dosage2. More and more doctors are agreeing with us3. You and your doctor can always discuss increasing the dosage when you need to in advance.

And since you never really know how a drug might affect you, it’s best to start when you have some time off of work. Like Friday night / Saturday morning, or your equivalent. Better still would be to get someone to stay with you or at least check on you frequently, especially if you’re the primary caretaker of young children and similar critters.4

Lexapro (escitalopram) Dosage and Doses

One 5–10mg (or 15 or 20mg) tablet once a day.

Special Instructions/Best Way to Take Lexapro (escitalopram)

Like all SSRIs you’ll have to figure out for yourself if taking Lexapro in the morning or at night works better. Start with taking it in the morning and give it at least a week before switching to taking it at night if it makes you too drowsy, as the drowsiness could be a short-term side effect. Most people find Lexapro to be “activating” (i.e. it has a mild stimulant effect) than sedating.

Lexapro (escitalopram) Titration (Dosage Increase)

The official titration schedule from Forest for all applications: Start at 10mg once a day, that’s it. There’s no benefit to taking 20mg a day, and there’s no 15mg tablet. At least if you live in the United States.

If you look at some of Lexapro’s PI sheets from other countries you’ll find that Lundbeck (the original developers, or pioneering company) recommends going up to 20mg if required. In Canada they recommend decreasing the dosage to 5mg if the side effects seem to be too harsh, and in Israel they recommend starting at 5mg for panic disorder.

We say: Start at 5mg a day. At least we agree that the dosage should be increased only if needed.

There have been studies experimenting with dosages up to 50mg(!) a day. This is the first time I’ve read a Lundbeck-sponsored study of Lexapro where there has been a significant number of people quitting due to side effects (20%). 30mg could be a dosage to consider, especially if you know or suspect you’re a rapid or ultra-rapid metabolizer of drugs cleared by CYP2D6 (substrates), or you take a drug that induces CYP2D6, like Tegretol (carbamazepine). 40mg seems to be the upper limit of real efficacy.


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One thing PI sheets and doctors infrequently discuss, and don’t go into enough detail about, is how to discontinue a medication. With some meds it’s not too bad, but with others (most notably SNRIs like Effexor and Cymbalta) it can be a nightmare if not done carefully.

How to Stop Taking Lexapro (escitalopram)

Decrease your dosage by 5mg every week. So if you’re taking 10mg a day, take 5mg for a week, then you can stop. If you’re at 5mg a day then you should be OK.
Like Celexa, Lexapro has a long half-life, as far as SSRIs & SNRIs are concerned. So discontinuing Lexapro tends to be a lot easier than most other SSRIs.

If you do have the symptoms of SSRI discontinuation syndrome you can always cut 5mg tablets in half and take one of those each day for a week.

If you’ve been splitting 10mg tablets to save money you and your doctor will have to figure out which is going to suck the least: staying on Lexapro until you can fill a prescription for 5mg tablets or the oral solution, putting up with the discontinuation syndrome, or trying to quarter 10mg tablets.

Discontinuation Symptoms

The usual for SSRIs/SNRIs. Dizziness, numbness and tingling in your extremities (paraesthesias), electric shock sensations (brain zaps), agitation, anxiety, impaired concentration, headaches (comparable to migraines, actual migraines if you’re susceptible to them), tremors, nausea, vomiting, and excessive sweating.

Notes, Tips, Helpful Hints, etc. for Withdrawing Lexapro (escitalopram)

As mentioned above, the oral solution allows you to taper off as slowly as you need to.

And there’s always the old standby for severe SSRI/SNRI discontinuation syndrome: a prescription for generic Prozac (flouxetine). One to two weeks at 10mg a day is usually enough to take the edge off, if not completely get rid of, the discontinuation symptoms for any med. Prozac also has an oral solution, one that doesn’t taste too bad (it’s like a good, mint-flavored mouthwash with the consistency of cough syrup).



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References

  1. Lexapro full US Prescribing Information
  2. Faught, Edward. “Topiramate in the treatment of partial and generalized epilepsy.” Neuropsychiatric disease and treatment 3.6 (2007): 811-821.

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How Long & How Likely To Work, Comparisons with Other Meds | Lexapro Index | Pros & Cons, Interesting Stuff Your Doctor Didn’t Tell You


1 And everyone has the time to do their jobs properly, when said time isn't being wasted by idiots asking for grocery store phone numbers** or they aren't playing Angry Farmers on the Faecesbooks.

2 Although not everyone has the luxury of stopping at a dosage when the symptoms abate and not increasing it unless the return. Sometimes you just have to keep going up until you reach that target dosage. E.g. you have a history of seizures that haven't yet responded to several medications.

3 Most notably Dr. Edward Faught, founder and Director of the Epilepsy Center, and vice chairman of the Department of Neurology, at the University of Alabama School of Medicine in Birmingham. His article on new antiepileptic drugs in Volume 7 issue 1 of Peer Review in Review stressed starting at low dosages, doing a slow titration, and stopping at the dosage where symptoms were under control. In Topiramate in the treatment of partial and generalized epilepsy, the one free, full-text article I could find (that's not about geriatric patients), he again stresses the low and slow approach to avoid or lessen most side effects, while still achieving seizure control in the same amount of time.

4 Assuming you have the luxury of a job, being able to cope with your symptoms not being dealt with for however many days you need to wait in order to do this, and/or someone who can and is willing to stay with you for a few days. Read enough of this site and you can tell what sort of fantasy world I live in.

**DrugMonkey, Master of Pharmacy, answers the question “Why your prescription takes so damn long to fill”


If you have any questions not answered here, please see the Crazymeds Lexapro discussion board. We welcome criticisms of the articles, notifications of bad links, site problems, consumer experiences with medications, etc. I’m not always able to write back. Hence I never answer questions about meds via e-mail that are answered by this or other articles. Especially if they have been repeatedly asked on the forum. That’s why we write these damn things. Questions about which meds are best for your condition should also be asked on the forum; because this is a free site, so the price of admission is making things easier for somebody else searching for the same answer. We don’t deal with children on the forum or in private because after doing this for ten years I don’t have the emotional stamina to deal with kids who have brain cooties. How to contact Crazymeds. — Jerod Poore, CME, Publisher Crazymeds (crazymeds.us)


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Lexapro, and all other drug names on this page and used throughout the site, are a trademark of someone else. Lexapro’s PI Sheet will probably have the name of the manufacturer and trademark owner (they’re not always the same company) at or near the very bottom. Or ask Google who the owner is. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of the trademark may have changed without my noticing. It may of changed hands by the time you finished reading this article.




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1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.

2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.

3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?* I don’t even need my big-ass rant any more. Heartbleed has made my case for me. And that’s just the one that got all the media attention. The very nature of an open source operating system makes security as much of an illusion as anonymity on teh Intergoogles. Before you flip out too much: the domain Crazymeds is hosted on uses a version of SSL that is not affected by the Heartbleed bug. That’s one of the many reasons why I pay a lot of money and keep this site on Lunarpages.

* Yes, I know I’m using open source browsers. I also test the site using the now-defunct IE and Safari browsers. Their popularity - and superiority - killed IE and Safari, so that’s why I rely on the open source browsers. It’s like brand vs. generic meds. Sometimes the generic is better than the brand.

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