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SSRI (Selective Serotonin Reuptake Inhibitor) Pregnancy: Avoid near term — neonatal adaptation syndrome; compatible early pregnancy if risk-benefit favourable

Escitalopram

Brand names: Cipralex

Adult dose

Dose: Starting: 10 mg OD. Increase to 20 mg OD after 2–4 weeks if insufficient response.
Route: Oral
Frequency: Once daily (morning or evening)
Max: 20 mg OD (10 mg OD in elderly)
Active enantiomer of citalopram. Has one of the cleanest side effect profiles among SSRIs. QT prolongation risk greater than other SSRIs — MHRA 2011 restriction (max 10 mg OD in elderly or with hepatic impairment or QT prolongation risk).

Paediatric dose

Route: Oral
Frequency: OD
Max: Not licensed in children
Concentration: 5 mg/mL oral drops mg/ml
Not licensed for paediatric use in UK

Dose adjustments

Renal

No dose adjustment required (mild-moderate); caution in severe renal impairment

Hepatic

Maximum 10 mg OD in hepatic impairment

Clinical pearls

  • MHRA 2011: QT prolongation risk with escitalopram/citalopram — check ECG before starting in cardiac patients; max 10 mg OD in elderly or QT risk factors
  • Hyponatraemia: more common in elderly on SSRIs (SIADH) — check sodium at 1 month in elderly or at-risk patients
  • Onset of antidepressant effect: 2–4 weeks; full benefit at 4–8 weeks — counsel patients to persist
  • Discontinue gradually over several weeks — acute discontinuation causes dizziness, headache, nausea

Contraindications

  • Concomitant MAOIs
  • Congenital long QT syndrome
  • QT prolongation or risk factors
  • Elderly with QT risk factors (max 10 mg)

Side effects

  • Nausea (first 2 weeks)
  • Insomnia or somnolence
  • Sexual dysfunction
  • Dry mouth
  • Sweating
  • QT prolongation
  • Hyponatraemia (SIADH — elderly risk)
  • Discontinuation symptoms

Interactions

  • MAOIs — serotonin syndrome (14-day washout)
  • QT-prolonging drugs — additive risk
  • Tramadol/triptans — serotonin syndrome risk
  • NSAIDs — GI bleeding risk
  • Anticoagulants — may affect INR

Monitoring

  • ECG (QTc) in at-risk patients
  • Serum sodium (elderly)
  • Mood and suicide risk assessment

Reference: BNFc; BNF; MHRA Drug Safety Update 2011; NICE NG222. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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