How to shift my medication schedule while in Europe?
August 20, 2018 4:34 PM   Subscribe

I take my Lexapro every night at 9:30 pm. This weekend, I'm leaving on a weeklong trip to Europe. This is the first time I've traveled abroad since taking the medication, and I'm having anxiety about the best way to handle this. How should I transition to a new medication schedule? See more below.

Before you ask, I did indeed call my psychiatrist for advice on this. As per his nurse, "take it at whatever time you can remember to take it" and "it's okay if you skip a day" but "don't take more than one dose in 24 hours."

This seemed straightforward, until I really started thinking about the logistics of all this. I'm already pretty anxious about the first part of the trip; my flight leaves the East Coast at 9:30 pm Friday night, and by the time I land, it will be 9:30 am in Western Europe. I don't sleep well on planes, so I'll already be sleep deprived, and sleep deprivation + long plane ride + brand new surroundings = anxiety. If I were home and the nurse told me to skip my Lexapro for a day, I'd do it without much hesitation. But I'm starting to think obsessively about how this change in med routine will compound the other anxiety I'll probably have.

In a perfect world, I would take my Lexapro when I get on the plane (9:30 pm Friday, EST) and then again when I go to bed in Europe (again, around 9:30 local time), but because of time zones, that's only about 18 hours after I took it on the plane, and I don't want to overmedicate myself. If I wanted to wait 24 hours as usual, I'd have to wake myself up at 3:30 in the morning. I guess I could start taking it in the morning, i.e. take it Friday night, then again on Sunday morning, but I usually take it at night, so I'd prefer to help myself settle into the new time zone with pre-bed Lexapro as usual.

Sorry if this is hard to follow -- my anxiety leads me to some pretty serious overthinking! Maybe I'm overestimating how much my body "needs" the Lexapro within a certain window of time; it's obviously built up in my system for quite a while now. What's my best course of action?
posted by leftover_scrabble_rack to Health & Fitness (13 answers total) 1 user marked this as a favorite
Since it’s okay if you skip a day, to keep it simple I would just take it at the same time of the day you usually do, only local time.
posted by Automocar at 4:37 PM on August 20, 2018 [9 favorites]

Call them back, ask if it's okay to take it at 9.30pm CEST (or whatever time zone) and, if not, can you take a half-dose?

Or... skip tomorrow, take it at 3.30 Thursday and Friday and return to before bed on Saturday.

(Honestly, if this were me, I'd probably skip Friday.)
posted by hoyland at 4:43 PM on August 20, 2018

Are you having panicky anxiety? Would it be helpful to ask for a scrip for 3-5 Xanax at the lowest dose, and you could take one of those if the anxiety is really rising but it’s too soon for your Lexapro?
posted by epj at 4:55 PM on August 20, 2018 [2 favorites]

Dont skip it, you will have a particularly bad day. Take it at your normal time leaving and at bed time on your arrival in Europe.

Returning will be more difficult as you'll be going through a bit of withdrawal.
posted by arnicae at 4:56 PM on August 20, 2018

I also take Lexapro. What I do is I set a daily reminder on my iPhone at a specific time to take my dose, and this stays consistent for my body even across time zones (e.g. if normal time is 7am, then I just take it whenever the reminder goes off, even if it's 12pm local time).

If I happen to be sleeping when the reminder goes off, I just take it when I wake up. You're right, once it's built up in your system there isn't too much worry about taking it at precise times, but that few hours delay shouldn't make much of a difference.
posted by lesser weasel at 5:43 PM on August 20, 2018 [5 favorites]

Also, let's say that due to time zones that the reminder to take your medication goes off when you're sleeping. If you take your dose when you wake up, and if you wake up at roughly the same time every day when you're in Europe, then you've essentially shifted your schedule with not much extra hassle.

I make at least one very long distance flight each year (Asia->US and back again) for the holidays, and this is the setup that's worked for me for the past 4 years.
posted by lesser weasel at 5:47 PM on August 20, 2018

If it makes you feel any better, with most any SSRI, skipping a day is quite unlikely to have a meaningful effect. They take a while to build up in the system, and a while for their effects to dissipate.
posted by praemunire at 6:00 PM on August 20, 2018 [4 favorites]

The half-life of lexapro is 27-32 hours. That means it takes a fairly long time to build up in your system when you first start taking it, and also that it takes a long time for it to stop working when you stop taking it. The minor adjustments in the timing of your dose will have literally zero effect on your experience.

But do get a few xanax/valium from your doc -- it sounds like this trip will be miserable otherwise!
posted by nixxon at 6:08 PM on August 20, 2018

I have taken trips and ended up taking Lexapro at 19/20 hours and at 28-30 hours and have not noticed anything wonky. I think you have a pretty big margin to work with. First time I travelled I would only add or subtract 1 hour per 24 hours, but that was not necessary. Now I just make one switch to the new time zone.
posted by kerf at 6:23 PM on August 20, 2018

I used to take Lexapro in the morning and when I travelled to the US from Australia, a considerably larger time difference, I'd take it the next morning. So I'd leave Oz 11am and arrive in the US about 10am on the same day - by the clock, before I left (a neat bit of time travel) but only about 16 or so hours had elapsed. So I'd take it the morning of the next day, which was more than 24 hours, but it kept the time of day consistent which worked better for me. I never experienced any ill effects. Later, when I weaned off of Lexapro before switching meds, I absolutely noticed. So I think one dose more than 24 hours later is fine, esp given what others have said about the half life of the drug.
posted by Athanassiel at 6:15 AM on August 21, 2018

How long have you been on Lexapro? I've been on it for about ten years and miss doses all the time. I only get withdrawal symptoms if I miss 4 days. of course it is better to take it steadily as you do bit don't let a half day difference add to your anxiety, especially if you've been on it for a while. also I'm from central Canada and am in the UK right now. no problems adjusting and I have no idea what the gap was between doses
posted by biggreenplant at 6:40 AM on August 21, 2018

Morning all. There was enough conflicting information here that I decided to call my doctor back ... then had a flash of insight and called my pharmacist instead. She said that it's really not a big deal to take doses 18 hours apart, so I should take the Lexapro on Friday night at 9:30 EST, and then Saturday night at 9:30 CEST. No problem at all.

Good advice also re: having a benzo on hand! I've had an Ativan scrip for 11 years now. Have only need to take it once in the last year (my anxiety is VERY well managed), but it seems like it might be a good tool to use during this trip. I haven't traveled abroad in 20 years so it's definitely spiking my anxiety a bit!

Thanks for weighing in.
posted by leftover_scrabble_rack at 7:14 AM on August 21, 2018 [2 favorites]

I just want to say that contrary to some answers above, I never noticed anything from skipping or missing a Lexapro dose until about the 48 hour mark. YMMV, but when I took it my experience was that there was quite a bit of wiggle room in the dosing schedule. This seems consistent with what your pharmacist and psychiatrist had to say, although keep in mind that the guidelines they use are naturally a bit conservative. You should be just fine pretty much no matter what you do.
posted by Anticipation Of A New Lover's Arrival, The at 5:25 PM on August 21, 2018 [1 favorite]

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