A selective serotonin reuptake inhibitor (SSRI) called Celexa (citalopram) is a medication that is frequently used to treat depression and anxiety. It is selective because it does not interact with the histamine, GABA, dopamine, adrenergic, as well as muscarinic receptor subtypes. Thus, it does not have all the side effects of the TCAs (Tricyclic antidepressant drugs).

Read all the contraindications & Side effects of Citalopram

Celexa dosage in anxiety and other disorders:

Commonly recommended dosages of Celexa include 10 mg and 20 mg tablets. Patients with severe depression who have not responded to lower dosages may be given the full dose of 40 mg.

Note: 

1. The danger of arrhythmias should be considered when administering doses more than 40 mg. The chance of a prolonged QT interval rises with dosage.
2. Patients with severe liver disease such as those with ascites, blood in vomitus, and drowsiness or hepatic encephalopathy should avoid citalopram (and other sedatives as well)
3. Older patients and those taking omeprazole and cimetidine (Tagamet) should not take more than 20 mg of citalopram daily.
4. The usual initial dose is 10 mg and should be gradually increased over the weeks to avoid adverse effects associated with it.
5. Little data is available regarding its use in children. Citalopram dosage in children can be viewed here (Citalopram)

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Celexa dosage in Generalized anxiety disorder:

• 10 mg once daily initially.
• The dose may gradually be increased based on the response and tolerability in 10 mg increments at intervals of one week.
• The maximum dose is 40 mg/day for adults less than 60 years and 20 mg/day for adults older than 60 years of age.

Citalopram dosage in Panic disorder:

• 10 mg once daily for 3 - 7 days initially, then 20 mg once daily.
• Adults less than 60 years of age may increase the dose gradually weekly intervals to a maximum dose of 40 mg/day.
• Adults older than 60 years of age should not exceed the maximum dose of 20 mg/day.

Citalopram dosage in Posttraumatic stress disorder:

• 20 mg once daily.
• Adults less than 60 years of age may increase the dose gradually weekly intervals to a maximum dose of 40 mg/day
• Adults older than 60 years of age should not exceed the maximum dose of 20 mg/day.

Celexa (citalopram) use in Social anxiety disorder:

• 10 to 20 mg once daily.
• Adults younger than 60 years of age may gradually increase the dose after 6 weeks based on response and tolerability in 10 to 20 mg increments at weekly intervals to a maximum dose of 40 mg/day.
• Adults older than 60 years of age should not exceed the maximum dose of 20 mg/day.

Citalopram dosage in Unipolar Major depressive disorder:

• 20 mg once daily.
• Adults less than 60 years of age may increase the dose gradually weekly intervals to a maximum dose of 40 mg/day
• Adults older than 60 years of age should not exceed the maximum dose of 20 mg/day.

Celexa use in Obsessive-compulsive disorder:

• 20 mg once daily.
• Adults less than 60 years of age may increase the dose gradually weekly intervals to a maximum dose of 40 mg/day
• Adults older than 60 years of age should not exceed the maximum dose of 20 mg/day.

How to discontinue Celexa (citalopram)?

• It should be gradually tapered off when the treatment has lasted at least 3 weeks.
• The dose should be gradually tapered off over 2 – 4 weeks to minimize withdrawal symptoms.
• Patients who develop withdrawal symptoms should resume the previous dose and then start tapering the drug more slowly over a period of 3 months or more.

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How to switch to other antidepressants:

• Different strategies are used:
  • Cross titration is the gradual discontinuation of one drug and an incremental increase of another antidepressant.
  • A direct switch is abruptly discontinuing the first antidepressant and then starting the new antidepressant at an equivalent dose or lower dose and increasing it gradually.

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Switching to or from an MAOI:

A time-lapse of 14 days should be allowed between discontinuing an MAOI and initiation of citalopram. [select-faq faq_id='7626'] [select-faq faq_id='7627']