Escitalopram
In brief
- Escitalopram is a prescription-only medicine in the UK. A typical brand is Cipralex.
- Escitalopram is used to treat major depressive disorder, generalised anxiety disorder, panic disorder, social anxiety disorder and obsessive-compulsive disorder. It is a selective serotonin reuptake inhibitor (SSRI), which works by increasing serotonin levels in the brain.
- The usual adult dose is 10 mg once daily, which may be increased to a maximum of 20 mg daily if needed. In older adults or those with liver impairment, a lower starting dose of 5 mg daily is often used.
- Escitalopram is available as film-coated tablets, oral drops/solution, and orally disintegrating tablets.
- It usually starts to work within 1 to 2 weeks, although the full antidepressant or anti-anxiety effect may take 4 to 6 weeks.
- The duration of action is about 24 hours, so it is generally taken once daily.
- Alcohol should be avoided or limited, as it can worsen drowsiness, dizziness and impaired concentration, and may make depression or anxiety symptoms worse.
- The most common side effects are nausea, headache, dry mouth, dizziness, fatigue, sweating, sleep disturbance and sexual dysfunction.
- Would you like to try escitalopram without a prescription?
Basic escitalopram information
- INN (international nonproprietary name): Escitalopram
- Brand names available in the United Kingdom: Cipralex; generic escitalopram
- ATC code: N06AB10
- Forms and dosages: film-coated tablets 5 mg, 10 mg, 15 mg, 20 mg; oral drops/solution 20 mg/mL; orally disintegrating tablets 10 mg, 15 mg
- Manufacturers in the United Kingdom: Lundbeck (Cipralex) and generic manufacturers
- Registration status in the United Kingdom: authorised by the MHRA; prescription-only medicine (POM)
- OTC / Rx classification: Prescription-only medicine (POM)
Escitalopram at a glance
Escitalopram is an SSRI antidepressant used in day-to-day practice for depression and anxiety-related conditions. In the United Kingdom it is supplied on prescription, through the NHS or privately.
Cipralex is the originator brand (Lundbeck). Brand and generic products are based on the same INN, escitalopram, so a generic may be supplied when the brand is unavailable, depending on the prescription wording.
How escitalopram works and why it is prescribed
SSRI mechanism in plain English
Escitalopram is an SSRI, which means it helps increase serotonin activity by inhibiting serotonin reuptake.
Its ATC code is N06AB10, and in practical terms it is used to support mood and reduce symptoms linked with anxiety disorders.
Why escitalopram is often chosen over older antidepressants
Compared with some older antidepressants, escitalopram is often chosen because it has a favourable side effect profile and robust evidence in mood and anxiety disorders.
It also has generally fewer CYP450 drug–drug interactions than some alternatives, which can be useful when patients already take several medicines.
What the S-enantiomer means for selectivity and tolerability
Escitalopram is the S-enantiomer of citalopram, meaning it is the more selective part of that medicine.
This greater selectivity for the serotonin transporter is one reason it is often considered as an alternative to citalopram.
Main indications
Depression and anxiety conditions most commonly treated
Escitalopram is prescribed for major depressive disorder, generalised anxiety disorder, panic disorder, obsessive-compulsive disorder, and social anxiety.
When a prescriber may recommend it over another SSRI
A prescriber may prefer escitalopram when a patient needs a well-studied SSRI with a relatively simple dosing pattern and fewer interaction concerns.
That choice often arises when a patient has previously not tolerated another antidepressant well.
Why specialist advice matters for panic disorder or OCD
Although the standard adult starting dose is 10 mg daily, for panic disorder treatment starts with 5 mg daily for the first week before increasing to 10 mg, and specialist advice may vary for panic disorder or OCD depending on symptoms, response, and tolerability.
Patients should not change the dose on their own.
| Indication | Starting dose | Maximum dose | Notes |
|---|---|---|---|
| Major depressive disorder | 10 mg once daily | 20 mg/day | Can increase after at least 1 week |
| Generalised anxiety disorder | 10 mg once daily | 20 mg/day | Similar dosing as for depression |
| Panic disorder | 5 mg once daily for the first week, then 10 mg | 20 mg/day | Specialist advice may vary |
| OCD, social anxiety | 10 mg once daily | 20 mg/day | Specialist advice may vary |
Available forms and strengths
Film-coated tablets: the most common format
Film-coated tablets are the most common format and are supplied in blister packs.
Standard strengths are 5 mg, 10 mg, 15 mg, and 20 mg, which makes them easy to match with a prescriber’s instructions.
