SSRI Antidepressant Pregnancy: Should not be used during pregnancy unless clearly necessary and only after careful risk/benefit consideration; observe neonates if used in late pregnancy (risk of neonatal discontinuation symptoms and persistent pulmonary hypertension of the newborn). Breast-feeding is not recommended during treatment.

Escitalopram

Brand names: Cipralex

Used in: Depression & Anxiety

Escitalopram is a selective serotonin reuptake inhibitor (SSRI) antidepressant used for depression and anxiety disorders; in older people it requires attention to dose, QT prolongation and hyponatraemia risk.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Elderly patients over 65 years: 5 mg once daily initially, may be increased to 10 mg daily. Adults under 65: 10 mg once daily (major depressive episodes, social anxiety disorder, generalised anxiety disorder, obsessive-compulsive disorder)

Route: Oral

Frequency: Once daily, with or without food

Max: Adults: 20 mg daily (safety of daily doses above 20 mg has not been demonstrated). In elderly patients over 65 years the SPC describes increasing only to 10 mg daily.

Elderly (>65 years): initial dosage 5 mg once daily; depending on individual response the dose may be increased to 10 mg daily. Efficacy in social anxiety disorder has not been studied in elderly patients. Adult regimens by indication: major depressive episodes 10 mg once daily, may increase to a maximum of 20 mg daily — 2-4 weeks are usually needed for antidepressant response and treatment should continue for at least 6 months after symptoms resolve. Panic disorder with or without agoraphobia: 5 mg for the first week then 10 mg daily, up to a maximum of 20 mg daily; maximum effectiveness at about 3 months. Social anxiety disorder: 10 mg once daily, may be decreased to 5 mg or increased to a maximum of 20 mg daily; 12 weeks recommended to consolidate response. Generalised anxiety disorder and obsessive-compulsive disorder: 10 mg once daily initially, up to a maximum of 20 mg daily. Poor CYP2C19 metabolisers: 5 mg daily for the first two weeks, then may increase to 10 mg daily. Mild or moderate hepatic impairment: 5 mg daily for the first two weeks, then may increase to 10 mg daily; caution and extra careful titration in severely reduced hepatic function. Discontinuation: avoid abrupt cessation — reduce gradually over at least one to two weeks. Should not be used in children and adolescents under 18 years.

Dose adjustments

Renal

No dosage adjustment necessary in mild or moderate renal impairment. Caution is advised if creatinine clearance is less than 30 ml/min.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to escitalopram or any excipient
Concomitant non-selective, irreversible MAO inhibitors (risk of serotonin syndrome)
Combination with reversible MAO-A inhibitors (e.g. moclobemide) or the reversible non-selective MAO inhibitor linezolid
Known QT interval prolongation or congenital long QT syndrome
Concomitant use with medicinal products known to prolong the QT interval

Side effects

Headache (very common); nausea (very common)
Insomnia, somnolence, dizziness, tremor and paraesthesia
Diarrhoea, constipation, vomiting and dry mouth
Increased sweating, decreased/increased appetite, weight increase, anxiety and restlessness; sexual dysfunction (ejaculation disorder, impotence, anorgasmia, decreased libido)
Hyponatraemia/inappropriate ADH secretion, QT prolongation and ventricular arrhythmia including torsade de pointes (not known frequency)

Interactions

MAO inhibitors (irreversible, moclobemide, linezolid) — contraindicated; serotonin syndrome risk
QT-prolonging medicinal products — contraindicated
Pimozide — contraindicated (US label); increased pimozide concentrations and QT prolongation risk
Other serotonergic drugs (other SSRIs, SNRIs, triptans, tricyclics, opioids, lithium, buspirone, tryptophan, St John's wort) — serotonin syndrome risk
NSAIDs, aspirin, other antiplatelet drugs and warfarin — increased bleeding risk
In diabetes, SSRIs may alter glycaemic control — insulin and/or oral hypoglycaemic doses may need adjustment

Clinical monograph

How it works

It selectively inhibits the serotonin transporter, increasing synaptic serotonin availability and thereby improving mood and anxiety over several weeks.

Prescribing in practice

Older patients should receive a reduced maximum dose because of dose-dependent QT-interval prolongation, and concurrent QT-prolonging or interacting drugs should be reviewed.
SSRIs increase the risk of hyponatraemia (often from SIADH) and of gastrointestinal bleeding, particularly with concurrent NSAIDs, antiplatelets or anticoagulants; consider gastroprotection.
Withdraw gradually to avoid discontinuation symptoms and monitor for increased agitation or suicidal thoughts early in treatment.

Monitoring

Monitor mood and suicidality early in treatment, check sodium in those at risk of hyponatraemia, and consider ECG where there are additional QT risk factors.

Counselling the patient

Benefit builds over a few weeks; continue as prescribed even if you feel no immediate change.
Report dizziness, drowsiness, confusion or falls, which may indicate low sodium.
Do not stop suddenly, and ask before taking anti-inflammatory painkillers.

Evidence & guidelines

MHRA guidance highlights dose-dependent QT prolongation with (es)citalopram and recommends lower maximum doses in older adults, while SSRI efficacy in late-life depression is supported by trial evidence.

Reference: MHRA Drug Safety Update 2011 (escitalopram QT); NICE CG90 (Depression); AGS Beers Criteria 2023; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways