How to decrease the dose of Celexa (citalopram)?

How to Decrease the Dose of Celexa (Citalopram)

When decreasing the dose of citalopram, a gradual reduction rather than abrupt cessation is strongly recommended to minimize withdrawal symptoms.

General Principles for Dose Reduction

• Citalopram should be tapered gradually over 10-14 days to limit withdrawal symptoms 1
• A gradual reduction in dose is preferred over abrupt discontinuation whenever possible 2
• If intolerable symptoms occur during dose reduction, resuming the previously prescribed dose may be considered before attempting a more gradual taper 2

Specific Tapering Schedule

Standard Tapering Approach

• For patients on 40 mg/day:

  • Reduce to 20 mg/day for 7-10 days 2
  • Then reduce to 10 mg/day for 7-10 days
  • Then discontinue

• For patients on 20 mg/day:

  • Reduce to 10 mg/day for 7-10 days 2
  • Then discontinue

For Sensitive Populations

• For elderly patients (>60 years), those with hepatic impairment, or CYP2C19 poor metabolizers:
  • Use more gradual tapering with smaller decrements 2
  • Consider longer intervals between dose reductions (2-3 weeks) 1

Monitoring During Dose Reduction

• Monitor for discontinuation symptoms including:

  • Dizziness, fatigue, lethargy, general malaise, headaches 1
  • Nausea, vomiting, diarrhea, insomnia 1
  • Sensory disturbances, paresthesias, anxiety, irritability, and agitation 1

• If withdrawal symptoms emerge:

  • Slow the rate of taper or temporarily return to the previous dose 2
  • Resume tapering at a more gradual rate once symptoms resolve 2

Special Considerations

• Patients with severe renal impairment require more cautious dose reduction 2
• Patients with a history of discontinuation symptoms may benefit from an even more gradual taper 1
• For patients switching to another antidepressant, cross-tapering may be preferable to complete discontinuation 1

Common Pitfalls to Avoid

• Avoid abrupt discontinuation which increases risk of withdrawal symptoms 2
• Do not taper too quickly in elderly patients or those with hepatic impairment 2
• Remember that citalopram's elimination half-life is about 27-33 hours, so steady-state concentrations take 7-10 days to achieve at each dose level 3
• Be aware that some patients may require an even more gradual taper than the standard recommendation 1