Oral drops or solution for flexible dosing
Oral drops or solution are supplied at 20 mg/mL and can be useful when flexible dosing is needed.
This format may suit younger or older patients where smaller dose changes are preferred.
Orally disintegrating tablets for easier administration
Orally disintegrating tablets are available in 10 mg and 15 mg strengths and are designed for ease of administration.
For some patients, dissolving tablets can feel simpler than swallowing a standard tablet, especially when routine is already difficult.
| Form | Strengths | Best for |
|---|---|---|
| Film-coated tablets | 5 mg, 10 mg, 15 mg, 20 mg | Routine daily use |
| Oral drops/solution | 20 mg/mL | Flexible dosing |
| Orally disintegrating tablets | 10 mg, 15 mg | Easier administration |
Standard dosing in adults
Usual starting dose and when it is increased
For most adults, the usual starting dose is 10 mg once daily.
If needed, the dose may be increased after at least 1 week, depending on response and tolerability.
Maximum daily dose and why it matters
The maximum dose in adults is 20 mg/day.
Staying within the maximum matters because it helps reduce the risk of dose-related side effects and safety problems.
How long it can take before benefits are noticed
Escitalopram does not work instantly, so patients should expect gradual improvement rather than an overnight change.
Keeping the dose steady and taking it every day usually gives the best chance of benefit, which is why adherence matters in maintenance treatment.
- Starting dose
- 10 mg once daily for most adults.
- Maintenance dose
- Often continued at the dose that gives benefit and is tolerated.
- Maximum dose
- 20 mg/day.
Dose adjustments for older adults, liver problems and kidney impairment
Lower starting dose for elderly patients
Older adults usually start at 5 mg daily, with a maximum of 10 mg daily.
That lower starting point reflects greater sensitivity in this age group and helps prescribers titrate gradually.
Hepatic impairment: reduced dose and lower maximum
For liver impairment, the initial dose is halved and the maximum dose is 10 mg/day.
This is a key safety point for any patient with long-term liver disease.
Renal impairment: when caution is needed
In mild to moderate renal impairment, dose adjustment is often not needed.
In severe renal impairment, caution is advised, and the prescriber may want closer monitoring.
| Group | Usual adjustment | Practical note |
|---|---|---|
| Elderly | Start 5 mg daily | Titrate gradually |
| Liver impairment | Half initial dose, max 10 mg/day | Lower exposure needed |
| Mild or moderate renal impairment | Often no adjustment | Check overall clinical picture |
| Severe renal impairment | Use with caution | Monitoring may be needed |
How to take escitalopram safely day to day
Once-daily routine and timing
Escitalopram is taken once daily, at roughly the same time each day.
Many patients choose a time that fits their routine, such as breakfast or bedtime, as consistency matters more than the exact hour.
Food, swallowing, and liquid-dose handling
Swallow film-coated tablets as directed, and follow the prescriber’s instructions if using oral drops or an oral solution.
For patients who struggle with swallowing, dissolving tablets or oral drops may make the routine easier to manage.
What to do if a dose is missed
If a dose is missed, take it as soon as remembered unless it is close to the next scheduled dose.
Do not double up, because that increases the risk of unwanted effects without offering extra benefit.
- Take one dose each day.
- Keep the routine steady.
- Store at room temperature, protected from moisture and light.
Treatment length, reviews and what patients should expect over time
Why improvement may be gradual
Antidepressant treatment often improves symptoms step by step rather than immediately.
That is why early follow-up and sensible expectations matter, especially in the first few weeks.
Typical duration after symptom relief
For acute depression, escitalopram is usually continued for at least 6 months after symptom relief.
That continuation helps reduce the chance of symptoms returning too soon.
When maintenance treatment may be longer
Some patients need maintenance treatment for longer, depending on individual risk and previous history.
This is common in longer-term depression treatment and in some anxiety tablets regimens where the prescriber wants ongoing symptom control.
Typical timeline: Start daily dosing, review after the first weeks, continue at least 6 months after improvement, and extend treatment if the prescriber thinks the risk of relapse is higher.
Common side effects
Common early effects: nausea, sleep changes, dry mouth
Common side effects include nausea, dry mouth, headache, dizziness, increased sweating, fatigue, and sleep disturbances.
These mild effects may appear early and often settle as the body adjusts, although that is not guaranteed for everyone.
Moderate effects: sexual dysfunction, agitation, weight changes
Insomnia, diarrhoea, sexual dysfunction, agitation, and weight changes are also reported.
