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Lexapro (Escitalopram Oxalate)
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What is Lexapro (Escitalopram)?

Lexapro (escitalopram) is one in a group of drugs called selective serotonin reuptake inhibitors (SSRIs). It is taken by adults and adolescents at least 12 years of age to treat major depressive disorders. In adults, it is also used to treat anxiety.

How does Lexapro work?

Lexapro has an effect on the brain, altering certain chemical levels in people who may be suffering from depression or generalized anxiety disorder. On a chemical level, Lexapro is similar to Celexa (escitalopram) and both are SSRIs, along with Prozac (fluoxetine), Paxil (paroxetine) and (Zoloft) sertraline.

SSRIs affect neurotransmitters that communicate in the brain to send and receive information. Neurotransmitters are created by the nerves in the brain and are sent on to become attached to other nerves. In some cases, the neurotransmitters do not attach to their intended receptors and end up returning to the nerves that originally created them. This imbalance of neurotransmitters is known as “reuptake” and experts believe this to be the cause of depression.

Lexapro stops serotonin from returning to its original nerve, resulting in higher levels of serotonin available in the brain to bind to receptors.

Lexapro Dosing information

The amount you are prescribed will depend upon a variety of factors, including your age and medical condition. Generally, adults will begin with a daily dose of 10 mg. If necessary, this may be increased after a minimum of one week.

Typical dose for adults with generalized anxiety disorder:

Initially, 10 mg orally daily, increasing, if necessary, after a minimum of one week to 20 mg to be taken once each day.

Maintenance dose: 10 mg to 20 mg to be taken orally once each day

Maximum dose: 20 mg orally to be taken once each day

Please note:

  • Treatment should be re-evaluated regularly to assess its efficiency. There have not been systematic studies of Lexapro’s efficacy beyond 8 weeks.

Typical dose for adults with major depressive disorder

Initially, 10 mg to be taken orally once each day, to be increased after a minimum of one week, if necessary, to 20 mg once each day

Maintenance dose: 10 mg to 20 mg to be taken orally once each day

Maximum dose: 20 mg orally to be taken once each day

Please note:

  • Several months of sustained pharmacological therapy, or even longer, may be needed to address acute episodes.
  • Treatment should be regularly re-evaluated to assess the necessity for maintenance treatment.

Typical geriatric dose for major depressive disorder

The recommended dose is 10 mg to be taken orally once each day.

Typical pediatric dose for major depressive disorder

For adolescents aged 12 and older, the initial dose is 10 mg to be taken orally once each day. This may be increased after a minimum of  3 weeks of treatment, if necessary, to 20 mg to be taken once each day

Maintenance dose: 10 mg to 20 mg to be taken orally once each day

Maximum dose: 20 mg orally to be taken once each day

Please note:

  • Sustained pharmacological therapy may need to continue for several months or longer beyond the initial response to an acute episode.
  • The treatment should be re-evaluated regularly to assess the need for maintenance treatment.

How should you take Lexapro (Escitalopram)?

Lexapro should be used precisely as instructed on the label, or as your doctor has prescribed. Do not increase or decrease the amounts or use Lexapro for longer than has been recommended to you. Be sure to read all the information and instructions and follow the advice on the prescription label.

Try to take Lexapro at the same time each day. It can be taken with or without food.

Use a dosing syringe or a medicine dosing device to measure out a liquid dose, but do not use a normal kitchen spoon.

Make your doctor aware of any changes in your sexual activities after commencing your Lexapro treatment. Changes such as loss of sex drive and finding it difficult to achieve orgasm should be reported to your doctor. For men, trouble achieving an erection and ejaculation issues should also be reported to their doctor. Some sexual issues can be addressed with treatment.

Your treatment should be regularly re-evaluated so progress can be assessed. Children taking Lexapro should have their height and weight gain evaluated.

You mustn’t suddenly cease taking Lexapro. If you do, you might experience unpleasant withdrawal symptoms. Instead, take your doctor’s advice and gradually taper your dose.

How to store Lexapro

Be sure to store Lexapro away from moisture and heat, at room temperature.

Side Effects

Patients generally tolerate SSRIs, such as Lexapro, well, compared to other kinds of antidepressants. Generally, a higher dosage of Lexapro will make it more likely that a patient will have more side effects. Gastrointestinal side effects, such as diarrhea, are more likely with a high dosage of Lexapro.

