Converting Doses Of Lexapro (Escitalopram) To Zoloft (Sertraline)

In our latest question and answer, the pharmacist compares doses of Lexapro (escitalopram) and Zoloft (sertraline) as well switching recommendations.

Question

What is the equivalent of 40 mg of Lexapro to Zoloft? My doctor wants me to switch and I don't know how to do it.

Asked by Susan On Dec 08, 2022

Answered by
Medical Content Reviewed By HelloPharmacist Staff

Published Dec 08, 2022
Last updated Dec 08, 2022

Key points

  • There is no direct conversion between different SSRI (selective serotonin reuptake inhibitor) drugs (Lexapro and Zoloft in this case).
  • Generally, when switching between SSRIs, doses of each are compared on a low, moderate and high dosage basis.
  • There are several methods utilized when it comes to switching from one SSRI to another, including a 'direct switch' and a 'tapering' method.

Answer

There is no direct conversion between SSRI (Selective Serotonin Reuptake Inhibitors) drugs. Most practitioners, when comparing antidepressant doses, will review comparative doses (i.e., low, moderate, high) as well as recommended dosing guidelines to help assist with choosing the appropriate dose when switching between SSRIs.

Lexapro - Zoloft Dosing Comparison

Lexapro (escitalopram) comes in the following doses:

  • 5 mg
  • 10 mg 
  • 20 mg

Zoloft (sertraline) comes in the following doses:

  • 25 mg 
  • 50 mg
  • 100 mg
  • 200 mg

In general, the following would be considered 'low, moderate, or high doses' for both Zoloft and Lexapro:

  • Low Dose: Lexapro 5mg; Zoloft 25mg
  • Moderate Dose: Lexapro 10mg; Zoloft 50mg
  • High dose: Lexapro 20mg; Zoloft 100mg or greater

The maximum daily dose set for Lexapro (escitalopram) by the FDA is 20 mg per day. Doses above that (as per your question) are uncommon but have been used clinically in some situations and some studies suggest these doses can be both safe and effective for certain individuals.

Comparing 40 mg of Lexapro (escitalopram) to Zoloft (sertraline) would put it at the top dosing range of Zoloft (sertraline), which is typically 100 mg per day or greater, up to 200mg per day (the maximum daily dose of the drug).

Switching Between Lexapro And Zoloft

If you are switching from one antidepressant to the other, that is not uncommon.

A variety of studies have shown that the majority of individuals don't achieve remission on their first antidepressant medication and that trying a second antidepressant can improve symptoms in more than 50% of people.

When switching between drugs in the same class (e.g., between SSRI drugs), there are some general recommendations but no clear guidelines and there is no "one size fits all" approach.

It is highly recommended to speak with your doctor regarding the best way to change from Lexapro to Zoloft. There are a few methods that can be used, but the two most common are:

  • Direct switch 
  • Tapering switch

Since you are currently taking a high dose of Lexapro, the direct switch method generally isn't recommended for reasons I discuss in the next section.

Direct Switch

The 'direct switch' method consists of stopping the first agent (Lexapro in this case) and starting a dose of the new agent (Zoloft) that is in the same range as the first agent. In your case, it would be to a high dose of Zoloft since you are currently taking a high dose of Lexapro.

It should be noted that when switching between SSRI drugs in which you were on high doses, the direct switch method is not recommended due to an increased risk of adverse reactions and a risk of serotonin syndrome. It takes time to wash out the prior drug from your system and when you do a direct switch, you essentially will have high doses of both drugs in your system.

Taper

The tapering method consists of gradually reducing the dosage of Lexapro to a maximum of 10 mg/day or lower. This taper could take as long as 4-6 weeks. After the taper period, switch to sertraline at 50-100 mg and taper up to effectiveness.

There are also methods where you can do a cross-taper, meaning you taper down on one medication and gradually increase on the other. This can be a preferred method if your depressive symptoms were particularly severe before starting on any medication.

Final Words

The above switching methods are just general recommendations and are for informational purposes. Every situation and individual is different. Be sure to discuss with your doctor the best possible options for you.

Thanks for reaching out and do so again anytime!

References

  • Systematic review and guide to selection of selective serotonin reuptake inhibitors, PubMed
  • Response to an open trial of a second SSRI in major depression, PubMed
  • Zoloft Prescribing Information, AccessFDA
  • Switching antidepressants for treatment-resistant major depression, PubMed
  • Switching to duloxetine from selective serotonin reuptake inhibitor antidepressants: a multicenter trial comparing 2 switching techniques, PubMed
  • Switching and stopping antidepressants, PubMed

About the Pharmacist

Dr. Brian Staiger, PharmD

Dr. Brian has been practicing pharmacy for over 13 years and has wide-ranging experiences in many different areas of the profession. From retail, clinical, program development, and administrative responsibilities, he's your knowledgeable and go-to source for all your pharmacy and medication-related questions! Dr. Brian Staiger also has herbalist training and educational certificates in the field of medical ethnobotany. Feel free to send him an email at Hello@HelloPharmacist.com! You can also connect with Dr. Brian Staiger on LinkedIn.

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