Lexapro (Escitalopram) Tablets

Lexapro is a brand of escitalopram, a well-established selective serotonin reuptake inhibitor (SSRI) supplied as oral tablets. We offer Lexapro in 5 mg, 10 mg and 20 mg strengths, covering the standard escitalopram dose range used for depression and a number of anxiety disorders in adults. The sections below explain how escitalopram works, what a typical course of treatment involves, what to watch for and how Lexapro relates to other antidepressants, so that you can discuss the right choice with your prescriber with confidence.

What Lexapro is

Lexapro tablets contain escitalopram, the therapeutically active S-enantiomer of citalopram. Escitalopram belongs to the SSRI class and has the ATC code N06AB10. It is taken by mouth, usually once a day. We list 5 mg, 10 mg and 20 mg tablets, allowing a prescriber to select a lower starting dose, a usual maintenance dose or a higher dose when clinically appropriate.

Lexapro is a brand-name product, while escitalopram is the active ingredient. This distinction matters when comparing it with generic tablets: approved generic escitalopram contains the same active ingredient at the stated strength, but tablet appearance, inactive ingredients and packaging can differ between manufacturers.

Depression and anxiety in context

Major depressive episodes and anxiety conditions such as generalised anxiety disorder, panic disorder and social anxiety disorder are common, sometimes fluctuating conditions that can affect mood, sleep, concentration, appetite, energy, motivation and everyday functioning. They often coexist. Obsessive-compulsive disorder can also involve persistent intrusive thoughts and repetitive behaviours that cause marked distress. Escitalopram is used across this group of conditions because serotonin signalling is involved in the brain networks that regulate mood, fear, anxiety and repetitive behaviour.

Medicine is only one part of care. Depending on the condition and its severity, treatment may also include psychological therapy, sleep and activity support, management of alcohol or substance use and regular review of social or physical health factors. Anyone experiencing thoughts of self-harm, severe deterioration or an inability to stay safe needs prompt professional help rather than waiting for an antidepressant to take effect.

How escitalopram works

Escitalopram works by selectively blocking the serotonin transporter, the protein responsible for taking serotonin back into nerve cells after it has been released. This increases serotonin availability in the synaptic space between neurons. The transporter effect begins soon after a dose, but symptom improvement is delayed because the clinically useful response also depends on gradual downstream adaptations in receptors and neural signalling.

This explains why Lexapro does not produce an immediate antidepressant or anti-anxiety effect. Some people notice early changes in sleep, appetite or anxiety within the first two weeks, but a fuller assessment generally requires several weeks at a suitable dose. Escitalopram has relatively little affinity for many of the other neurotransmitter receptors affected by older antidepressants, contributing to a generally more favourable tolerability profile, although clinically important adverse effects and interactions still occur.

Evidence and effectiveness

Escitalopram has been studied extensively against placebo and other antidepressants, including citalopram, venlafaxine and sertraline. Trials commonly assess improvement, response and remission over approximately eight to twelve weeks. A widely cited network meta-analysis of 21 antidepressants, published in The Lancet in 2018, placed escitalopram among the better-performing options for the combined considerations of efficacy and acceptability in adults with major depressive disorder.

Trial averages cannot predict an individual's response. A medicine that works well for one person may be ineffective or poorly tolerated by another, and anxiety can occasionally feel worse during the first days of treatment. Prescribers therefore review symptom change, adverse effects, adherence and functioning rather than relying on dose alone. If there has been little benefit after an adequate trial, the next step may be a dose review, a check for another cause of symptoms, psychological treatment, a switch to another antidepressant or specialist advice.

Ingredients and formulation

Each Lexapro tablet contains escitalopram, generally presented as escitalopram oxalate, in an amount equivalent to the labelled escitalopram strength. The tablet also contains inactive ingredients used to form and coat it. Formulation details can vary with the authorised market and manufacturer, so anyone with a known allergy or intolerance should check the leaflet and packaging supplied with the exact pack.

Take the tablet with water. Some presentations may be scored, but a score line does not always mean that a tablet is intended to provide equal half-doses. Split a tablet only when the information supplied with that presentation or a pharmacist or prescriber confirms that this is appropriate.

