Nat Med

Escitalopram fails to reduce agitation in Alzheimer's patients, raises cardiac concerns

April 14, 2025

Study details: This double-masked, randomized, placebo-controlled phase 3 trial evaluated the efficacy and safety of escitalopram for treating agitation in Alzheimer's dementia (AD) after failure of a psychosocial intervention (PSI). Conducted across 27 community-based centers, the study included 173 adults with AD, significant agitation, and a Mini-Mental State Examination Telephone score of 3-20. Participants received escitalopram (up to 15 mg/day) or placebo for 12 weeks while continuing PSI.

Results: At 12 weeks, the unadjusted risk difference for clinically significant improvement in agitation was 0.08 (95% confidence interval, -0.21, 0.06), indicating no significant efficacy of escitalopram over placebo. Additionally, escitalopram was associated with drug-related QT interval prolongation, raising safety concerns.

Clinical impact: Escitalopram isn't effective in treating agitation in AD and poses potential cardiac risks. Clinicians should exercise caution when considering escitalopram as an alternative to citalopram for this indication, given the lack of demonstrated benefit and the observed safety issues.

Source:

Rajji TK; S-CitAD Research Group; et al. (2025, March 25). Nat Med. Escitalopram for agitation in Alzheimer's dementia: a randomized controlled phase 3 trial. https://pubmed.ncbi.nlm.nih.gov/40133524/