[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Selective serotonin reuptake inhibitors (SSRIs)](https://durgical.com/en/pharmacology/classes/selective-serotonin-reuptake-inhibitors/) › Escitalopram [Pharmacology](https://durgical.com/en/pharmacology/) · [Selective serotonin reuptake inhibitors (SSRIs)](https://durgical.com/en/pharmacology/classes/selective-serotonin-reuptake-inhibitors/) # Escitalopram An SSRI for depression and generalised anxiety. It is the active S-enantiomer of citalopram and very selective for the serotonin transporter. Updated 2026-11-01 - Class: [Selective serotonin reuptake inhibitors (SSRIs)](https://durgical.com/en/pharmacology/classes/selective-serotonin-reuptake-inhibitors/) - Transporter: Serotonin transporter (SERT) - ATC code: N06AB10 ⇄**Serotonin transporter (SERT)**Escitalopram ⓘ The figure shows S-citalopram (escitalopram) bound at the central site of a thermostabilised human SERT (ts3). **Target in 3D:** Serotonin transporter (SERT). PDB structure 5I71 (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/5I71) · Drag to rotate · pinch to zoom ## Mechanism of action Escitalopram is the S-enantiomer of racemic citalopram, the form that carries the activity. It binds the central site of the serotonin transporter and blocks serotonin reuptake. Crystal structures also show a second, allosteric site in the transporter's outer vestibule. - Escitalopram binds the central site of the serotonin transporter - Serotonin reuptake into the neuron is blocked - Serotonin acts longer at its receptors - Mood and anxiety improve over weeks ## Pharmacokinetics **Absorption** By mouth, with or without food **Metabolism** Mainly in the liver; CYP3A4 and CYP2C19 carry out the main step (N-demethylation) **Half-life** About 27 to 32 hours; longer in older adults **Onset and duration** Benefit builds over several weeks ## Indications - Major depressive disorder (adults and adolescents) - Generalised anxiety disorder ## Adverse effects ### Common - Nausea - Insomnia or somnolence - Sweating and fatigue - Sexual dysfunction (ejaculation disorders, low libido) ### Serious (rare, important) - Suicidal thoughts and behaviour in young people (boxed warning) - Serotonin syndrome - Hyponatraemia (SIADH) - Bleeding - Seizures - Activation of mania - Angle-closure glaucoma ## Contraindications - MAO inhibitors for psychiatric use, or within 14 days of stopping either drug; not started during linezolid or intravenous methylene blue - Pimozide - Hypersensitivity to escitalopram or citalopram ## Key interactions **MAO inhibitors, triptans, tramadol, fentanyl, lithium, St John's wort** Serotonin syndrome **NSAIDs, aspirin, warfarin** Higher bleeding risk **Citalopram** Same active molecule: not combined **Pimozide** QT prolongation ## What is monitored - Mood and suicidal thoughts, especially early and after dose changes - Sodium in older adults - Signs of mania - Bleeding with antithrombotic drugs ## Administration and safety - Given by mouth as tablets or oral solution, with or without food - Not given together with citalopram (the same active molecule) - Stopped gradually to avoid a discontinuation syndrome ## Nursing care - Screen for suicidal thoughts at the start and after each dose change, and teach families what to watch for - Teach that benefit takes weeks and that stopping suddenly can cause dizziness and irritability - Watch for confusion, headache or unsteadiness in older adults (low sodium) - Teach the signs of serotonin syndrome when other serotonergic drugs are added ## Pregnancy and breastfeeding Used in pregnancy after weighing risks and benefits; SSRI exposure late in pregnancy is linked to neonatal adaptation problems and persistent pulmonary hypertension. ## Memory aid ES-citalopram = the «S» half of citalopram: the half that does the work. ## Test yourself Think of the answer, then tap the question to see it. ## What is the relationship between escitalopram and citalopram? Citalopram is a racemic mixture; escitalopram is its S-enantiomer, the form responsible for blocking the serotonin transporter. ## Why are escitalopram and citalopram not given together? They are the same active molecule, so combining them only doubles the exposure and the adverse effects. ## What do the human SERT crystal structures show about where escitalopram binds? It binds the central substrate site, and a second molecule can bind an allosteric site in the extracellular vestibule. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/escitalopram/) ## Related drugs - [Sertraline](https://durgical.com/en/pharmacology/sertraline/) - [Fluoxetine](https://durgical.com/en/pharmacology/fluoxetine/) [← Back to the class: Selective serotonin reuptake inhibitors (SSRIs)](https://durgical.com/en/pharmacology/classes/selective-serotonin-reuptake-inhibitors/) Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given. Sources: [DailyMed - ESCITALOPRAM OXALATE solution](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ba60c357-8e61-4a3d-b1dc-25602dbbfc2a) (DailyMed (U.S. National Library of Medicine), 2026); [Escitalopram: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a603005.html) (MedlinePlus (U.S. National Library of Medicine), 2025); [5I73: X-ray structure of the ts3 human serotonin transporter complexed with s-citalopram at the central and allosteric sites](https://www.rcsb.org/structure/5I73) (RCSB Protein Data Bank, 2016). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/pharmacology/escitalopram/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/escitalopram/