Drug pharmacology, pharmacokinetics Brand name Generic name Dosing Indications for use Side effects Contraindications Pregnancy class You must also perform a cost analysis o

1

Lexapro (Escitalopram)

Pharmacology and Pharmacokinetics:

The brand name for escitalopram is Lexapro. Lexapro is a selective serotonin reuptake inhibitor.

This medicine acts to restrain serotonin reuptake from the presynaptic neuron, thus increasing

serotonin amounts in the brain. An increase in serotonin leads to increased serotonin in the

synaptic cleft. Absorption of escitalopram into the gastrointestinal tract is good, and on average,

its peak plasma concentrations are attained about 5 hours post-dose. It has a half-life of 27-32

hours and is mainly metabolized in the liver by the P450 enzyme CYP2C19. It is also partly

metabolized by CYP3A4 and CYP2D6.

Brand Name: Lexapro

Generic Name: Escitalopram

Dosing:

● Initial dose: 10 mg once daily

● Maintenance dose: 10-20 mg once daily

● The recommended dose for MDD and GAD is 10 mg/day as a starting dose and 10 to 20

mg/day as an effective dosing range, with a minimum of one week between the start of

treatment and an increase in dose. Subsequent titration to effective doses should be

initiated at intervals appropriate for how well the patient tolerates the product.

Indications for Use:

● Major depressive disorder (MDD)

● Generalized anxiety disorder (GAD)

Side Effects:

2

● Common: Drowsiness, insomnia, fatigue, dry mouth, increased sweating, tiredness,

diarrhea.

● Serious: Serotonin syndrome, QT prolongation, hypernatremia, increased risk of

bleeding, and suicidal thoughts/behaviors (particularly in young adults and adolescents).

Contraindications:

● Hypersensitivity to escitalopram or the inactive ingredients in the formulation.

● Concurrent use with MAOIs, such as linezolid, or within 14 days of stopping an MAOI.

● Avoid concomitant use with pimozide because of the risk of QT prolongation.

Pregnancy Class:

● Category C: Risk cannot be ruled out. In animal studies, adverse effects on the fetus have

been shown, but adequate and well-controlled studies have not been conducted in

humans. The benefit from the use of the drug in pregnant women may be acceptable

despite potential risks.

Cost Analysis:

● Prices will vary from incredibly low to steep, depending on the insurance and whether

you fill a prescription for the generic equivalent or the branded version of escitalopram.

A total price for a 1-month supply (30 tablets of 10 mg) usually averages $4 to $10 with

insurance or using discount cards. From $130 to $450 is the average total price for a

brand when one does not have insurance on file.

Patient Case Study:

Patient Profile:

● Name: Jane Doe

● Age: 32

3

● Medical History: Jane has had psychotherapeutic treatment for MDD and GAD in the

past. She still reports pervasive sadness, fatigue, poor concentration, and recurrent panic

attacks.

Treatment Plan:

● Initiate Lexapro at 10 mg once daily, with a plan to assess efficacy and tolerability after

one week, and consider increasing to 20 mg if necessary.

Evidence-Based Studies:

Escitalopram is very effective and safe in the treatment of major depressive disorder and

generalized anxiety disorder. The work of Landy and Estevez (2023) suggested that escitalopram

has a high efficacy rate in relieving depressive signs and symptoms based on a perfect side effect

profile; hence, it is also considered a first-line treatment. In a later systematic review and

meta-analysis by Yin et al. (2023), the results were methodologically superior to others; the

anti-depressant activity was even with the equivalence of efficacy in reducing depressive

symptoms, and there is better patient tolerance. Many subsequent studies have confirmed the role

of escitalopram in the management of depressive disorders, showing a high margin of safety.

Patient Education:

● Explain how Lexapro can be used to ameliorate depression and anxiety.

● Educate on potential side effects and the importance of taking the prescribed dose.

● Tell the patient that he needs to have follow-up visits at regular intervals to monitor the

progress and watch out for any untoward effects.

● Offer patient counseling on the risk of the discontinuation syndrome and that the doctor

should guide them on how to taper the medication, not to stop the medication abruptly.

Role as a Nurse Practitioner:

4

● Comprehensive evaluation should be conducted to ensure the diagnosis of MDD and

GAD.

● Lexapro should be prescribed according to clinical guidelines and the patient's needs.

● Patient education and informed consent regarding treatment options—benefits and risks.

● Monitor patient's response to medication and adjust dose—titrate dosage.

● Observe for early signs of undesirable effects, especially suicidal ideation and behaviors,

and intervene without delay.

Monitoring and Follow-Up:

● Appoint follow-up rechecks 1–2 weeks after starting Lexapro to discuss effectiveness and

tolerability.

● Monitor for serotonin syndrome, QT prolongation, and increased suicidal ideation,

especially when initiating therapy.

● Regular follow-up, after every 4-6 weeks: to assess clients' general mental health status.

● Dose adjustment according to therapeutic response and side effects.

● Collaborate in overall care with others in the mental health profession to provide holistic

mental health support for each patient.

5

References

Landy, K., & Estevez, R. (2023). Escitalopram. PubMed; StatPearls Publishing.

https://www.ncbi.nlm.nih.gov/books/NBK557734/

Yin, J. J., Song, X., Wang, C., Lin, X. D., & Miao, M. (2023). Escitalopram versus other

antidepressive agents for major depressive disorder: a systematic review and

meta-analysis. BMC Psychiatry, 23(1). https://doi.org/10.1186/s12888-023-05382-8