Below are the general guidelines for dosing citalopram (Celexa). Note that these dosages may be adjusted on a case-by-case basis for individual patients. Always follow your prescribing physician’s instructions for taking citalopram.
The following information comes from DailyMed, an FDA label information provider.
What if I miss a dose of citalopram?
According to Mayo Clinic, if you miss a dose of citalopram, take it immediately unless you are closer to your next dose. Never double dose.
What if I overdose on citalopram?
In clinical trials of citalopram, there were reports of citalopram overdose, including overdoses of up to 2000mg, with no associated fatalities. During the postmarketing evaluation of citalopram, Celexa overdoses, including overdoses of up to 6000 mg, have been reported. As with other SSRIs, a fatal outcome in a patient who has taken an overdose of citalopram has been rarely reported.
Symptoms most often accompanying citalopram overdose, alone or in combination with other drugs and/or alcohol, included dizziness, sweating, nausea, vomiting, tremor, somnolence, and sinus tachycardia. In more rare cases, observed symptoms included amnesia, confusion, coma, convulsions or seizures, hyperventilation, cyanosis, rhabdomyolysis, and ECG changes (including QTc prolongation, nodal rhythm, ventricular arrhythmia, and very rare cases of torsade de pointes).
Acute renal failure has been very rarely reported accompanying overdose.
Management of Overdose
Establish and maintain an airway to ensure adequate ventilation and oxygenation. Careful observation and cardiac and vital sign monitoring are recommended, along with general symptomatic and supportive care. Due to the large volume of distribution of citalopram, forced diuresis, dialysis, hemoperfusion, and exchange transfusion are unlikely to be of benefit. There are no specific antidotes for Celexa.
In managing overdosage, consider the possibility of multiple-drug involvement. The physician should consider contacting a poison control center for additional information on the treatment of any overdose.
Dosage and Administration
Celexa should be administered once daily, in the morning or evening, with or without food.
Celexa (citalopram) should be administered at an initial dose of 20 mg once daily, with an increase to a maximum dose of 40 mg/day at an interval of no less than one week. Doses above 40 mg/day are not recommended due to the risk of QT prolongation. Additionally, the only study pertinent to dose response for effectiveness did not demonstrate an advantage for the 60 mg/day dose over the 40 mg/day dose.
20 mg/day is the maximum recommended dose for patients who are greater than 60 years of age, patients with hepatic impairment, and for CYP2C19 poor metabolizers or those patients taking cimetidine, omeprazole or another CYP2C19 inhibitor. (see WARNINGS)
No dosage adjustment is necessary for patients with mild or moderate renal impairment. Celexa should be used with caution in patients with severe renal impairment.
Treatment of Pregnant Women During the Third Trimester
Neonates exposed to Celexa and other SSRIs or SNRIs, late in the third trimester, have developed complications requiring prolonged hospitalization, respiratory support, and tube feeding (see PRECAUTIONS). When treating pregnant women with Celexa during the third trimester, the physician should carefully consider the potential risks and benefits of treatment.
It is generally agreed that acute episodes of depression require several months or longer of sustained pharmacologic therapy. Systematic evaluation of Celexa in two studies has shown that its antidepressant efficacy is maintained for periods of up to 24 weeks following 6 or 8 weeks of initial treatment (32 weeks total). In one study, patients were assigned randomly to placebo or to the same dose of Celexa (20-60 mg/day) during maintenance treatment as they had received during the acute stabilization phase, while in the other study, patients were assigned randomly to continuation of Celexa 20 or 40 mg/day, or placebo, for maintenance treatment. In the latter study, the rates of relapse to depression were similar for the two dose groups (see CLINICAL TRIALS UNDER CLINICAL PHARMACOLOGY). Based on these limited data, it is not known whether the dose of citalopram needed to maintain euthymia is identical to the dose needed to induce remission. If adverse reactions are bothersome, a decrease in dose to 20 mg/day can be considered.
Discontinuation of Treatment with Celexa
Symptoms associated with discontinuation of Celexa and other SSRIs and SNRIs have been reported (see PRECAUTIONS). Patients should be monitored for these symptoms when discontinuing treatment. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose but at a more gradual rate.
Switching a Patient To or From a Monoamine Oxidase Inhibitor (MAOI) Intended to Treat Psychiatric Disorders
At least 14 days should elapse between discontinuation of an MAOI intended to treat psychiatric disorders and initiation of therapy with Celexa. Conversely, at least 14 days should be allowed after stopping Celexa before starting an MAOI intended to treat psychiatric disorders (see CONTRAINDICATIONS).