Established uses

Escitalopram is established in adults for treating major depressive episodes, generalised anxiety disorder, panic disorder with or without agoraphobia, social anxiety disorder and obsessive-compulsive disorder. The exact licensed indications attached to a branded pack can vary between countries, so the patient leaflet supplied with the medicine remains important.

Prescribers choose between SSRIs using factors such as the diagnosis, previous treatment response, likely adverse effects, other medicines, cardiac risk, pregnancy considerations and personal or family response history. If you are exploring other treatment areas to discuss with a clinician, you can also browse our AntiDepressants and Anxiety pages.

Strengths, pack sizes and general dosing

Our Lexapro tablets are supplied in 5 mg, 10 mg and 20 mg strengths for oral use. For each strength, we offer packs of 10, 20, 30, 60, 90, 120, 180, 270 or 360 tablets. Select the strength and quantity stated for your treatment rather than trying to recreate a dose by combining or splitting tablets without professional advice.

As general background rather than an individual dosing instruction, treatment for depression commonly starts at 10 mg once daily and may be increased to a maximum of 20 mg daily according to response and tolerability. Panic disorder commonly begins with 5 mg once daily during the first week before increasing to 10 mg daily, reducing the chance of an early rise in anxiety. Generalised anxiety disorder, social anxiety disorder and obsessive-compulsive disorder commonly use 10 mg once daily, with subsequent adjustment within the authorised range.

Adults over 65 commonly start at 5 mg once daily, and the usual UK maximum for this age group is 10 mg daily. A lower starting dose and lower maximum may also be needed in hepatic impairment or for known CYP2C19 poor metabolisers. Severe renal impairment requires caution. The appropriate dose must be decided by a prescriber because age, liver function, interactions, cardiac risk and the condition being treated can all change the balance of benefit and harm.

Escitalopram may be taken with or without food because food has little clinically important effect on absorption. Take it at a consistent time each day. Morning dosing may suit someone who experiences insomnia, while evening dosing may be preferable if it causes drowsiness, but a change in timing should still preserve the once-daily schedule. If a dose is forgotten, follow the supplied leaflet; do not take a double dose to compensate. Dose reductions should normally be gradual because abrupt withdrawal can cause dizziness, sensory disturbances, sleep problems, anxiety, nausea, sweating, tremor or headache.

Elimination and half-life

Escitalopram is metabolised mainly in the liver, principally through CYP2C19, with contributions from CYP3A4 and CYP2D6. Its elimination half-life is approximately 27 to 32 hours in adults. Steady-state blood levels are generally reached after about one week of consistent daily dosing, and after treatment stops the medicine clears gradually over several days rather than within hours.

People with reduced liver function, older adults and CYP2C19 poor metabolisers may have greater exposure to escitalopram. Kidney function has a smaller effect on routine elimination, although caution is appropriate in severe renal impairment. These differences help explain why dose limits and monitoring are individualised.

Important safety information

Escitalopram has several safety considerations shared with other SSRIs. Younger adults, particularly those under 25, may experience an early increase in suicidal thoughts or behaviour when starting treatment or changing dose. Patients and those supporting them should watch for marked agitation, unusual behaviour, worsening depression or new thoughts of self-harm, especially during the first weeks and after dose adjustments.

Serotonin syndrome is a rare but serious reaction involving combinations of mental changes, autonomic disturbance and abnormal muscle activity. Warning signs can include agitation, confusion, sweating, diarrhoea, high temperature, tremor, overactive reflexes and muscle rigidity. The risk is greater when escitalopram is combined with another serotonergic medicine.

Escitalopram can prolong the QT interval in a dose-dependent way and may increase the risk of an abnormal heart rhythm in susceptible people. Risk is greater with existing QT prolongation, significant bradycardia, recent heart attack, uncompensated heart failure, low potassium or magnesium and other QT-prolonging medicines. A prescriber may request an ECG or blood tests when cardiac or electrolyte risk factors are present.

