Escitalopram: uses, side effects and safety
Escitalopram (Lexapro) is a selective serotonin reuptake inhibitor (ssri) antidepressant. It has no US federal controlled-substance schedule. It is prescription only (rx) and remains on the US market.
What is Escitalopram?
Escitalopram is the generic name for Lexapro, and belongs to the Selective serotonin reuptake inhibitor (SSRI) antidepressant class.
| Generic name | escitalopram |
|---|---|
| Brand name(s) | Lexapro |
| Drug class | Selective serotonin reuptake inhibitor (SSRI) antidepressant |
| US legal status | No US federal schedule · Prescription only (Rx) |
| Route | Oral |
| Prescription required | Yes |
| Elimination half-life | Mean terminal half-life about 27-32 hours (increased approximately 50% in subjects 65 years and older; doubled in patients with reduced hepatic function) |
| Time to peak concentration | 5 |
| Metabolism | Human liver microsome studies indicate CYP3A4 and CYP2C19 are the primary isozymes involved in the N-demethylation of escitalopram, forming S-DCT and S-DDCT. Metabolites do not contribute significantly to antidepressant action. Approximately 7% of clearance is renal. |
What is Escitalopram used for?
Escitalopram is approved by the FDA for the following uses. Approval is granted per indication, and a specific product may not be approved for all of them.
- Major depressive disorder (MDD) in adults and pediatric patients 12 years of age and older
- Generalized anxiety disorder (GAD) in adults
How does Escitalopram work?
The mechanism of antidepressant action of escitalopram, the S-enantiomer of racemic citalopram, is presumed to be linked to potentiation of serotonergic activity in the central nervous system resulting from its inhibition of CNS neuronal reuptake of serotonin (5-HT). At least 100-fold more potent than the R-enantiomer..
It is metabolised primarily by Human liver microsome studies indicate CYP3A4 and CYP2C19 are the primary isozymes involved in the N-demethylation of escitalopram, forming S-DCT and S-DDCT. Metabolites do not contribute significantly to antidepressant action. Approximately 7% of clearance is renal..
The elimination half-life is roughly Mean terminal half-life about 27-32 hours (increased approximately 50% in subjects 65 years and older; doubled in patients with reduced hepatic function). Longer half-lives mean the drug and its active metabolites persist in the body for longer after the last dose.
Common side effects of Escitalopram
These are the side effects people report most often. Many diminish after the body adjusts, usually within one to two weeks.
- Nausea
- Headache
- Insomnia or somnolence
- Fatigue
- Dizziness
- Ejaculation disorder
- Dry mouth
- Constipation
- Increased sweating
What does Escitalopram interact with?
Interactions matter because two safe medicines can become dangerous together. The entries below are the ones most likely to cause harm.
- MAOIs (including linezolid and intravenous methylene blue): contraindicated - increased risk of serotonin syndrome
- Pimozide: contraindicated - QT prolongation and/or ventricular arrhythmias
- CYP2D6 substrates: escitalopram 20 mg/day increased desipramine (a CYP2D6 substrate) Cmax by 40% and AUC by 100%
- Drugs that lengthen QT interval
- NSAIDs and aspirin - increased bleeding risk
Use our drug interaction checker before combining any two prescriptions.
Serious side effects and warning signs
Seek emergency care for any of these
- Suicidal thinking and behavior in children, adolescents and young adults
- Serotonin syndrome
- QT prolongation
- Bleeding risk, especially with concomitant NSAIDs or aspirin
- Severe allergic reactions including anaphylaxis, angioedema and Stevens-Johnson syndrome
- Hyponatremia and SIADH
- Mania / activation of mania
Suspected overdose or a bad reaction should be reported to Poison Control on 1-800-222-1222. That is staffed around the clock and is free.
Legal status of Escitalopram
Escitalopram has no US federal controlled-substance schedule. An unscheduled medicine is not an over-the-counter medicine: it remains prescription-only, and individual states may regulate it independently. State rules are covered in our state-by-state section.
Statutory reference: Not listed in 21 CFR 1308.11 through 1308.15 (Schedules II-V), verified against the eCFR text current as of 2026-09-01. Citalopram is also absent from those sections..
Important note
schedule is null because escitalopram does not appear anywhere in 21 CFR 1308.11-1308.15 - a verified absence, not a missing lookup. onsetHours is null: MedlinePlus states only 'It may take several weeks before you feel the full benefit', and the label gives no onset figure. peakHours 5 is from the label statement that peak blood levels occur at about 5 hours after a single 20 mg tablet or solution dose. This particular generic label markets 5, 10 and 20 mg tablets only - it does not list 40 mg, so 40 mg is not included in strengths. Label also notes additional pediatric use information is approved for AbbVie's Lexapro but is not on this generic label due to AbbVie marketing exclusivity.
Can you get Escitalopram without a prescription?
Short answer: no. Escitalopram is a prescription medication. Sites advertising it without one are either operating illegally or selling something other than what they claim. We explain the legal routes, the counterfeit problem and how to check a source in detail.
Read the full answer: Escitalopram without a prescription →
Frequently asked questions
What is Escitalopram used for?
Major depressive disorder (MDD) in adults and pediatric patients 12 years of age and older Generalized anxiety disorder (GAD) in adults
Is Escitalopram a controlled substance?
Escitalopram has no US federal controlled-substance schedule. That is not the same as being available over the counter: it is still a prescription-only medicine, and a number of individual states regulate it separately.
What are the common side effects of Escitalopram?
The most frequently reported side effects are nausea, headache, insomnia or somnolence, fatigue, dizziness, ejaculation disorder. Many lessen over the first week or two of treatment.
What should not be combined with Escitalopram?
The most clinically important interactions are with maois (including linezolid and intravenous methylene blue): contraindicated - increased risk of serotonin syndrome, pimozide: contraindicated - qt prolongation and/or ventricular arrhythmias, cyp2d6 substrates: escitalopram 20 mg/day increased desipramine (a cyp2d6 substrate) cmax by 40% and auc by 100%, drugs that lengthen qt interval. Always give a pharmacist or prescriber a complete list of everything you take, including over-the-counter drugs and supplements.
Sources & references
Important
This site provides educational information only and does not sell, prescribe or dispense medications. Always consult a licensed healthcare provider. This page is not medical advice.