Lexapro (Escitalopram) – Patient Information for Australia
Basic Product Information
| International Nonproprietary Name (INN) | Escitalopram |
|---|---|
| Brand Names in Australia | Lexapro®, Esipram®, Loxalate®, GenRx Escitalopram, Cipramil (escitalopram products) |
| ATC Code | N06AB10 |
| Available Forms & Strengths | Tablets (5 mg, 10 mg, 20 mg), Oral solution (20 mg/mL) |
| Manufacturers | H. Lundbeck A/S, Alphapharm Pty Ltd, Sandoz Pty Ltd, and various other generic suppliers |
| Prescription Status | Prescription Only Medicine (Schedule 4) |
Mechanism of Action
For Patients: Lexapro (escitalopram) is a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI). It works by increasing levels of serotonin, a naturally occurring chemical in the brain that helps regulate mood, emotions, and sleep.
For Healthcare Specialists: Escitalopram, the S-enantiomer of citalopram, selectively inhibits the serotonin (5-HT) transporter, resulting in increased extracellular serotonin levels in the synaptic cleft. With minimal affinity for noradrenergic and dopaminergic receptors, it has a favourable adverse effect profile among SSRIs.
Pharmacokinetics
- Absorption: Well absorbed from the gastrointestinal tract, with peak plasma concentrations reached about 4 hours after oral administration.
- Metabolism: Extensively hepatic, mainly via CYP2C19, CYP3A4, and CYP2D6 enzymes. Produces demethylated metabolites, mostly inactive.
- Elimination: Half-life is about 27–32 hours; excreted mainly via urine (about 8% as unchanged drug).
- Duration: Once-daily dosing is sufficient due to long half-life, supporting steady blood levels.
Use in Daily Life and Best Practices
Lexapro is typically used to treat major depressive disorder (MDD) and generalised anxiety disorder (GAD). In Australia, it is also used for off-label conditions such as social anxiety disorder, panic disorder, and obsessive-compulsive disorder, though these uses should only follow medical advice.
- Typical Adult Doses: Start at 10 mg once daily; may be increased to 20 mg if needed.
- Taking the Medicine: Swallow tablets whole with a glass of water. Oral solution is available for those who have difficulty swallowing.
- Duration of Treatment: Benefits may be felt after 1–2 weeks, but it often takes up to 6–8 weeks to see the full effect. Treatment is usually continued for at least 6–12 months to reduce risk of relapse, per current Australian guidelines.
Dosing: Morning vs Evening
- Morning: Many patients in Australia take Lexapro in the morning to avoid sleep disturbances.
- Evening: Some prefer taking it in the evening if they experience daytime drowsiness as a side effect.
- Advice: Whatever time you choose, take your dose at the same time each day. Consult your pharmacist or doctor if you are unsure when is best for you.
Taking with Food or on an Empty Stomach
- Lexapro can be taken with or without food. Food does not affect how the medicine works.
- In the context of an English/Australia diet, it’s fine to take Lexapro with your main meal or a snack if you prefer. There is no need to avoid any specific foods unless advised by your doctor.
Interaction Warnings
| Interaction | Effect & Advice |
|---|---|
| Alcohol | Best avoided, as it can enhance drowsiness and increase the risk of side effects. |
| Other Antidepressants (especially MAOIs) | May cause dangerous serotonin syndrome. Never combine without direct medical supervision. |
| Blood Thinners (e.g. warfarin, aspirin) | Increased risk of bleeding. Your GP may monitor you more closely. |
| St John’s Wort | May increase side effects and efficacy unpredictably due to serotonin overload. |
| Other Medicines (see pharmacist) | Always inform your pharmacist or doctor of other medicines, including over-the-counter or herbal, as many can interact with Lexapro. |
Indications
| Condition | Approved / Off-label |
|---|---|
| Major Depressive Disorder (MDD) | Approved in Australia (TGA) |
| Generalised Anxiety Disorder (GAD) | Approved in Australia |
| Obsessive-Compulsive Disorder (OCD) | Off-label |
| Social Anxiety Disorder | Off-label |
| Panic Disorder | Off-label |
Dosing According to Clinical Indication
| Population | Indication | Starting Dose | Usual Dose | Maximum Dose |
|---|---|---|---|---|
| Adults | MDD, GAD | 10 mg once daily | 10–20 mg once daily | 20 mg once daily |
| Elderly (>65 yrs) | MDD, GAD | 5 mg once daily | 5–10 mg once daily | 10 mg once daily |
| Paediatric (12–17 yrs) | MDD (only if prescribed by specialist) | 5 mg once daily | 10 mg once daily | 20 mg once daily (rare, specialist supervision) |
| Children (<12 yrs) | Not recommended | Safety and efficacy not established | ||
Safety Profile and Side Effects
| Common (≥1 in 10) | Nausea, headache, fatigue, drowsiness, increased sweating, dry mouth, insomnia |
|---|---|
| Uncommon (1 in 100 – 1 in 10) | Decreased appetite, dizziness, anxiety, sexual dysfunction, constipation or diarrhoea |
| Rare (≤1 in 1000) | Serotonin syndrome, severe allergic reaction, abnormal heart rhythm (QT prolongation) |
| Warnings | May increase suicidal thoughts in some young people (usually in the first few weeks) |
Side effects are often mild and improve over time. Seek medical help if you develop severe symptoms, such as thoughts of self-harm, severe allergic reactions (rash, swelling, breathing difficulties), or chest pain.
