Escitalopram

Escitalopram, commonly known by the brand name Lexapro^®, is a selective serotonin reuptake inhibitor (SSRI) used to treat depression and anxiety disorders, including generalized anxiety disorder (GAD) and major depressive disorder (MDD). It works by increasing available serotonin levels in the brain, which can help to regulate mood, emotions, and stress responses. 

In women's health, escitalopram is sometimes prescribed off-label for conditions like premenstrual dysphoric disorder (PMDD), postpartum depression, and perimenopausal mood disturbances.

The typical prescription dosage starts at 10 milligrams (mg) per day, with a maximum recommended dose of 20 mg per day. A healthcare provider will adjust the level based on patient response and tolerance.

Women considering escitalopram should discuss their reproductive plans and any existing health conditions with their healthcare provider to ensure the medication is the right fit for their needs.

Escitalopram is the active ingredient in the brand-name medication Lexapro^®, which is the focus of the information below. According to the United States Food and Drug Administration (FDA), “Generic medicines use the same active ingredients as brand-name medicines and work the same way, so they have the same risks and benefits as the brand-name medicines.”

Lexapro (escitalopram) is indicated for the:

• Treatment of major depressive disorder (MDD) in adults and pediatric patients 12 years of age and older

• Treatment of generalized anxiety disorder (GAD) in adults and pediatric patients 7 years and older

Selective serotonin reuptake inhibitor (SSRI)

Most commonly observed adverse reactions (incidence ≥ 5% and at least twice the incidence of placebo patients) are:

• Insomnia

• Ejaculation disorder (primarily ejaculatory delay),

• Nausea

• Sweating increased

• Fatigue and sleepiness

• Decreased libido

• Inability to orgasm

The cost of escitalopram varies depending on your insurance plan, which pharmacy you use, the dosage, and quantity. Without insurance, generic escitalopram may cost about $60 for a month’s supply of 10 mg tablets, but coupons and discount cards may be available to bring down the price. Lexapro, the brand-name version of the medication, costs about $575 for a month’s supply of 20 mg tablets. Insurance may cover all or some of the cost of this medication.

A prescription for escitalopram through Hers starts at $49 per month and includes key benefits of using the Hers telehealth platform, such as free shipping and unlimited messaging with a provider.

You can get a prescription for escitalopram after being evaluated by your primary care provider or a specialist who can determine if the medicine is right for you based on factors like your symptoms and medical history. 

Hers offers access to escitalopram. When you connect with a provider through the Hers platform, they’ll determine if this medication is right for you. If it’s deemed a good fit, your medication will be shipped directly to your door. Your prescription costs include shipping and ongoing asynchronous messaging with your provider and our customer service team.

Concomitant use with SSRIs, SNRIs or Tryptophan is not recommended 
Use caution when concomitant use with drugs that affect Hemostasis (NSAIDs, Aspirin, Warfarin)

• Do not use MAOIs intended to treat psychiatric disorders with Lexapro or within 14 days of stopping treatment with Lexapro. Do not use Lexapro within 14 days of stopping an MAOI intended to treat psychiatric disorders. In addition, do not start Lexapro in a patient who is being treated with linezolid or intravenous methylene blue

• Concomitant use of pimozide

• Known hypersensitivity to escitalopram or citalopram or any of the inactive ingredients

• Drug interactions: SSRIs, SNRIs, tryptophan, drugs that affect hemostasis (NSAIDs, aspirin, warfarin)

• Serotonin syndrome

• Discontinuation syndrome

• Seizures

• Activation of mania/hypomania

• Low blood sodium: Can occur in association with syndrome of inappropriate antidiuretic hormone secretion

• Increased risk of bleeding

• Interference with cognitive and motor performance

• Angle closure glaucoma

• Use in patients with concomitant illness

• Sexual dysfunction

• Pregnancy: SSRI use, particularly later in pregnancy, may increase the risk for persistent pulmonary hypertension and symptoms of poor adaptation (respiratory distress, temperature instability, feeding difficulties, hypotonia, tremor, irritability) in the neonate

WARNING: SUICIDAL THOUGHTS AND BEHAVIORS

Increased risk of suicidal thoughts and behavior in pediatric and young adult patients taking antidepressants. Closely monitor all antidepressant-treated patients for clinical worsening and emergence of suicidal thoughts and behaviors. Lexapro is not approved for use in pediatric patients less than 7 years of age.

Other medications are available to treat conditions such as depression or anxiety disorders. Some of these drugs may be better suited to you than others. If you’re interested in finding an alternative to escitalopram, discuss your options with a healthcare provider.

Examples of medications that a provider may prescribe for depression or anxiety include the drugs listed below:

• Other SSRIs:

  • citalopram (Celexa^®)

  • fluoxetine (Prozac^®)

  • paroxetine (Paxil^®)

  • sertraline (Zoloft^®)

• Serotonin-norepinephrine reuptake inhibitors (SNRIs):

  • desvenlafaxine (Pristiq^®)

  • duloxetine (Cymbalta^®)

  • venlafaxine (Effexor^®)

• Monoamine oxidase inhibitors (MAOIs):

  • isocarboxazid (Marplan^®)

  • phenelzine (Nardil^®)

  • selegiline (Emsam^®)

  • tranylcypromine (Parnate^®)

• Tricyclic antidepressants (TCAs):

  • clomipramine (Anafranil^®)

  • imipramine (Tofranil^®)

  • desipramine (Norpramin^®)

  • nortriptyline (Pamelor^®)

• Atypical antidepressants:

  • bupropion (Wellbutrin^®)

  • mirtazapine (Remeron^®)

  • vortioxetine (Trintellix^®)

*This information is from the label for brand name Lexapro^®. See the Full Prescribing Information for more complete information. Escitalopram, the active ingredient in Lexapro, may also be the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient escitalopram.