What is the recommended protocol for transitioning from Lexapro (escitalopram) 20 mg to Celexa (citalopram)?

From the Guidelines

The recommended protocol for transitioning from Lexapro (escitalopram) 20 mg to Celexa (citalopram) involves a cross-taper approach, starting by reducing Lexapro to 10 mg while simultaneously beginning Celexa at 10 mg for about 7 days, then discontinuing Lexapro completely while increasing Celexa to its target dose, usually 20-40 mg daily, as this approach helps minimize withdrawal symptoms and maintains therapeutic effect 1.

Key Considerations

• The cross-taper approach is recommended to minimize withdrawal symptoms and maintain therapeutic effect.
• The equivalent dosing is approximately 10 mg of Lexapro to 20 mg of Celexa, so a patient on 20 mg of Lexapro would typically need about 40 mg of Celexa for similar effect.
• Patients should monitor for side effects like increased anxiety, headaches, or sleep disturbances during the transition.
• If significant withdrawal symptoms occur, the taper can be slowed.
• It's essential to make this transition under medical supervision, as individual responses vary and dosage adjustments may be needed based on therapeutic response and tolerability.

Important Safety Information

• Citalopram may cause QT prolongation associated with Torsade de Pointes, ventricular tachycardia, and sudden death at daily doses exceeding 40 mg/d and should be avoided in patients with long QT syndrome 1.
• The risk of QT prolongation is dose-dependent, and the maximum recommended dose of citalopram is 40 mg per day or 20 mg per day in adults older than 60 years 1.

Monitoring and Follow-up

• Systematic assessment of treatment response using standardized symptom rating scales can be considered as a supplement to monitor the patient's progress during the transition.
• Patients should be closely monitored for any adverse effects, and dosage adjustments should be made as needed to optimize the benefit-to-harm ratio.

From the Research

Transitioning from Lexapro to Celexa

To transition from Lexapro (escitalopram) 20 mg to Celexa (citalopram), it is essential to follow a recommended protocol to minimize potential complications.

• The process involves gradually tapering the first antidepressant, in this case, Lexapro, followed by an adequate washout period before starting the new antidepressant, Celexa 2.
• A conservative switching strategy is preferred to avoid drug toxicity, including serotonin syndrome, which may result from inappropriate co-administration of antidepressants 2.
• Clinical expertise is necessary for more rapid or cross-taper switching, as it requires careful observation and management to prevent adverse effects.

Key Considerations

• Antidepressants can cause withdrawal syndromes if discontinued abruptly after prolonged use, and relapse and exacerbation of depression can also occur 2.
• Gradual dose reduction over days to weeks reduces the risk and severity of complications 2.
• Escitalopram and citalopram are related compounds, with escitalopram being the therapeutically active S-enantiomer of RS-citalopram 3, 4.
• The dosage of Celexa (citalopram) may need to be adjusted, considering that escitalopram is effective at half the dosage of citalopram 3, 5.

Recommended Approach

• Consult a healthcare professional to determine the best approach for transitioning from Lexapro to Celexa, taking into account individual patient needs and medical history.
• Follow a gradual tapering schedule for Lexapro, as recommended by a healthcare professional, to minimize the risk of withdrawal symptoms and other complications 2.
• After completing the tapering process, allow an adequate washout period before initiating Celexa (citalopram) therapy 2.