Citalopram Dosage Guidelines
Celexa (citalopram HBr) is a well known drug that is used for the treatment of depression. Four to six weeks of controlled trials of outpatients who had diagnosis that fell under the DSM-III-R and DSM – III categories of major depressive disorders established the efficiency of Celexa as a treatment for depression.
Researchers conducted two placebo-controlled 6 – 8 weeks trials of Celexa and it showed its efficiency in maintaining an antidepressant response lasting for up to 24 weeks. Moreover, physicians who choose to use the medication for longer periods should regularly do a re-evaluation of the medication’s long-term usefulness for the patient.
Dosage
To be administered once per day. Celexa can be taken in the morning or in the evening, with or without prior food intake.
Initial Treatment
To be administered at a 20mg initial dose once per day. The dosage of Celexa (citalopram HBr) is increased to a 40 mg maximum dose per day. Dosage increase should occur in 20 mg increments during intervals of not less than a week. Dosages that go above the 40 mg per day limit is ill-advised as it increases the risk of QT prolongation. Moreover, a study done with a 60 mg per day dosage did not yield any advantageous results compared to the 40 mg per day dosage.
Patients who are experiencing moderate or mild renal impairment do not need any dosage adjustments. Patients who have severe renal impairments should be administered with Celexa cautiously.
Citalopram for Pregnant Women
Complications are developed by babies who were exposed to Celexa as well as other SNRIs or SSRIs during their late third trimester stages. This often required tube feeding (read Precautions), respiratory support, and prolonged hospitalization. When there is a need to treat pregnant women in their third trimester with Celexa, the physician is required to carefully weight out the possible risks and possible benefits acquired from the treatment. It is possible for the physician to consider tapering Celexa during the third trimester.
Maintenance Treatment
It has been agreed that several or longer months of sustained pharmacologic therapy is required to treat acute episodes of depression. The efficiency of Celexa as an antidepressant has been systematically evaluated in two studies which showed that it is able to maintain its efficiency for extensive periods reaching up to 24 weeks, which followed six to eight weeks of initial treatment, thus having a 32-weeks total. In one particular study conducted, patients were randomly assigned either to placebos or to 20 mg or 40 mg per day doses of Celexa during the maintenance treatment just as what they had during the acute stabilization phase. On the other study, the patients were randomly assigned to wither a continuation of the 30 mg or 40 mg per day doses of Celexa or placebo for their maintenance treatment. The findings in the latter study showed the rates of depression relapse were identical to the two dose groups. Based on the limited information acquired, it is still unknown whether the citalopram dose that is needed for euthymia maintenance is similar to the required dosage for induced remission. A decrease in the dosage to 20 mg per day can be possibly considered if the adverse reactions prove to be bothersome.
Discontinuing Celexa Treatment
There are symptoms that have been associated with the discontinuation of SNRIs, SSRIs, as well as Celexa. When discontinuing the treatments, patients should be closely monitored for the symptoms to ensure their safety. It is recommended to gradually reduce the dose instead of an abrupt discontinuation. Resuming to the intake of the previously prescribed dosage can be done whenever the symptoms occur during continuation or reduction of dosage. Physicians can also choose a gradual dosage reduction if the need to discontinue the treatment is crucial.
