TaperCommunitycitalopram
Boxed Warning
Suicidality risk in children, adolescents, and young adults under 25 during initial treatment.
Citalopram is a racemic SSRI approved for major depressive disorder. It is the racemic form of escitalopram and one of the most selective SSRIs for the serotonin transporter. The FDA limits maximum dose to 40mg due to dose-dependent QT prolongation.
10mg, 20mg, 40mg
Tablets: 10mg, 20mg, 40mg; Oral solution: 10mg/5mL
Category C (risk cannot be ruled out)
Selective serotonin reuptake inhibitor (SSRI) that blocks the serotonin transporter (SERT) with high selectivity. The S-enantiomer is responsible for most of the therapeutic activity.
Liquid formulation available. Hyperbolic taper recommended for final reductions.
Oral solution (10mg/5mL) available for precise dose reductions. Follow hyperbolic tapering schedule.
Toxicity
Dose-dependent QT prolongation (maximum recommended dose 40mg/day, 20mg/day in patients >60 years). Serotonin syndrome with serotonergic combinations.
Pharmacokinetics
Rapidly and well absorbed after oral administration. Bioavailability ~80%. Tmax ~4 hours. Food does not significantly affect absorption.
~12 L/kg
Hepatic via CYP3A4 and CYP2C19 (primary) to demethylcitalopram (DCT) and didemethylcitalopram (DDCT), both with weak pharmacological activity.
Renal (~10% unchanged) and hepatic metabolism. Fecal excretion minor.
~80%
~330 mL/min (oral clearance)
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