Escitalopram
Escitalopram is a selective serotonin reuptake inhibitor (SSRI) widely used for major depression and anxiety disorders. It is the active S-enantiomer of citalopram and is marketed as Lexapro and Cipralex.
- Chemical formula
- C20H21FN2O
- CAS number
- 128196-01-0
- ATC code
- N06AB10
- Molecular weight
- 324.39 g/mol
- Drug class
- Selective serotonin reuptake inhibitor (SSRI)
- Also known as
- Lexapro, Cipralex, S-citalopram
What is it?
Escitalopram is the pharmacologically active S-enantiomer of citalopram, approved in 2002 for major depressive disorder. It has since become one of the most prescribed SSRIs worldwide for depression and several anxiety disorders. The molecule is on the WHO Essential Medicines List and is available as authorised generic in most regulated markets in addition to the originator brands Lexapro (Forest/Allergan) and Cipralex (Lundbeck).
Mechanism of action
Escitalopram selectively inhibits the serotonin reuptake transporter (SERT) at the synaptic cleft, increasing serotonin availability for postsynaptic receptors. Compared with citalopram, escitalopram has higher SERT selectivity and a cleaner pharmacological profile. The therapeutic effect develops over weeks as downstream receptor adaptations occur; immediate biochemical SERT inhibition is detectable within hours of the first dose.
Pharmacokinetics
After oral administration, escitalopram is well absorbed with bioavailability of approximately 80%. Peak plasma concentrations are reached 4–5 hours after dosing. The terminal half-life is approximately 27–32 hours, allowing once-daily dosing with steady state reached in about a week. Hepatic metabolism is via CYP2C19, CYP3A4 and CYP2D6 with multiple metabolites; renal excretion is the main elimination route.
Indications
Escitalopram is approved for major depressive disorder, generalised anxiety disorder, social anxiety disorder, panic disorder and obsessive-compulsive disorder, with regional variation in licensing. It is generally considered first-line therapy for depression in adult primary care and is widely used in adolescents under specialist supervision. Off-label uses include premenstrual dysphoric disorder and certain other anxiety presentations.
Safety profile
Common adverse effects include nausea, headache, sexual dysfunction, fatigue, sleep disturbance and increased sweating, most prominent in the first 2–4 weeks. Serious risks include QT prolongation (dose-related, more relevant with citalopram than escitalopram), serotonin syndrome with co-administered serotonergic agents, increased suicidality risk in young adults during initiation, and SSRI discontinuation syndrome on abrupt cessation.
Products containing this ingredient
Frequently asked questions
How long does escitalopram take to work? ▾
Some users notice mood and sleep improvements within 1–2 weeks, but full antidepressant effect typically requires 4–6 weeks of consistent dosing. Anxiety symptoms may improve faster than depressive symptoms. According to clinical guidelines, the medication should not be judged ineffective before 4–6 weeks at an adequate dose.
Is escitalopram addictive? ▾
Escitalopram is not addictive in the sense of causing craving or compulsive use. However, abrupt discontinuation can produce a discontinuation syndrome (dizziness, flu-like symptoms, electric-shock sensations) that resolves with tapered withdrawal. According to the prescribing information, escitalopram should be tapered over weeks rather than stopped abruptly.
Can escitalopram be combined with other medications? ▾
Most combinations are safe, but a few are contraindicated or require caution: MAOIs (washout period required), other serotonergic agents (serotonin syndrome risk), tramadol, triptans, and certain antiarrhythmics. According to the prescribing information, the full medication list should be reviewed by the pharmacist before adding escitalopram.
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