Common side effects

Lexapro side effects appear to be the same for men and women, but they are slightly different between adults and children.

Amongst adults, the side effects may include:

  • nausea
  • sleepiness
  • weakness
  • dizziness
  • anxiety
  • sleeping trouble
  • sexual problems, such as decreased sex drive and erectile dysfunction
  • sweating
  • shaking
  • loss of appetitive
  • dry mouth
  • constipation
  • infection
  • yawning

Amongst children and adolescents, the side effects may include the above, but also the following:

  • increased thirst
  • abnormal increase in muscle movement or agitation
  • nosebleeds
  • trouble urinating
  • heavy menstrual periods
  • slowed growth and weight change

There have been reports of Lexapro use in children and adolescents resulting in a loss of appetite and a decrease in weight. Your child’s doctor should monitor their height and weight throughout treatment.

Depression tends to leave patients with a decreased appetite and weight loss. However, there have been some cases of Lexapro causing adults to put on a little bit of weight. It is important to bear in mind that gaining weight might simply be a case of balance being restored. With better-managed depression comes a better appetite. Some patients find they lose weight whilst on Lexapro. In this case, it could be that the increase in serotonin is resulting in a loss of appetite.

Most of the above side effects are negligible and should dissipate without any need for additional treatment. If they turn severe or do not dissipate, the patient should inform their doctor.

Serious Side Effects

Lexapro has been known to increase thoughts of suicide and suicidal actions, particularly amongst children, teenagers, and young adults. This is more probable during changes in dosage or within the first 2 or 3 months of being treated with Lexapro. The patient should immediately contact their doctor after they notice any of the following symptoms.

  • suicide attempts
  • carrying out dangerous impulses
  • aggressive or violent actions
  • thoughts about suicide or dying
  • new or worse depression
  • new or worse anxiety or panic attacks
  • feeling restless, angry, or irritable
  • having trouble sleeping
  • increased activity (doing more than what is normal for you)
  • other unusual changes in your behavior or mood

If these symptoms are new, getting worse or becoming upsetting, the patient should contact local emergency services.

Other side effects


Do not take Lexapro if you are allergic to it or any of its ingredients. Allergy symptoms can include:

  • having trouble breathing
  • swelling of your face, tongue, eyes, or mouth
  • severe rash, hives (itchy welts), or blisters with fever or joint pain

Seizures or convulsions

There have been cases of patients on Lexapro having seizures, so individuals with a history of seizures are more vulnerable.

Serotonin syndrome

Serotonin syndrome occurs when there is too much serotonin in the body. It is a serious condition that is more likely to happen if the patient is also taking other medications that may increase serotonin. These include antidepressants or lithium. The symptoms can include:

  • agitation
  • hallucinations
  • coma
  • coordination problems, overactive reflexes, or muscle twitching
  • racing heart rate
  • high or low blood pressure
  • sweating or fever
  • nausea, vomiting, or diarrhea
  • muscle stiffness

Low salt levels

Lexapro can result in low salt levels, but this is more likely in senior patients, those who take water pills, or patients who are dehydrated. The side effect can cause the following:

  • headache
  • confusion
  • trouble concentrating
  • thinking or memory problems
  • weakness
  • unsteadiness that can lead to falls
  • seizures

Manic episodes

Lexapro may cause a patient to have manic episodes if they have bipolar disorder. Being treated with Lexapro without taking other drugs for bipolar disorder may trigger a manic episode. The symptoms may include the following:

  • big increase in energy
  • much difficulty sleeping
  • racing thoughts
  • irresponsible behavior
  • unusually grand ideas
  • excessive happiness or irritability
  • talking quickly or more than normal

Trouble with vision

Your pupils may become dilated due to using Lexapro, leading to a glaucoma attack, even if the patient does not have a background of eye trouble. The symptoms may include the following:

  • eye pain
  • changes in your vision
  • swelling or redness in or around your eye

Warnings & Interactions

Do not use Lexapro if you are already taking pimozide or citalopram (Celexa).

Do not use Lexapro 14 days before or 14 days after using an MAO inhibitor. This includes but is not limited to:

  • Isocarboxazid
  • Linezolid
  • Methylene blue injection
  • Phenelzine
  • Rasagiline
  • Selegiline
  • Tranylcypromine

Younger patients sometimes have suicidal thoughts when first taking antidepressants, so it is important to monitor mood changes and changes in symptoms. Make the doctor aware of any new or worsening symptoms. Children under the age of 12 should not take Lexapro.

