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Tips for tapering off Celexa (citalopram)

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Altostrata

Aka Cipramil, Celeza, Citrol, Seropram, Talam, Citabax, Citaxin (Poland), Citalec (Slovakia), Recital (Israel), Zetalo (India), Celapram, Ciazil (Australia, New Zealand), Zentius (South America), Ciprapine (Ireland), Cilift (South Africa), Citox (Mexico), Citopam, Akarin (Denmark), Cipram (Turkey, Denmark), and Celius (Greece)

 

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FDA Adds More Warnings to Antidepressant's Label

In a follow-up to a warning that high doses of the popular antidepressant Celexa can cause potentially fatal abnormal heart rhythms, the U.S. Food and Drug Administration has issued new dosing and use recommendations.

Last August, the FDA said doses of Celexa (citalopram hydrobromide) greater than 40 milligrams a day can cause changes in the electrical activity of the heart, which can lead to abnormal heart rhythms, including a potentially deadly arrhythmia known as Torsade de Pointes.

Patients at high risk include those with preexisting heart conditions (including congestive heart failure) and those prone to low levels of potassium and magnesium in the blood, the FDA said...

Here are the latest FDA recommendations:

Celexa should not be used at doses greater than 40 milligrams (mg)....

 

From official FDA information at http://www.drugs.com/pro/citalopram-tablets.html
 

 

Quote

Discontinuation of Treatment with Citalopram
Symptoms associated with discontinuation of citalopram and other SSRIs and SNRIs have been reported (see PRECAUTIONS). Patients should be monitored for these symptoms when discontinuing treatment. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose but at a more gradual rate.
....
PRECAUTIONS
....
Discontinuation of Treatment with Citalopram


During marketing of citalopram and other SSRIs and SNRIs (serotonin and norepinephrine reuptake inhibitors), there have been spontaneous reports of adverse events occurring upon discontinuation of these drugs, particularly when abrupt, including the following: dysphoric mood, irritability, agitation, dizziness, sensory disturbances (e.g., paresthesias such as electric shock sensations), anxiety, confusion, headache, lethargy, emotional lability, insomnia, and hypomania. While these events are generally self-limiting, there have been reports of serious discontinuation symptoms.

Patients should be monitored for these symptoms when discontinuing treatment with citalopram. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose but at a more gradual rate....

 

Citalopram comes in these dosages, from http://www.drugs.com/ppa/citalopram.html
- Tablets, oral 10 mg
- Tablets, oral 20 mg
- Tablets, oral 40 mg
- Solution, oral 2 mg/mL

Celexa has a half-life of about 35 hours. Liver enzymes CYP3A4, CYP2C9, CYP2C19, and CYP2D6 are involved in its metabolism per http://www.drugbank.ca/drugs/DB00215

Reduce by 10% per month to start
The 10% rule holds for Celexa, just like other psychiatric drugs: Reduce by 10% per month, calculated on the last dosage. (The amount of the reduction gets progressively smaller.)

See Why taper by 10% of my dosage?

Use Celexa liquid concentrate to taper
In the US, the liquid oral solution comes in 10 mg/5 mL (2 mg/mL), peppermint flavor. The bottle contains 240 mL. Pharmacy identifier is NDC 0456-4130-08

Use an oral syringe to precisely measure out doses as small as .01mg.

Making a Celexa solution yourself
See making-a-celexa-solution-yourself and how-to-make-a-liquid-from-tablets-or-capsules

 

 

Tapering by cutting up tablets
The tablets are scored, which means they can be cut up.

Use a digital scale to accurately measure doses cut from tablets.

 

Using a combination of tablets and liquid

Rather than switch directly to an all-liquid dose, you may wish to take part of your dose in liquid and part in tablets, gradually converting to all-liquid as you get to lower dosages. This can be very convenient and reduce any problems switching from one form of the drug to another.

 

FYI, for those in the UK:

 

On 9/28/2018 at 5:51 AM, Caspur said:

Hi ButterflyHope,

If you are in the UK, then yes it should be possible for you to get a liquid form of citilopram via your GP. The problem I've seen from others reporting is the cost. Some GPs will have one eye on their budgets. The liquid preps are expensive at £100-120 a 150ml bottle. My GP prescribed liquid venlafaxine for me with me even prompting him! That said, if there's any objections just make it clear that the NHS got you onto this drug so it has a moral obligation to help you get off it, whatever the cost!

The British National Formulary shows it is available as oral drops 40mg per ml of liquid; see link here.

https://bnf.nice.org.uk/medicinal-forms/citalopram.html

I'm sure it would be possible for the NHS to get it made up at a lower concentration which is probably what you need.

Good luck with your taper.

Caspur

 

 

Edited by Altostrata
updated information

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Nikki

It comes in a liquid oral solution, with 10 mg/5 mL, peppermint flavor.

 

Alto I forgot about tapering a liquid in terms of measurement can you explain please.

 

Would I just fill the syringe up to the 40mg. mark and then drop out enough to have 39.50 in the syringe if I only want to drop 1/2 mg. at a time?