Other concerns include hyponatraemia, abnormal bleeding, activation of mania or hypomania, seizures, akathisia and altered blood glucose control. People with diabetes may need closer glucose monitoring and adjustment of insulin or other diabetes treatment. Escitalopram tablets should generally not be used to treat children or adolescents under 18. Use during pregnancy requires an individual benefit-risk assessment, and abrupt discontinuation during pregnancy should be avoided. UK product information generally advises against breast-feeding during treatment because escitalopram is expected to pass into breast milk.

Escitalopram can affect judgement, alertness or coordination. Do not drive, cycle or operate machinery until you know how it affects you. Alcohol may worsen drowsiness or other adverse effects and can aggravate depression or anxiety, so it is sensible to discuss alcohol use with a clinician.

Prescription status and how we supply Lexapro

Escitalopram tablets are prescription-only medicines in the United Kingdom and require authorisation from an appropriate prescriber for lawful supply. Separately, our ordering policy for this listing does not require you to submit a prescription document before we accept your order. This ordering step does not change the medicine's UK prescription-only classification or any clinical requirements that apply before supply.

Our support team, including a pharmacist, is available by email and online chat 24 hours a day, seven days a week, to answer questions before or after you order. We can help with our listed strengths, pack quantities, checkout, packing, dispatch and UK delivery process. Questions about whether escitalopram is suitable for you, changing a dose or switching treatment require an individual clinical assessment by a prescriber.

Contraindications

Escitalopram must not be used by anyone with known hypersensitivity to escitalopram or any ingredient in the tablet. It is contraindicated with non-selective, irreversible monoamine oxidase inhibitors (MAOIs) and with reversible MAO-A inhibitors such as moclobemide because of the risk of serotonin syndrome. Required washout periods must be observed when switching. Other monoamine oxidase-inhibiting medicines, including linezolid, also require careful professional assessment, while the selective MAO-B inhibitor selegiline requires particular caution.

Escitalopram is also contraindicated in people with known QT-interval prolongation or congenital long QT syndrome and with medicines known to prolong the QT interval. Pimozide is an important example. A history of mania, epilepsy, significant cardiac disease, bleeding tendency, glaucoma risk or severe liver or kidney impairment is not automatically an absolute contraindication in every case, but it requires prescriber review and may change treatment or monitoring.

Interactions

Escitalopram can interact with other medicines by increasing serotonergic activity, adding to QT prolongation or bleeding risk, or changing escitalopram concentrations through shared metabolic pathways. The table below summarises the medicine groups most important to check before starting Lexapro.

Examples that need review include MAOIs, tramadol, triptans, lithium, tryptophan and other antidepressants because of serotonin toxicity; antipsychotics, certain antiarrhythmics and some antimicrobials because of QT effects; and aspirin, non-steroidal anti-inflammatory drugs, anticoagulants and antiplatelet medicines because of bleeding. Omeprazole, esomeprazole, fluconazole, fluvoxamine and ticlopidine may inhibit CYP2C19 and increase escitalopram exposure.

Tell a prescriber or pharmacist about every prescription medicine, over-the-counter product, supplement and herbal remedy you use. St John's wort can increase serotonergic adverse effects and should not be added without professional advice. Do not stop an interacting medicine independently; the correct action may be avoidance, a dose change, monitoring or selection of an alternative.

Side effects and when to act

Nausea and headache are among the most frequently reported effects. Other common effects include dry mouth, increased sweating, insomnia, drowsiness, dizziness, fatigue, restlessness, diarrhoea or constipation, appetite or weight changes and sexual effects such as reduced desire, delayed orgasm or ejaculation difficulties. Some early effects improve over the first one to two weeks, although sexual dysfunction can persist and should be discussed rather than silently tolerated.

Contact a clinician promptly about persistent or troublesome adverse effects, unusual bleeding or bruising, severe restlessness, signs of mania, a seizure, marked weakness or confusion, or worsening mood. Symptoms such as confusion, severe headache, unsteadiness or seizures can indicate low sodium. Black stools, vomiting blood or bleeding that will not stop require urgent assessment.