A patient should inform their doctor of all over-the-counter and prescription medications, supplements and herbs they are taking.


You may have to use Lexapro for up to 4 weeks before you begin to notice your symptoms improving. Continue using it as your doctor has instructed and let them know if you do not notice your symptoms improving.

Patients should not stop taking Lexapro without first consulting their doctor. To avoid unpleasant side effects, treatment should be tapered, not suddenly stopped.

If you do not gradually reduce your dose, you may experience the following:

  • mood swings
  • headache
  • tiredness
  • sleep changes
  • brief sensations like electric shocks

Lexapro can be sourced in either tablet form (5, 10, and 20 mg) or oral solution (1 mg/ml).

Lexapro has not been established as safe for pregnancy and breastfeeding, so it should not be used whilst the patient is pregnant unless their doctor believes the anticipated benefits to the mother outweigh the hazards to the fetus.

Since Lexapro is excreted through breast milk, it should not be taken by nursing mothers unless their doctor believes the anticipated benefits to the mother outweigh the hazards to the fetus.

Patients can take Lexapro orally, either with or without food. It is usually taken once each day, either in the morning or evening.

If you miss a dose, try to take it as soon as you can. However, if it is almost the time for your next dose, skip the one you missed. Continue with the next dose and do not attempt to take two doses to make up for the one you missed.

Seek emergency medical attention as soon as possible. If someone has collapsed or isn’t breathing after taking an overdose of Lexapro, call emergency services immediately.

When you begin your Lexapro treatment, your reactions could be compromised. You should avoid driving or any other potentially hazardous activity until you identify how the medicine affects you.

You should avoid drinking alcohol whilst taking Lexapro as it can exacerbate the symptoms of your condition and lead to other unpleasant side effects. If you drink alcohol whilst taking Lexapro, it’s better to drink in moderation and discuss it with your doctor beforehand.

Not everyone taking Lexapro will experience side effects if they drink alcohol too. However, they are strong substances and drinking alcohol while using Lexapro can cause:

  • the medication to not work as well for your condition
  • increased anxiety
  • worsening depression
  • drowsiness
  • liver problems
  • alcoholism

Mixing the drug with alcohol may also increase the risk of Lexapro’s side effects becoming more severe. These include:

  • nausea
  • insomnia
  • sleepiness
  • dry mouth
  • diarrhea

Lexapro can also increase suicidal thoughts and behaviors. Since alcohol can exacerbate depression worse, it can mean a patient is more at risk of suicide. Most patients should not drink alcohol whilst taking Lexapro. But if the drug is good at managing your condition, your doctor may agree that it’s safe to have an occasional drink. However, depending on your situation, your doctor may recommend you stop drinking whilst on Lexapro.

Sometimes Lexapro is also used “off-label” for conditions it is not approved for. These conditions include:

  • Obsessive-compulsive disorder (OCD)
  • Panic disorder
  • Premenstrual dysphoric disorder
  • Insomnia

It’s unlikely that your weight will change due to Lexapro. If you are concerned about your weight fluctuating whilst being treated with Lexapro, you should bring it up with your doctor. They may be able to advise you on changes to your lifestyle to balance out any changes to your weight.

Lexapro may interact with the following:

  • Blood thinners, such as warfarin.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin.
  • Other drugs are used to treat depression.

Having certain health conditions means a patient should either not use Lexapro, have their doctor lower the dosage, or have them carefully monitor the patient’s progress if they are treated with it. Before taking Lexapro, patients should make sure their doctor is aware of it if they have any of these health conditions.

  • A history of suicidal thoughts or behaviors – Lexapro can increase suicidal thoughts and behavior.
  • Bipolar disorder – taking Lexapro without other medications for bipolar disorder may cause a manic episode.
  • Seizures – Lexapro may cause seizures and exacerbate seizure disorder.
  • Glaucoma – Lexapro may cause a glaucoma attack.
  • Low salt levels – Lexapro may lower already low salt levels.
  • Pregnancy – it is unknown whether Lexapro may harm an unborn baby.
  • Breastfeeding – Lexapro may be excreted into breast milk, causing side effects in a breastfeeding child.