Escitalopram

The active enantiomer of citalopram: selective serotonin reuptake inhibition with minimal activity at other receptors or CYP enzymes.

• Major depressive disorder
• Generalised anxiety disorder
• Panic disorder
• Obsessive-compulsive disorder

Bioavailability

~80%

Half-life

27 to 32 h

Elimination

hepatic: CYP2C19 and CYP3A4; unlike fluoxetine and paroxetine it barely inhibits CYP2D6

Protein binding

~56%

• Nausea and gastrointestinal upsetcommonEarly and usually self-limiting.
• Sexual dysfunctioncommonPersistent, under-discussed, and a leading cause of silent non-adherence.
• HyponatremiaseriousSIADH, mainly in older adults and in the first weeks.
• QT prolongationseriousDose-dependent, which is why the ceiling is a hard one.
• Increased bleeding riskseriousPlatelets depend on serotonin uptake; the risk multiplies with NSAIDs or anticoagulants.
• Emotional bluntingcommon

• SSRIs / SNRIs + MAO inhibitors (including linezolid)avoidSerotonin syndrome: agitation, clonus, hyperthermia: potentially fatal.
• SSRIs / SNRIs + TramadolcautionSerotonin syndrome (usually milder spectrum) and seizures, especially at higher doses or in the elderly.
• SSRIs + NSAIDs / anticoagulantsmonitorUpper GI bleeding risk roughly doubles versus either alone.

• It takes four to six weeks to know whether it is working. The early days can feel worse before better.
• Do not stop suddenly; it is tapered.
• Tell us about sexual side effects. They are common, we can do something about them, and they are not something to put up with silently.
• Check with us before taking ibuprofen or naproxen.
• Tell any clinician you take this before starting a new medicine, particularly for migraine or pain.

• The commonest reason an antidepressant is abandoned is sexual dysfunction that was never raised, by either party. Asking directly at the first review changes adherence more than any dose adjustment.
• SSRI plus NSAID multiplies gastrointestinal bleeding risk well beyond either alone; if both are genuinely needed, gastroprotection is part of the prescription.

• Escitalopram product monograph (consult the current version for your market) (monograph)
• Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed. (reference-work)

Last reviewed 2026-08-16 · jurisdiction: global · drug information changes; verify against current references before practice use.