Seek emergency help for severe agitation with fever and stiffness, fainting or a very irregular heartbeat, a seizure lasting several minutes, facial or throat swelling, difficulty breathing or immediate danger from thoughts of self-harm. In the UK, call 999 or go to A&E for a medical emergency. NHS 111 can advise when urgent help is needed but the situation is not immediately life-threatening. Suspected adverse effects can also be reported to the MHRA through the Yellow Card Scheme.

Overdose and toxicity

An escitalopram overdose may cause dizziness, tremor, agitation, drowsiness, nausea, vomiting, a fast heartbeat and changes in blood pressure. More serious poisoning can cause seizures, reduced consciousness, metabolic disturbances or QT prolongation with an abnormal heart rhythm. Risk can be greater when other medicines or alcohol have also been taken, and serious toxicity may develop before the person recognises every symptom.

If someone has taken more than their prescribed dose, seek urgent advice even if they initially feel well. In the UK, contact NHS 111 for immediate assessment and have the medicine packet, approximate amount and time of ingestion available. Call 999 or go to A&E immediately if the person collapses, has a seizure, has difficulty breathing, cannot be awakened, has severe symptoms or is in immediate danger. Do not induce vomiting. An intentional overdose or suspected self-harm always requires urgent emergency and mental health support.

Storage

Store Lexapro tablets at 25 °C; excursions between 15 °C and 30 °C are permitted. Keep the container tightly closed and protect the tablets from moisture. Retain them in their original packaging, out of the sight and reach of children, and do not use them after the stated expiry date. Return unwanted or expired tablets to a pharmacy for safe disposal rather than putting them in household waste or wastewater.

Benefits and trade-offs

Escitalopram's practical advantages include once-daily dosing, use with or without food, a generally favourable tolerability profile compared with older antidepressant classes and a substantial evidence base across depression and several anxiety disorders. The availability of 5 mg, 10 mg and 20 mg tablets supports gradual dose adjustment when clinically appropriate.

Trade-offs include a gradual onset measured in weeks rather than days, possible early anxiety or nausea, sexual adverse effects, withdrawal symptoms after abrupt discontinuation and the need to consider cardiac rhythm, sodium, bleeding and interaction risks. Some people need ongoing treatment for months after recovery to reduce relapse risk, while recurrent illness can require longer-term treatment. Duration should be reviewed periodically rather than determined only by how many tablets remain.

Compared with citalopram, its racemic parent compound, escitalopram is generally used at roughly half the milligram dose for a broadly similar therapeutic role. That does not make the two medicines interchangeable milligram for milligram without a planned switch, and neither is universally better for every patient.

Generic equivalents and similar medicines

Generic escitalopram tablets contain the same active ingredient as Lexapro at the stated strength. Other escitalopram brands, including Cipralex in some markets, have the same core pharmacological action, although inactive ingredients, appearance, pack design and brand availability can differ. A change between brand and generic products is usually straightforward, but anyone sensitive to excipients or confused by a change in tablet appearance should check the dispensing label and leaflet.

Therapeutic alternatives include other SSRIs such as sertraline, fluoxetine, citalopram and paroxetine, and serotonin-noradrenaline reuptake inhibitors such as venlafaxine and duloxetine. These medicines differ in withdrawal risk, half-life, interaction burden, activating or sedating effects, cardiac considerations and the conditions for which they are licensed. Bupropion is used as an antidepressant in some countries, but it is not routinely licensed for treating depression in the UK.

For example, Paxil contains paroxetine, another SSRI with the same broad transporter target but a shorter half-life and a different emphasis in adverse effects and withdrawal symptoms. Sertraline is often considered where cardiac risk or pregnancy planning affects selection, while fluoxetine's long half-life can reduce some withdrawal problems but makes interactions persist longer. SNRIs may be considered after an inadequate SSRI response but can have additional effects on blood pressure and discontinuation symptoms.

Any switch between antidepressants should be planned and supervised by a prescriber. Depending on the medicines involved, the plan may use a direct switch, gradual cross-taper or a washout period. Combining antidepressants without specialist direction can increase serotonin toxicity and other adverse effects.