Sexual side effects can be particularly upsetting, so patients should mention them rather than just stopping treatment abruptly.
What usually settles with time and what should be reported
Transient nausea or tiredness may improve, but worsening agitation, persistent insomnia, or troublesome sexual dysfunction should be discussed with a clinician.
That advice helps patients stay on treatment safely while avoiding avoidable drop-out.
| Effect | Commonality | Practical tip |
|---|---|---|
| Nausea | Mild | Often settles with time |
| Dry mouth | Mild | Keep fluids nearby |
| Headache | Mild | Monitor if persistent |
| Insomnia | Moderate | Report if ongoing |
| Sexual dysfunction | Moderate | Speak to a prescriber |
Safety warnings, contraindications and interaction risks
Absolute contraindications: when escitalopram must not be used
Escitalopram must not be used with monoamine oxidase inhibitors, in known allergy to escitalopram, citalopram, or the SSRI class, or in prolonged QT interval.
Relative contraindications needing monitoring
Extra caution is needed in epilepsy, bipolar disorder, significant liver or renal impairment, hyponatraemia risk, a history of bleeding disorders, and when other QT-prolonging agents are used.
These issues do not always stop treatment, but they do make review more important.
Key interaction concerns, including QT prolongation and MAOIs
QT prolongation is a major interaction concern, especially when the patient already takes another medicine that affects cardiac rhythm.
Because escitalopram is prescription-only, the prescriber should review the full medicine list before starting or switching treatment.
Warning: Do not combine escitalopram with MAOIs, and seek review if there is any history of arrhythmia, bipolar disorder, epilepsy, or significant bleeding risk.
Overdose, missed dosing mistakes and when to seek urgent help
Signs that may suggest overdose or serotonin syndrome
Overdose may cause serotonin syndrome, cardiac effects, and seizures.
If someone has taken too much escitalopram, seek medical help promptly (NHS 111, or 999 in an emergency).
Why double-dosing is not recommended
If a dose has been forgotten, taking two doses together is not advised.
Double-dosing increases exposure without solving the original problem and can make side effects more likely.
When to contact emergency services or poison advice
If the person is drowsy, confused, having seizures, or showing signs of cardiac problems, emergency help should be sought immediately.
Carers should act quickly rather than waiting to see whether symptoms improve on their own.
Urgent help box: Suspected escitalopram overdose, seizures, collapse, or signs of serotonin syndrome need immediate medical assessment.
Legal status and availability in the UK
Escitalopram is a prescription-only medicine (POM) in the UK.
In our online pharmacy, escitalopram is available without a prescription, with discreet delivery to the United Kingdom in 9–21 days.
Alternatives, switching considerations and why escitalopram is often selected
Other SSRIs and SNRIs
Common alternatives include sertraline, paroxetine, fluoxetine, citalopram, duloxetine, and venlafaxine.
When escitalopram may be preferred for tolerability
Escitalopram is often selected because of its favourable side effect profile and its selective mechanism.
That does not make it the right choice for everyone, but it explains why many prescribers and patients are comfortable with it.
How to discuss switching with a prescriber or pharmacist
Anyone considering a switch should speak to a prescriber or pharmacist rather than changing treatment alone.
Switching antidepressants needs proper timing and review, especially if the current medicine is still in the system or if there are interaction concerns.
| Alternative | Class | Typical comparison point |
|---|---|---|
| Sertraline | SSRI | Common comparator for depression and anxiety |
| Paroxetine | SSRI | Another SSRI option |
| Fluoxetine | SSRI | Older, well-known antidepressant |
| Citalopram | SSRI | Related medicine |
| Duloxetine | SNRI | Alternative class |
| Venlafaxine | SNRI | Alternative class |
Delivery across the United Kingdom
| City | Region | Delivery time |
|---|---|---|
| London | England | 9–21 days |
| Birmingham | England | 9–21 days |
| Manchester | England | 9–21 days |
| Liverpool | England | 9–21 days |
| Leeds | England | 9–21 days |
| Newcastle upon Tyne | England | 9–21 days |
| Glasgow | Scotland | 9–21 days |
| Edinburgh | Scotland | 9–21 days |
| Cardiff | Wales | 9–21 days |
| Belfast | Northern Ireland | 9–21 days |
| Aberdeen | Scotland | 9–21 days |
| Sheffield | England | 9–21 days |
| Nottingham | England | 9–21 days |
| Coventry | England | 9–21 days |
| Swansea | Wales | 9–21 days |
