Escitalopram: uses, dosage and side effects

Escitalopram is an SSRI antidepressant taken as a daily tablet and prescribed for depression and for anxiety disorders including panic disorder, generalised anxiety disorder, social anxiety and obsessive compulsive disorder. In Ireland it is prescription-only and it is not a controlled drug. This page explains what escitalopram is used for, how it is taken, which side effects are reported most often, why it must not be stopped abruptly and how continuing an established course works. It is information, not an offer of the medicine.

What escitalopram is used for

Escitalopram is licensed for major depressive episodes and for several anxiety disorders: panic disorder with or without agoraphobia, generalised anxiety disorder, social anxiety disorder and obsessive compulsive disorder. It is a selective serotonin reuptake inhibitor, which means it increases the amount of serotonin available between nerve cells by blocking its reabsorption. It is the active half of citalopram, so the effective doses are lower and the two are not interchangeable milligram for milligram. Escitalopram treats symptoms rather than curing the underlying condition, and it works best alongside psychological therapy, sleep, activity and support rather than instead of them. Treatment is normally continued for a period after you feel well, because stopping as soon as mood improves is one of the commonest reasons for relapse; how long that period should be is a decision for the doctor following your care, based on how many episodes you have had.

Side effects of escitalopram

The effects reported most often are nausea, headache, dry mouth, sweating, disturbed sleep or drowsiness, tiredness, diarrhoea or constipation, reduced appetite and sexual difficulties including reduced desire, delayed orgasm and erectile problems. Anxiety and restlessness can increase during the first week or two before they improve, which is expected but should be reported if severe. Escitalopram can prolong the QT interval on the heart tracing in a dose-dependent way, so heart rhythm and interacting medicines matter. Low sodium in the blood occurs mainly in older people and shows as confusion, weakness or unsteadiness. The risk of bleeding rises when it is combined with anti-inflammatory painkillers or anticoagulants. Antidepressants can, especially in the first weeks and after any dose change, increase agitation and thoughts of self-harm, most clearly in people under 25. Seek help urgently if that happens; in an emergency in Ireland ring 112 or 999.

Dosage and how to take it

Escitalopram is taken once a day as a tablet or as drops, with or without food, at whatever time of day suits you, as long as it is consistent; people who feel drowsy on it often take it at night, while people who feel activated take it in the morning. Treatment usually starts at a low dose, and any increase is a prescribing decision made after seeing how you respond. Anxiety disorders often need a slower start, because the initial jitteriness is more noticeable. If you miss a dose, take it when you remember unless the next dose is close, in which case skip it rather than doubling up. Do not stop suddenly: discontinuation symptoms including dizziness, electric-shock sensations, nausea, irritability, vivid dreams and flu-like feelings are common after abrupt withdrawal, so the dose is tapered gradually under medical supervision, sometimes over months.

Is escitalopram available without a prescription in Ireland?

No. Escitalopram is prescription-only in Ireland and no pharmacy can supply it over the counter. It is not a controlled drug, which is a separate legal category covering opioids, benzodiazepines and stimulants, but the prescription requirement here is clinical: the first weeks of antidepressant treatment need monitoring, the dose is limited by effects on heart rhythm, and the diagnosis itself has to be right, since bipolar disorder treated with an antidepressant alone can be made worse. Buying antidepressants from a site that asks no medical questions leaves you without any of that, and without a plan for stopping safely later. A prescription written by a doctor in another EU or EEA country can be dispensed in Ireland when it carries the details required for cross-border prescriptions, and the Pharmaceutical Society of Ireland publishes guidance for pharmacists on how to handle such prescriptions.

Why we do not assess escitalopram online

We do not assess antidepressants online at the moment, not even as a continuation of treatment a prescriber has already established. There is nothing to buy on this page and no fee to pay. The reason is the nature of the service: you answer a written questionnaire and a doctor reviews it separately, with no video consultation, no telephone appointment and no live chat. With a medicine whose dose is adjusted against mood, sleep and side effects, that adjustment belongs with a prescriber who knows you and can speak to you. If you are already taking escitalopram and your supply is running low, contact your GP or the service following you in good time, and do not stop on your own, because stopping abruptly can cause withdrawal symptoms. If you are newly unwell, if your symptoms have changed, or if you are having thoughts of harming yourself, contact your GP, an out-of-hours GP service, or an emergency service on 112 or 999.

Cost and reimbursement in Ireland

Escitalopram is available generically from several manufacturers, so private prices are usually modest, though every pharmacy sets its own and it is worth comparing if you pay in full. Holders of a medical card receive prescribed medicines under the GMS scheme for a small charge per item, subject to a monthly household cap. Everyone else can use the Drugs Payment Scheme, which caps what one household pays for prescribed medicines in a calendar month; the HSE publishes the current charge and cap, so take the figure from there rather than from an older page. Mental health conditions are not on the Long Term Illness Scheme list, so that scheme does not usually apply. If cost is a reason you are considering stopping, say so to your prescriber: there are usually cheaper options within the same class, and stopping an antidepressant abruptly to save money is the worst available option.

