Maximum Dosage of Citalopram for Alcohol Use Disorder
The maximum dose of citalopram for alcohol use disorder is 40 mg per day, which is the same as the maximum dose recommended for other indications. 1
Citalopram for Alcohol Use Disorder
While citalopram is not FDA-approved specifically for alcohol use disorder (AUD), it has been studied for this indication with mixed results:
- Early research showed that citalopram 40 mg/day (but not 20 mg/day) decreased alcohol consumption and increased abstinent days in problem drinkers 2
- Later studies demonstrated that citalopram 40 mg/day reduced cue-induced alcohol craving and decreased desirability and liking of alcohol 3, 4
- However, more recent research found poorer drinking outcomes with citalopram treatment compared to placebo, with higher numbers of heavy drinking days 5
Dosing Considerations
When using citalopram for AUD, follow these dosing guidelines:
- Initial dose: 10-20 mg per day
- Maximum dose: 40 mg per day 1
- Do not exceed 40 mg daily due to risk of QT prolongation
- Titration: Increase gradually over 1-2 weeks as tolerated
Safety Considerations
Several important safety considerations apply when using citalopram for AUD:
- QT prolongation risk: Doses above 40 mg/day are associated with QT prolongation and should be avoided
- Hepatic impairment: Use with caution in patients with alcoholic liver disease; consider lower doses
- Drug interactions: Monitor for interactions with other medications commonly used in AUD treatment
- Side effects: Common side effects include nausea, dry mouth, sweating, tremors, nervousness, insomnia or somnolence, dizziness, and sexual dysfunction
Alternative FDA-Approved Medications for AUD
Consider these FDA-approved alternatives for AUD treatment:
- Naltrexone: 50 mg/day orally or 380 mg monthly injection; reduces alcohol cravings but has hepatotoxicity concerns 1, 6
- Acamprosate: 666 mg three times daily; well-tolerated in liver disease; helps maintain abstinence 1, 6
- Baclofen: 30-60 mg/day; GABA-B receptor agonist with evidence in patients with alcoholic cirrhosis 1, 6
Treatment Algorithm for AUD
- First-line: Consider FDA-approved medications (naltrexone, acamprosate) combined with psychosocial interventions
- Second-line: Consider baclofen, especially in patients with liver disease
- Third-line: Consider off-label medications like citalopram (maximum 40 mg/day) only when first and second-line options are contraindicated or ineffective
- All patients: Combine pharmacotherapy with psychosocial interventions (CBT, motivational interviewing, support groups)
Monitoring
When using citalopram for AUD:
- Monitor for improvement in alcohol consumption patterns
- Assess for side effects, particularly QT prolongation
- Evaluate liver function regularly
- Screen for worsening depression or emergence of suicidal thoughts
Remember that complete alcohol abstinence remains the most important intervention to prevent progression of alcoholic liver disease, regardless of which medication is used 1, 6.