Citalopram Tapering Schedule for Discontinuation
The recommended tapering schedule for discontinuing citalopram 20 mg is a gradual reduction of 5 mg every 2-4 weeks to minimize withdrawal symptoms. 1, 2
Understanding Citalopram Discontinuation Syndrome
Abrupt discontinuation of citalopram can lead to significant withdrawal symptoms due to its relatively short half-life compared to other SSRIs like fluoxetine. These symptoms may include:
- Dizziness, light-headedness, vertigo, and sensory disturbances 3, 4
- Nausea, vomiting, and gastrointestinal distress 3
- Fatigue, lethargy, myalgia, and flu-like symptoms 3, 2
- Anxiety, irritability, agitation, and mood disturbances 3, 4
- Confusion, trouble concentrating, and cognitive effects 4
- Sleep disturbances and insomnia 2
Recommended Tapering Schedule
For a patient on citalopram 20 mg using 5 mg increments:
- First reduction: Decrease from 20 mg to 15 mg daily and maintain for 2-4 weeks 1, 2
- Second reduction: Decrease from 15 mg to 10 mg daily and maintain for 2-4 weeks 1, 2
- Third reduction: Decrease from 10 mg to 5 mg daily and maintain for 2-4 weeks 1, 2
- Final step: Discontinue completely after 2-4 weeks at 5 mg 1, 2
Important Considerations
- Extended taper may be necessary: For patients experiencing significant withdrawal symptoms, consider extending the taper duration at each dose level or implementing smaller incremental decreases 5, 2
- Monitor for relapse: Be aware that discontinuation symptoms can be mistaken for relapse of depression 3, 6
- Symptom management: If withdrawal symptoms become severe, return to the previous dose and resume tapering at a slower rate 2
- Risk factors: Higher doses and plasma concentrations of citalopram are associated with greater risk of discontinuation syndrome 4
Special Situations
- Patients with anxiety disorders: May require even more gradual tapering as they can be more sensitive to discontinuation effects 1
- Long-term users: Patients who have been on citalopram for years may benefit from an even more gradual taper, potentially extending over several months 5
- Concurrent medications: If the patient is also taking benzodiazepines, taper the citalopram first as benzodiazepine withdrawal can be more dangerous 1
Follow-up Recommendations
- Schedule follow-up appointments at each dose reduction stage to monitor for withdrawal symptoms 2
- Educate patients that some symptoms may persist for weeks to months after complete discontinuation 2
- Consider providing symptomatic relief for specific withdrawal symptoms as needed 2
Remember that research has shown that patients who discontinue antidepressants have a higher risk of relapse within 52 weeks compared to those who maintain therapy, so careful monitoring for depression recurrence is essential 6.