Use of Celexa with Other MAOIs, Such as Linezolid or Methylene Blue
Do not start Celexa in a patient who is being treated with linezolid or intravenous methylene blue because there is an increased risk of serotonin syndrome. In a patient who requires more urgent treatment of a psychiatric condition, other interventions, including hospitalization, should be considered (see CONTRAINDICATIONS).
In some cases, a patient already receiving Celexa therapy may require urgent treatment with linezolid or intravenous methylene blue. If acceptable alternatives to linezolid or intravenous methylene blue treatment are not available and the potential benefits of linezolid or intravenous methylene blue treatment are judged to outweigh the risks of serotonin syndrome in a particular patient, Celexa should be stopped promptly, and linezolid or intravenous methylene blue can be administered. The patient should be monitored for symptoms of serotonin syndrome for 2 weeks or until 24 hours after the last dose of linezolid or intravenous methylene blue, whichever comes first. Therapy with Celexa may be resumed 24 hours after the last dose of linezolid or intravenous methylene blue (see WARNINGS).
The risk of administering methylene blue by non-intravenous routes (such as oral tablets or by local injection) or in intravenous doses much lower than 1 mg/kg with Celexa is unclear. The clinician should, nevertheless, be aware of the possibility of emergent symptoms of serotonin syndrome with such use (see WARNINGS).
How is citalopram supplied?
10 mg Bottle of 100 NDC # 0456-4010-01
Beige, oval, film-coated.
Imprint on one side with “FP”. Imprint on the other side with “10 mg”.
|20 mg||Bottle of 100||NDC # 0456-4020-01|
|10 x 10 Unit Dose||NDC # 0456-4020-63|
Pink, oval, scored, film-coated.
Imprint on scored side with “F” on the left side and “P” on the right side.
Imprint on the non-scored side with “20 mg”.
|40 mg||Bottle of 100||NDC # 0456-4040-01|
|10 x 10 Unit Dose||NDC # 0456-4040-63|
White, oval, scored, film-coated.
Imprint on scored side with “F” on the left side and “P” on the right side.
Imprint on the non-scored side with “40 mg”.
Store at 25°C (77°F); excursions permitted to 15 – 30°C (59-86°F).
Generic Name: Citalopram HBr
Class: Antidepressant [Selective Serotonin Reuptake Inhibitor (SSRI)]
Availability: Prescription only
Molecular Formula: C20H22BrFN2O
Substance UNII: I1E9D14F36
What is Citalopram?
Citalopram is a selective serotonin reuptake inhibitor (SSRI) given as a prescription. It is the generic name of the trade name Celexa.
What is Citalopram Used For?
Citalopram is an antidepressant that is used to treat depression. When used as an antidepressant, it is designed to bring about better mental balance by improving a person’s mood by increasing the serotonin levels present in the brain.
During certain occasions, medical professionals may also prescribe this drug to treat other conditions such as alcoholism, eating disorders, social phobia (excessive interaction anxiety), panic disorders, and premenstrual dysphoric disorder, according to MedlinePlus. This list of conditions that citalopram is prescribed for is not complete, as you should speak with a medical professional regarding additional uses. Since citalopram can be prescribed for conditions other than what it was originally approved for by the FDA, it is considered an off-label drug and has off-label uses.
How Does Citalopram Work?
Citalopram is a selective serotonin reuptake inhibitor (SSRI) used to increase the serotonin levels in the brain. Serotonin is a chemical created naturally by the body that helps with certain bodily functions, such as digestion and bowel movements. It is also believed that serotonin helps to regulate a person’s mood.
When serotonin levels are low, a person may experience a low mood and symptoms of depression. Citalopram prevents the nerve cells from reabsorbing the serotonin. By blocking this reabsorption, it helps to increase the levels of serotonin that are present for the brain. The higher serotonin levels available for the brain helps to improve the person’s mood.
How Long Does It Take for Citalopram to Work?
Citalopram can take anywhere from 1 to 4 weeks before a person starts to see noticeable results. It can be prescribed as a tablet or as a solution. It may be taken with or without food.
Do Not Use Citalopram If:
There are several situations where taking this medication may not be the right choice for a person. According to the FDA, you should not use citalopram if having these conditions or experiencing these situations:
- Taking MAOIs
- After stopping treatment of MAOIs for 14 days
- Concomitant use of pimozide
- Having a hypersensitivity to citalopram or its inactive ingredients
Please understand that this list of contradictions may not be complete. There may possibly be other situations where starting the use of this drug is not advisable.