Guidelines for Proper Use
- Take Lexapro exactly as prescribed, even if you start to feel better.
- Do not stop abruptly without consulting your doctor, as withdrawal symptoms (dizziness, sleeping problems, agitation) may occur.
- Keep regular appointments for review, especially in the first weeks of treatment.
- Tell your pharmacist about all other medications you are taking, including over-the-counter and complementary medicines.
- If you forget a dose, take it as soon as you remember unless it’s almost time for your next dose. Do not double up doses.
- Store Lexapro at room temperature and keep out of reach of children.
- Contact your doctor if you develop any new or worsening symptoms.
Alternative Treatment Options (PBS-listed)
- SSRIs: Sertraline, fluoxetine, paroxetine, citalopram – similar effectiveness, but side effect profiles differ. All are covered by the Pharmaceutical Benefits Scheme (PBS).
- SNRIs: Venlafaxine, desvenlafaxine, duloxetine - also listed on PBS, may be considered if SSRIs are not tolerated or effective.
- Tricyclic Antidepressants: Amitriptyline, nortriptyline – older, effective for depression, but more side effects.
- Mirtazapine: Useful if insomnia or lack of appetite is significant.
- Psychological therapies: Cognitive behavioural therapy (CBT) and other talking therapies are highly recommended, alone or alongside medication.
Comparative overview: Lexapro is generally well-tolerated, with lower chances of significant drug interactions compared to some other antidepressants. However, choice of treatment should be individualised with your healthcare provider.
Legal, Registration, and Reimbursement Status in Australia
- Legal classification: Schedule 4 (Prescription Only), per Therapeutic Goods Administration (TGA) and Australian law.
- Approval and registration: Registered with TGA (AUST R number varies by brand and formulation).
- Reimbursement: Available on prescription and subsidised by the PBS (Pharmaceutical Benefits Scheme) for approved indications such as MDD and GAD.
- Private scripts: Available for off-label uses, but PBS reimbursement applies only to approved indications.
Latest Research & Clinical Guidance (2022–2025)
- Guidelines from the Royal Australian and New Zealand College of Psychiatrists (RANZCP) continue to recommend SSRIs, including escitalopram, as first-line for depression and anxiety disorders.
- Recent reviews (e.g., Australian Prescriber, 2023) highlight the importance of shared decision-making and routine side effect monitoring in antidepressant therapy.
- Current research supports the use of SSRIs in long-term prevention of depressive relapse, particularly when combined with psychological therapy (BMJ, 2023; RANZCP, 2024).
Availability and Delivery
| Pack Size | Form | Indicative PBS Price (AUD) | Availability | Delivery Times (Business Days) |
|---|---|---|---|---|
| 28 tablets | 10 mg, 20 mg film-coated tabs | $13.50 (PBS co-payment) | Readily available at most community pharmacies across Australia | Sydney: 1–2, Melbourne: 1–2, Brisbane: 1–3, Adelaide: 1–3, Perth: 2–4, Hobart: 1–3, Darwin: 3–5 |
| Oral solution, 15 mL bottle | 20 mg/mL | $13.50 (PBS co-payment) | May require order in advance; check with your pharmacy | Sydney: 2–3, Melbourne: 2–3, Regional and Rural: +1–2 |
Note: Prices and supply may vary depending on location and specific brands. PBS access subject to clinical criteria.
Frequently Asked Questions (FAQ)
- How long does it take for Lexapro to work?
Some improvement may be felt in 1–2 weeks, but it may take 4–8 weeks for full benefits with regular use. Continue taking as prescribed, and consult your doctor if you have concerns. - Can I drink alcohol while taking Lexapro?
It is best to avoid alcohol, as it can increase drowsiness and risk of side effects. If you drink occasionally, talk to your doctor or pharmacist first. - What should I do if I miss a dose?
Take the missed dose as soon as you remember. If it’s close to your next dose, skip the missed dose—do not take a double dose. - Is Lexapro addictive?
No, Lexapro is not addictive and does not cause cravings. However, stopping suddenly can cause withdrawal effects. Always follow your doctor’s instructions. - Can I take Lexapro during pregnancy or breastfeeding?
Inform your doctor if you are pregnant, planning pregnancy, or breastfeeding. The risks and benefits need to be weighed carefully. Do not stop or start Lexapro without medical advice.
For more information, consult your doctor or a registered pharmacist. This information does not replace medical advice, which should be specific to your circumstances.
