Uses
Major Depressive Disorder
Management of major depressive disorder.
Efficacy in hospital settings not established.
Obsessive-Compulsive Disorder
Has been used in the management of obsessive-compulsive disorder†.
Panic Disorder
Has been used in the management of panic disorder† with or without agoraphobia†.
Social Phobia
Has been used in the management of social phobia† (social anxiety disorder).
Alcohol Dependence
Has been used in the management of alcohol dependence†.
Premature Ejaculation
Has been used for the management of premature ejaculation†.
May be less effective than some other SSRIs (e.g., paroxetine).
Eating Disorders
Has been used in the management of bulimia nervosa† or anorexia nervosa† with equivocal efficacy.
Diabetic Neuropathy
Has been used in the management of diabetic neuropathy†.
Posttraumatic Stress Disorder
Has been used in a limited number of adults with civilian- or combat-related posttraumatic stress disorder† (PTSD).
Dosage and Administration
General
- Allow at least 2 weeks to elapse between discontinuance of an MAO inhibitor and initiation of citalopram, and vice versa.
- Monitor for possible worsening of depression, suicidality, or unusual changes in behavior, especially at the beginning of therapy or during periods of dosage adjustments. (See Worsening of Depression and Suicidality Risk under Cautions.)
- Sustained therapy may be required; monitor periodically for need for continued therapy.
- Avoid abrupt discontinuance of therapy. To avoid withdrawal reactions, taper dosage gradually. (See Worsening of Depression and Suicidality Risk and also see Withdrawal of Therapy under Cautions.)
- Consider cautiously tapering dosage during third trimester of pregnancy prior to delivery. (See Fetal/Neonatal Morbidity and Mortality under Cautions.)
Administration
Oral Administration
Administer orally once daily (morning or evening) without regard to meals.
Dosage
Available as citalopram hydrobromide; dosages expressed in terms of citalopram.
Adults
Major Depressive Disorder
Oral
Initially, 20 mg once daily. If no clinical improvement is apparent, increase in 20-mg increments at intervals of ≥1 week.
Optimum duration not established; may require several months of therapy or longer.
Obsessive-Compulsive Disorder
Oral
Initially, 20 mg once daily. Gradually increase dosage according to clinical response.†
Usual maintenance dosage: 40–60 mg daily.†
Panic Disorder
Oral
Usual initial dosage: 10 mg daily. Increase dosage after ≥1 week in 10- or 20-mg increments up to a dosage of 20–60 mg daily, depending on individual patient response and tolerability.†
Usual maintenance dosage: 20–30 mg daily.†
Prescribing Limits
Adults
Major Depressive Disorder
Oral
Maximum of 40 mg daily usually recommended; some patients may require up to 60 mg daily.
Obsessive-Compulsive Disorder
Maximum 60 mg daily.†
Panic Disorder
Maximum 60 mg daily.†
Special Populations
Dosage in Hepatic Impairment
Major Depressive Disorder
Oral
Initially, 20 mg once daily; titrate to 40 mg once daily only in nonresponders.
Dosage in Renal Impairment
Major Depressive Disorder
Oral
No dosage adjustment necessary in patients with mild to moderate renal impairment. Dosage adjustment may not be necessary in patients with severe renal impairment, but caution is recommended. (See Elimination: Special Populations, under Pharmacokinetics.)
Geriatric Patients
Initially, 20 mg once daily; titrate to 40 mg once daily only in nonresponders.
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