Citalopram Dosage

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Usual Adult Dose for:

Usual Geriatric Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Depression

Initial dose: 20 mg orally once a day.
Maintenance dose: 20 to 40 mg/day. The initial dose may be increased in 20 mg increments not more often than once a week up to a maximum of 40 mg per day.

Usual Geriatric Dose for Depression

20 mg/day orally is the maximum recommended dose for patients who are greater than 60 years of age.

Usual Pediatric Dose for Depression

Children Up To 11 Years:
Initial dose: 10 mg orally once daily; increase dose slowly by 5 mg/day every 2 weeks as clinically needed; dosage range: 20 to 40 mg/day

12 to 18 Years:
Initial: 20 mg orally once daily; increase dose slowly by 10 mg/day every 2 weeks as clinically needed; dosage range: 20 to 40 mg/day

Usual Pediatric Dose for Obsessive Compulsive Disorder

Children Up To 11 years: Initial: 5-10 mg/day given once daily; increase dose slowly by 5 mg/day every 2 weeks as clinically needed; dosage range: 10 to 40 mg/day.
12 to 18 years: Initial: 10 to 20 mg/day given once daily; increase dose slowly by 10 mg/day every 2 weeks as clinically needed; dosage range: 10 to 40 mg/day.

Renal Dose Adjustments

CrCl 20 mL/min or more: no adjustment recommended.
CrCl less than 20 mL/min: no information is available.

Liver Dose Adjustments

20 mg per day is recommended in adult patients with hepatic impairment.

Precautions

Citalopram is contraindicated in patients with congenital long QT syndrome.

20 mg/day is the maximum recommended dose for patients who are CYP450 2C19 poor metabolizers or those patients taking cimetidine or another CYP450 2C19 inhibitor.

Citalopram should not be used at doses greater than 40 mg per day because it can cause abnormal prolongation of the QT interval which can lead to an abnormal heart rhythms (including Torsade de Pointes), which can be fatal. Patients at particular risk for developing prolongation of the QT interval include those with underlying heart conditions and those who are predisposed to low levels of potassium and magnesium in the blood.

Children, adolescents, and young adults (18 to 24 years of age) with major depressive disorder and other psychiatric disorders may be at an increased risk of suicidal thinking and suicidality with antidepressant use, particularly during the first few months of treatment. Medical evidence has not shown this increased risk to exist in adults older than 24 years of age, but adults 65 years of age and older taking antidepressants appear to have a decreased risk of suicidality. The results of a meta-analysis indicate an overall favorable risk-to-benefit profile for the use of antidepressants (i.e., selective serotonin and/or norepinephrine reuptake inhibitors) in the treatment of pediatric patients (less than 19- years- old) with major depressive disorders (MDD), obsessive-compulsive disorder (OCD), or non- OCD anxiety disorders. Although this study also reports an overall increased risk of suicidal ideation/suicide attempt associated with the use of antidepressants in pediatric patients, the risk may be less than originally estimated. Additional prospective studies are warranted in order to confirm these findings.

Controlled clinical trials on children and adolescents treated with citalopram have reported that suicide attempts have occurred more often by citalopram treated patients than by placebo treated patients. These trials also reported 16 cases of adolescents self- harm.

Worsening of depression and/or increased suicidal thinking or behavior may always be a possibility in patients treated with antidepressant medications, particularly those being treated for depression. Anxiety, agitation, panic attacks, insomnia, irritability, hostility, impulsivity, akathisia (severe restlessness), hypomania, and mania have been reported in patients being treated with antidepressants for major depressive disorder as well as for other indications, both psychiatric and nonpsychiatric. It is unknown if these symptoms are a precursor to either worsening of depression or the emergence of suicidal impulses; however, there is concern that patients who experience one or more of these symptoms may be at increased risk for worsening depression or suicidality. Although the FDA has not concluded that antidepressant drugs cause worsening depression or suicidality, health care providers should be aware that worsening of symptoms could be due to the underlying disease or might be a result of drug therapy.

Health care providers should carefully monitor patients receiving antidepressants for possible and/or persistent worsening of depression or emergent suicidality, especially at the beginning of therapy or when the dose either increases or decreases. If symptoms are severe, abrupt in onset, or were not part of the patient's presenting symptoms, the health care provider will need to determine what intervention, including discontinuing or modifying the current drug therapy, is indicated. Prescriptions should be written for small quantities of drug to reduce the risk of an attempt to overdose. Health care providers should instruct patients, their families and their caregivers to be alert for the emergence of agitation, irritability, and the other symptoms described above, as well as the emergence of suicidality and worsening depression, and to report such symptoms immediately to their health care provider.

Because antidepressants are believed to have the potential for inducing manic episodes in patients with bipolar disorder, there is a concern about using antidepressants alone in this population. Therefore, patients should be adequately screened to determine if they are at risk for bipolar disorder before initiating antidepressant treatment so that they can be appropriately monitored during treatment. Such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression.

The concurrent use of citalopram and MAO inhibitors is contraindicated. At least 14 days should elapse between discontinuation of an MAO inhibitor and initiation of citalopram, or vice versa.

Dialysis

Caution is recommended for use in patients with severe renal dysfunction.
Hemodialysis, hemoperfusion or exchange transfusion are not expected to remove citalopram.

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