As with all psychiatric drugs, Lexapro must be tapered for safe discontinuation.
Lexapro comes in 5, 10, and 20mg tablets and as a liquid solution. It is available as a generic. Its half-life is 27–32 hours http://www.ncbi.nlm....pubmed/17375980
In the UK, Lundbeck's version, Cipralex http://sweden.lundbe...cksedel_ENG.pdf , comes in the same tablet dosages and in liquid form http://xpil.medicine...spx?DocID=21927
In Canada, Lundbeck's Cipralex comes in 5, 10, 15, 20 mg tablets http://www.lundbeck....2_MKT_E_CLN.pdf (PDF).
Official US information:
- Description at PubMed http://www.ncbi.nlm....lth/PMH0000214/
- FDA documentation, including history of warnings, http://www.fda.gov/D...s/ucm053342.htm
- Prescribing information: http://www.lexapro.c...rmation-pi.aspx
The liver enzymes represented by P450 CYP3A4 and CYP2C19 are the primary avenues of metabolization.
Following a single oral dose (20 mg tablet) of escitalopram, peak blood levels occur at about 5 hours. Absorption of escitalopram is not affected by food.
From the FDA-mandated US package insert (PDF):
Discontinuation of Treatment with Lexapro
During marketing of Lexapro and other SSRIs and SNRIs (serotonin and norepinephrine reuptake inhibitors), there have been spontaneous reports of adverse events occurring upon discontinuation of these drugs, particularly when abrupt, including the following: dysphoric mood, irritability, agitation, dizziness, sensory disturbances (e.g., paresthesias such as electric shock sensations), anxiety, confusion, headache, lethargy, emotional lability, insomnia, and hypomania. While these events are generally self-limiting, there have been reports of serious discontinuation symptoms.
Patients should be monitored for these symptoms when discontinuing treatment with Lexapro. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose but at a more gradual rate [see Dosage and Administration (2.4)].
A significant characteristic of Lexapro is that milligram for milligram, it is much stronger than other SSRIs. Chemically, Lexapro is a variation of Celexa; the molecule was re-engineered to be patentable as Celexa's patent was about to expire. The streamlined molecule is a more potent SSRI, 2 to 4 times stronger than others. (Wikipedia has a good explanation of this at https://secure.wikim...ki/Escitalopram.)
However, many doctors are unaware that escitalopram is stronger than other SSRIs and dose it as though it were the same strength. Although the so-called usual starting dose of escitalopram, 10mg, is equivalent to 20mg-30mg or more of, for example, paroxetine (Paxil), your doctor may have moved you to an even higher dose. If you are taking 20mg of escitalopram, you are taking a hefty dose of an SSRI.
If you are taking 5mg, it's not tiny, it's equivalent to 10-20mg Paxil or Celexa.
Consequently, when you taper off escitalopram, you should be careful to decrease by small amounts, as each drop is magnified by escitalopram's extra potency. If you find withdrawal symptoms from a 10% decrease to be too difficult, after 3-4 weeks decrease by a smaller amount.
Cold-turkeying off Lexapro is not a good idea. It's like throwing your brain off a cliff.
Reduce by 10% per month to start
The 10% rule holds for Lexapro, just like other psychiatric drugs: Reduce by 10% per month, calculated on the last dosage. (The amount of the reduction gets progressively smaller.)
See Why taper by 10% of my dosage?
Cutting up tablets
Although 5mg tablets are available, if you are taking 20mg Lexapro, a drop to 15mg would be a 25% decrease. This is a larger decrease than the 10% recommended.
If you wish to try cutting up tablets, they can be cut up with a pill splitter like other medications in tablet form. Keep the pieces you don't use in a clean pill bottle labeled with the dosage for future use.
Reducing with a combination of tablets and liquid
If you are taking, for example, 15mg, and want to decrease by 10% (1.5mg), you can take one 10mg tablet and 3.5mg in the liquid form for a total of 13.5mg.
Titrating using liquid formulation
Using the liquid form is the best way to control the amount of each decrease. The US formulation provides 5 mg per 5 mL (amounting to 1mg of the medication in a milliliter of the liquid, or 1mg:1mL).
You can measure out dosages under 10mg by using a 10mL oral syringe, see http://survivinganti...ndpost__p__2607
NDC Code 0456-2101-08 <-- this is the order code
Package Description 240 mL in 1 BOTTLE
Proprietary Name Lexapro
Non Proprietary Name ESCITALOPRAM OXALATE
Dosage Form Name LIQUID
Labeler Name Forest Laboratories, Inc.
Substance Name ESCITALOPRAM OXALATE
Strength Number 5
Strength Unit mg/5mL
The 10mL oral syringe has markings that enable measuring out amounts as small as .20mL.
If you are at 5mg, for example, use a 10 milliliter oral syringe to measure a 10% decrease, i.e. .5mg. Subtracting .5mg from 5mg would give you a reduced dose of 4.5mg.
If you need to measure an even smaller fraction of a milligram, use a 1 milliliter oral syringe, see http://survivinganti...ndpost__p__2284
NOTE: In the UK, the liquid form is available at a 10mg:1mL or 20mg:1mL concentration -- very inconvenient for tapering. One version of the liquid form is Cipralex from Lundbeck.
To take 1mg of the 10:1 liquid, use the small slim 1mL oral syringe to take 0.1mL (one-tenth milliliter). The 1mL oral syringe has 10 ticks within .1mL, enabling taking .01mL (one-hundreth milliliter) or, given the 10:1 concentration, .1mg (one-tenth milligram) escitalopram.
This information from Lundbeck, a manufacturer of escitalopram drops in Europe, http://www.medicines...rops, solution/ suggests the liquid form can be diluted with water:
Cipralex oral drops, solution: A bottle with dropper applicator or an oral syringe may be used for administration. The oral syringe bears a graduation in mg referring to the escitalopram dose.
Cipralex oral drops, solution can be mixed with water, orange juice or apple juice.
It is still unclear how long a diluted solution would last. Since water is part of the original formulation, it is unlikely additional water will cause the dilution to degrade. However, being exposed to light, etc. may do this, so it is unclear how long a diluted solution will last in potency.
People report that they can make their own liquid from Lexapro tablets and water.
It is soluble in water, see http://www.drugbank.ca/drugs/DB01175 -- stability (shelf-life of dilution) is unknown.
See How to make a liquid from tablets or capsules
Switching to Prozac
The risks of this method may not be worth switching from Lexapro to Prozac. This is usually used for medications with shorter half-lives than Lexapro. If you want to try this, make sure you consult a doctor who has done it many times and knows what he or she is doing.
Edited by Altostrata, 06 April 2014 - 08:46 AM.