 

Thanks

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Altostrata

It comes in a liquid oral solution, with 10 mg/5 mL, peppermint flavor.

Be careful with the concentration. Here, the oral solution is concentrated 2:1, twice as strong. There are 2mg Celexa in 1mL of the liquid.

 

If you wanted to take 40mg Celexa, you would take 20mL of the liquid (20mL x 2mg = 40mg).

 

If you wanted to take 39.5mg Celexa, you would take 19.75mL of the liquid (19.75mL x 2mg = 39.5mg).

 

You can combine tablets and solution. For example, to take 39.5mg Celexa, you could take one 20mg tablet + 9.75mL liquid.

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Francis

Hi all- Does anyone know if I can simply dilute liquid celexa with water (a given amount of each) in order to be able to reduce my intake by smaller amounts? I am down to 0.6mg and it is difficult, with the syringe I have, to reduce in smaller increments than 0.1-.2mg. I tried to go to 0.4mg and I am feeling the bad impact.

 

If I can dilute it with water, do I have to do the mix right when I take it or can I mix up enough for 2 weeks in advance?

 

Thanks so much for any help

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Altostrata

Here is the product insert sheet (PDF) for liquid Celexa from the US National Institutes of Health:

http://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid=6278

Celexa oral solution contains citalopram HBr equivalent to 2 mg/mL citalopram base. It also

contains the following inactive ingredients: sorbitol, purified water, propylene glycol,

methylparaben, natural peppermint flavor, and propylparaben.

As it already contains water, this suggests it can be diluted.

 

You may wish to check with a pharmacist.

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AmberV

Hello

I have been on 20mg Celexa for 4 weeks.

The celexa is making me extremely tired, lazy and almost catatonic and I want to get off it as soon as possible.

 

As I have been on it only such a short period of time, what would a recommended tapering period look like please? Thankyou

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Altostrata

You might want to try a fast taper, 5mg every 2 weeks. If you get withdrawal symptoms, reinstate and reduce slower and by smaller decrements.

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Rhiannon

I'm down to about 1 mg out of a 10 mg tablet so I wanted to see how many doses I could get out of that and how long I could keep them safely. Found this article below. It sounds like citalopram is pretty stable in aqueous (water) solution ("d" stands for days).

 

Good news for me, I can probably pre-make and keep doses as long as I want, which means not having to deal with doctors and refills.

 

http://www.ncbi.nlm.nih.gov/pubmed/16050577

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Skyler

Hi Rhi.. speaking of the length of time one can keep a suspension... I've been meaning to let you know how much I appreciated your comments on my issue with Lyrica... I had no idea the drug was dissolved by the H2O (as opposed to being a suspension) and this might affect the length of time it could be kept in the fridge. Thanks so much for your input! You solved my mystery.. and I've stopped beating myself up for not realizing more quickly what the problem was.. Now I'm confident about keeping the solution for 3 days.. but no longer.

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Gibby

I'm pretty glad that citalopram comes in a liquid form! Trying to measure out those little jumps would be maddening without it. 

 

Is the liquid form more expensive than the regular tablets?

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Altostrata

The cost of the liquid form depends on your insurance coverage and availability in your area. Generally, if you have to pay out of pocket, it is more expensive, but if you are tapering and taking small doses, it will last a long time.

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kesh

Was wondering if anyone has noticed interdose withdrawal when at the low end of their taper. Serum levels drop by about a third between daily doses, and at the low end this MIGHT have a marked effect, as the dose-response curve is pretty steep in the low milligrams.

 

Anyone done twice daily dosing?

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Altostrata

Yes, in the last phase of a chapter, the drug may be metabolized more quickly and interdose withdrawal may result. We've had very few instances of this. Dosing more than once a day may help.

 

However, you just started tapering. Please ask questions specific to your situation in your Intro topic.

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kesh
6 hours ago, Altostrata said:

Yes, in the last phase of a chapter, the drug may be metabolized more quickly and interdose withdrawal may result. We've had very few instances of this. Dosing more than once a day may help.

 

However, you just started tapering. Please ask questions specific to your situation in your Intro topic.

Yes. I spoke about it there also. As I'm tapering from a low starting point, 2.5mg, it may apply to me. I was looking for advice from citalopram/celexa experts.

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Altostrata

An accurately reported symptom pattern relative to when you take your drugs and their dosages will enable us to determine if you are having interdose withdrawal symptoms.

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mariella

hi altostrata, what is interdose withdrawal?

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Altostrata

Some drugs have short half-lives, when they wear off between doses, you can get interdose withdrawal symptoms.

 

This mostly applies to benzodiazepines, but sometimes when people are tapering other drugs, they get down to such low doses that they metabolize the drug quickly. In these situations, divided doses will help.

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mariella

Thank you altostrata. 

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Nolabud1

Can somebody please let me know how low to taper off Citalopram. Started 4.5 months ago on 5mg. I’ve been slowly tapering and now I’m down to 2.5 mg. How much lower can I go before quitting? Splitting pills becomes annoying at 2.5 mg and under. 

Thanks.

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Altostrata

Nolabud, please read this topic from the beginning and post questions about your taper in your Introductions topic.

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