From the Guidelines
The recommended approach to switch from citalopram (Celexa) 20 mg daily to escitalopram (Lexapro) in an adult is a direct switch without tapering, starting escitalopram 10 mg the next day after stopping citalopram, as escitalopram is the active S-enantiomer of citalopram and 10 mg of escitalopram is approximately equivalent to 20 mg of citalopram in therapeutic effect. This approach is supported by the understanding that citalopram and escitalopram have similar pharmacological profiles, with escitalopram being the active component of citalopram 1. The switch can be made without a washout period due to their similar mechanisms of action.
When making this switch, it's crucial to monitor the patient for any unusual side effects, although significant withdrawal symptoms are unlikely due to the medications' similar profiles. Patients should be advised to take escitalopram once daily, typically in the morning or evening at the same time each day, with or without food. The rationale behind this switch is that escitalopram may offer similar efficacy with potentially fewer side effects compared to citalopram, given that it contains only the therapeutically active enantiomer.
Key considerations during the transition include:
- Monitoring for symptoms of serotonin syndrome, especially if other serotonergic drugs are being used concurrently 1.
- Being aware of the potential for drug-drug interactions, although citalopram/escitalopram may have a lower propensity for such interactions compared to other SSRIs 1.
- Recognizing that a discontinuation syndrome can occur with SSRIs, characterized by various symptoms such as dizziness, fatigue, and nausea, especially after missed doses or acute discontinuation 1.
Given the information provided and the focus on minimizing morbidity, mortality, and maximizing quality of life, the direct switch from citalopram to escitalopram without tapering is the most appropriate approach, based on the most recent and highest quality evidence available 1.
From the Research
Switching from Citalopram to Escitalopram
To switch from citalopram 20 mg daily to escitalopram (Lexapro) in an adult, consider the following steps:
- Dose equivalence: Escitalopram is the active enantiomer of citalopram, and its dosage is typically half that of citalopram 2. Therefore, a dose of 10 mg escitalopram may be equivalent to 20 mg citalopram.
- Cross-tapering: One approach is to gradually taper the citalopram dose while simultaneously introducing escitalopram at a low dose, with the goal of minimizing potential withdrawal symptoms or adverse effects 3.
- Direct switching: Another approach is to directly switch from citalopram to escitalopram, taking into account the equivalent dose. For example, switching from 20 mg citalopram to 10 mg escitalopram 2, 4.
- Monitoring: Close monitoring of the patient's response to the new medication, including potential side effects and efficacy, is crucial during the switching process.
Key Considerations
When switching from citalopram to escitalopram, keep in mind:
- Pharmacokinetics: Escitalopram has a faster onset of action and a shorter elimination half-life compared to citalopram 3.
- Efficacy: Escitalopram has been shown to be effective in treating major depressive disorder, with some studies suggesting a faster onset of action and greater efficacy compared to citalopram 2, 4.
- Tolerability: Escitalopram is generally well-tolerated, with a similar side effect profile to citalopram 3, 4.