Intro
Brand Name: Lexapro
Class: SSRI
MOA: Selective Serotonin Reuptake Inhibitor
Indications
FDA indications: MDD (12y/o and over); GAD (7y/o and over)
Off-Label uses: Panic Disorder; OCD; PTSD
Dosing
Forms: Tablet: 5, 10 (scored), 20 (scored)
Solution: 5mg/5mL
Starting: 10mg qDay; Increase to 20mg qDay if needed
Maintenance: 10-20mg qDay
Max: 20mg
Pharmacokinetics
Half-life: 27-32 hours
Substrate of: CYP2C19, CYP3A4
Side Effects
Serious: Serotonin Syndrome, SIADH
Notable: Sexual dysfunction (dose dependent, delayed ejaculation, anorgasmia), GI (n/v/d, dec appetite), Sedation, Brusing
Gems
-Good option for patients taking multiple medications
-Escitalopram may be preferred to citalopram due to risk of QT prolongation
-Citalopram is a racemic mixture, containing both the R-enantiomer and S-enantiomer of citalopram. Escitalopram is only the S-enantiomer of citalopram (hence “es”-citalopram)
=>10mg dose of S-citalopram (Lexapro) may have therapeutic efficacy of 40mg dose of R,S-citalopram
Special Populations
Renal Impairment: No dose adjustment in mild-moderate
Hepatic Impairment: 10mg qDay
Elderly (60y/o +): 10mg qDay
Adolescents: Approved for depression for 12-17y/o. Approved for anxiety for 7+y/o.
Breast feeding: Some drug may be found in mother’s breast milk
References
Prescriber’s Guide: Stahl’s Essential Psychopharmacology