What is the recommended dose of citalopram (Celexa) syrup in milliliters (ml) for adults and pediatric patients with depression?

Citalopram Syrup Dosing

For adults with depression, start citalopram at 20 mg once daily (equivalent to 10 mL of a 2 mg/mL oral solution), which can be increased to a maximum of 40 mg/day (20 mL) after 1-2 weeks if response is insufficient. 1

Standard Adult Dosing

• The typical dosage range is 20 to 40 mg per day (10-20 mL of 2 mg/mL solution) for most adult outpatients 1
• The recommended starting dose of 20 mg (10 mL) appears appropriate for most patients, with the option of raising the dose in non-responders, particularly those with more severe depression 2
• When increasing the dose, wait at least 1-2 weeks before escalating, as full therapeutic response requires 4-8 weeks 1

Elderly Patients (≥60 Years)

• Start at 10 mg daily (5 mL) with a maximum dose of 20 mg/day (10 mL) due to increased risk of QT interval prolongation 1
• The American Academy of Family Physicians recommends starting doses of approximately 50% of standard adult doses for elderly patients 1

Patients with Hepatic Impairment

• Start at 10 mg/day (5 mL) with a maximum dose of 20 mg/day (10 mL) 1

Patients Taking CYP2C19 Inhibitors

• The maximum dose must be reduced to 20 mg/day (10 mL) in patients taking CYP2C19 inhibitors such as omeprazole or cimetidine, due to significantly reduced citalopram clearance 1

Critical Safety Considerations

• The maximum dose should not exceed 40 mg per day (20 mL) due to the risk of QT interval prolongation 1
• For patients older than 65 years, the maximum recommended dose is 20 mg/day (10 mL) 1
• Regular monitoring for signs of QT prolongation is recommended, especially when initiating treatment or adjusting doses 1
• Monitor for common adverse effects including nausea, vomiting, and sexual dysfunction, as well as signs of hyponatremia, which occurs in 0.5-12% of older adults taking SSRIs 1

Pediatric Dosing

• Citalopram is not FDA-approved for pediatric use and specific pediatric syrup dosing guidelines are not established in the available evidence
• For anxious or sensitive patients, lower doses (10 mg/day or 5 mL) may be used initially 1

Treatment Duration

• Treatment for a first episode of major depression should last at least 4 months, and continue for 4-12 months after remission 1
• Patients with recurrent depression may benefit from prolonged treatment 1

Discontinuation

• When discontinuing citalopram, taper gradually over 10-14 days minimum to limit withdrawal symptoms 1

Common Pitfalls to Avoid

• Do not exceed 40 mg/day (20 mL) in adults under 60 years or 20 mg/day (10 mL) in elderly patients due to cardiac safety concerns 1
• Do not forget to reduce the maximum dose to 20 mg/day when patients are taking CYP2C19 inhibitors 1
• Do not increase doses before waiting at least 1-2 weeks, as premature dose escalation may lead to unnecessary side effects 1