Interactions and alcohol

Escitalopram must not be combined with monoamine oxidase inhibitors, and a gap is required in both directions; pimozide is also contraindicated. Because it can prolong the QT interval, it must not be combined with other medicines that do the same, including certain antipsychotics, some antibiotics and some antiarrhythmics; the product information makes that combination a contraindication, not a matter of extra monitoring. Other serotonergic medicines, including tramadol, triptans, lithium, other antidepressants and St John's wort, raise the risk of serotonin syndrome. Anti-inflammatory painkillers, aspirin and anticoagulants increase the risk of bleeding when taken with an SSRI, and a stomach-protecting medicine is sometimes added. Cimetidine and some antifungals can raise escitalopram levels. Alcohol is not formally forbidden but is discouraged: it worsens sleep and mood, adds to any drowsiness and undermines the treatment. Tell your pharmacist about everything you take, including anything bought without a prescription.

Who should not take escitalopram

Escitalopram must not be taken by anyone allergic to it, by anyone taking a monoamine oxidase inhibitor or pimozide, or by anyone with a known QT interval prolongation or congenital long QT syndrome, and it must not be taken together with any other medicine that prolongs the QT interval. Caution and closer supervision apply in a history of seizures, in bipolar disorder because of the risk of switching into mania, in a history of bleeding disorders or with anticoagulants, in significant liver or kidney impairment, in glaucoma of the narrow-angle type, in heart disease and low potassium or magnesium levels, and in older adults, who are more prone to low blood sodium. Anyone under 18 should be treated only within a specialist service. Tell the prescriber about a personal or family history of self-harm, about previous manic episodes and about every other medicine, because the interactions here are the practical safety issue rather than the tablet itself.

Generic and brand names

The active substance is escitalopram, first marketed as Cipralex or Lexapro and now available generically in Ireland from several manufacturers as tablets and as oral drops. Generic versions contain the same active substance in the same strength and are authorised on that basis, so the pharmacy may supply a different manufacturer from your last pack and the tablets may look different. Escitalopram and citalopram are related but not the same: escitalopram is the active enantiomer, so the doses differ and switching between them is a prescribing decision. Other SSRIs such as sertraline, fluoxetine or paroxetine are alternatives with different interaction profiles, and a change between them is planned by a doctor rather than improvised. On a cross-border prescription the medicine should be named by its international non-proprietary name, escitalopram, with strength, form and quantity, so that an Irish pharmacist can dispense it correctly.

Pregnancy and breastfeeding

The decision about escitalopram in pregnancy is individual and belongs with a doctor who knows your history, because untreated depression or severe anxiety in pregnancy carries its own risks for parent and baby. SSRIs are among the antidepressants with the most experience of use in pregnancy, and some are preferred over others; a prescriber may keep the current medicine or switch, but abrupt stopping on discovering a pregnancy is generally not advised. Use late in pregnancy has been associated with short-lived adaptation symptoms in the newborn and, in some studies, with a rare lung condition, so the maternity team should know in advance. Escitalopram passes into breast milk in small amounts and breastfeeding is often continued under supervision, watching the infant for drowsiness and feeding problems. Our online questionnaire does not lead to prescriptions for use during pregnancy or breastfeeding.

Patient information leaflet

Every pack sold in Ireland contains a patient information leaflet, and the same leaflet is published online. The Health Products Regulatory Authority (HPRA) is the medicines regulator here and lists authorised products together with their leaflets and summaries of product characteristics; medicines.ie publishes the same documents for products marketed in Ireland. Because escitalopram comes from several manufacturers, look up the leaflet for the pack you actually hold, and check whether you have tablets or oral drops, since the dosing instructions differ. Read it before starting a new pack, as the wording on warnings and side effects is updated from time to time. If anything does not match what you were told, ask your pharmacist rather than guessing; pharmacists in Ireland are registered with the Pharmaceutical Society of Ireland. A suspected side effect can be reported by you directly to the HPRA.

Who wrote and checked this page

This page was prepared by the medical content team at MEDINOW Sp. z o.o. and reviewed by lek. Damian Wojno, a doctor registered in Poland, PWZ no. 3211301. He holds no Irish registration and does not practise in Ireland; he works to Polish professional rules and issues cross-border prescriptions under Directive 2011/24/EU and Directive 2012/52/EU, which is the framework an Irish pharmacist applies when a prescription comes from another EU or EEA country. The content was verified on 29 August 2026 against the sources listed below, all of them official or regulator-published. This page is general information about a medicine: it is not personal medical advice, not a diagnosis and not an offer of the medicine itself, which we never supply. If your symptoms are new, severe or changing, contact your GP or a pharmacist; in an emergency in Ireland ring 112 or 999.

Is escitalopram prescription-only in Ireland?

Yes, it is prescription-only, although it is not a controlled drug. A prescription written by a doctor in another EU or EEA country can be dispensed in an Irish pharmacy when it carries the details required for cross-border prescriptions.

How long does it take to work?

Sleep and appetite may change within the first two weeks, while the improvement in mood or anxiety usually builds over four to six weeks at a stable dose. Anxiety can briefly worsen at the start, which is expected but worth reporting if it is severe.

What are the common side effects?

Nausea, headache, dry mouth, sweating, changes in sleep, tiredness and sexual difficulties are reported most often, and many ease after the first weeks. Effects on heart rhythm are dose-related, which is why the dose is not increased casually.

Can I drink alcohol with it?

Alcohol is best kept to a minimum. It is not formally forbidden, but it worsens sleep and mood, adds to drowsiness and works against the treatment, particularly in the early weeks.

How do I get a repeat prescription?

If you are already on escitalopram and nothing has changed, you can complete our online questionnaire and a doctor reviews it separately; there is no video consultation. If treatment can continue you receive a cross-border prescription as a PDF by e-mail. The fee covers the assessment, not the issuing of a document, and the service does not replace ongoing mental health care.