Revo: switching from escitalopram (cirpalex, lexapro) to citalopram (celexa)

[Revo]

Hello!  Newish member here (I've actually been a member for over a year but seldom come here I find it too triggering, sorry.)  I think this might be my first post!
 

I've been on 10mg escitalopram (cirpalex, lexapro) for over ten years and am thinking -- only thinking! -- of trying the Dutch "tapering strip" system.  However, they only offer it for citalopram (celexa).
 

They told me to switch to 2 x citalopram (i.e. 20mg in my case) , hold steady for 28 days and then I'd be ready to begin the taper. 

In theory escitalopram is twice as strong because citalopram is a "racemic" molecule, i.e. it has two symmetrical halves in a mirror image. As only one side "does the job" the boffins chopped off the useless side, making half the dose just as effective. So, eg, 20mg citalopram = 10mg escitalopram.

That's the theory but has anyone tried in real life?  Because I'm nervous as hell!  Thanks.

Edited July 15, 2020 by Gridley

[Gridley]

Welcome to SA, Revo.  I'm glad you wrote in before making any changes.

 

Switching from Lexapro to Citalopram solely to use the tapering strips carries some risks.  While Citalopram is the weaker "cousin" of Lexapro, it is a different drug and there is no way to foretell how you'll do on it.  You might do fine, but you might not. Also,  equivalencies are not an exact science, and while some, such as the tapering strip company, put the strength of Lexapro as twice as strong as Citalopram, other estimates put it at 4 X as strong. So that's another variable that would go into the mix.  The strips are very convenient, but you would have to consider whether this convenience outweighs the risks that a drug switch entails.

 

The following link details the various way to taper Lexapro.  In the U.K. Lundbeck's Cipralex comes in a liquid, but according to the link the dosage is not convenient to use.  You can make your own liquid, but you can judge whether the process is something you would want to undertake.  I'm at the very end of a dry taper of Lexapro using a digital scale, which has worked well for me.

 

Tips for tapering off Lexapro (escitalopram)

 

As you probably know, we recommend tapering by no more than 10% of your current dose every four weeks.

 

Why taper by 10% of my dosage?

 

The Brassmonkey slide taper is another taper we recommend.   You make weekly micro-taper reductions instead of a larger reduction once a month.  This is the method I used to taper Lexapro, and it has worked well for me.

 

The Brassmonkey Slide Method of Micro-tapering

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium and omega 3 (fish oil). Many people find these to be calming to the nervous system. 

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

Add in one at a time and at a low dose in case you do experience problems.

 

This is your Introduction topic, where you can ask questions and connect with other members.  We're glad you're here.

 

Edited July 15, 2020 by Gridley

[Revo]

Thanks Gridley, that's really helpful.

 

You said "I'm at the very end of a dry taper of Lexapro using a digital scale, which has worked well for me" -- does that mean cutting up tablets?

 

I did try a taper on the liquid form of the drug a few ago and had a nasty episode: I was on 10mg tablets and so switched to 9 drops (@1mg per drop) then 8.  I was doing really well (maybe a bit too well: 8mg liquid actually felt like a bigger, stronger dose than a 10mg tablet, presumably due to easier absorption).  However while I was away from home I took 7 drops before I went down for breakfast and realised that taking them on an empty stomach was a very bad idea: no pill filler to slow the release, I guess.  Taking the liquid after food seemed fine.

 

The Brassmonkey link was ace, thanks, as was Altostrata's advice.   4 weekly reductions @ 2.5% each totalling 10% and then a two week holding period.  I'm tempted to try that with a combination a 5mg pill and the liquid form, reducing the latter slowly as per Brassmonkey's slide rule.  That would save pill splitting and mess.  Also, it seems to me that different brands of the medication come in different sized (and there weight?) pills, so the x amount of one pill by weight might be more or less than the same amount of a different brand.

BTW I can't see how to reply to the "Tips for tapering off Lexapro (escitalopram)" thread, has it been locked to new content?  Or do need privileges to be able to post there? 

Thanks again

PS I saw you edited my thread, now sure what you changed but apologies if I said anything bad / wrong. 

 

Edited July 16, 2020 by ChessieCat
reduced font size

[Gridley]

48 minutes ago, Revo said:

does that mean cutting up tablets?

Yes, I crush the tablet between two spoons and weigh my dosage on the scale.

 

48 minutes ago, Revo said:

presumably due to easier absorption

 

Many people react differently to liquid as opposed to tablet.  

 

48 minutes ago, Revo said:

Also, it seems to me that different brands of the medication come in different sized (and there weight?) pills, so the x amount of one pill by weight might be more or less than the same amount of a different brand.

 

Definitely true.  Ideally, you would stick with one brand.. That way, everything stays consistent.  If you had to switch, you would need to recalculate the weight of the new brand tablet. 

 

48 minutes ago, Revo said:

 I'm tempted to try that with a combination a 5mg pill and the liquid form, reducing the latter slowly as per Brassmonkey's slide rule

 

If you are going to switch to a part liquid, part tablet approach, we recommend a gradual crossover, not switching all at once to half tablet, half liquid.  That helps avoid a shock to your system.  A gradual switchover would entail some weighing of powder to make the switch from tablet to liquid gradual.   Our standard crossover recommendation, as applied to the 5mg liquid you would want to arrive at, is:

 

3/4 dose tablet, 1/4 dose liquid for 3 to 7 days

1/2 dose tablet, 1/2 dose liquid for 3 to 7 days

1/4 dose tablet, 3/4 dose liquid for 3 to 7 days

all liquid on the 5mg part of your dose thereafter..

 

You would not taper during the crossover period.  Only make one change at a time.

 

48 minutes ago, Revo said:

BTW I can't see how to reply to the "Tips for tapering off Lexapro (escitalopram)

 

That's a locked reference file.  Anything to do with your own situation you should post here in your Introduction thread.  That way, all your information will be in one place.

Edited July 15, 2020 by Gridley

[ChessieCat]

12 hours ago, Revo said:

BTW I can't see how to reply to the "Tips for tapering off Lexapro (escitalopram)" thread, has it been locked to new content?  Or do need privileges to be able to post there? 

 

11 hours ago, Gridley said:

That's a locked reference file.

 

The Tips for Tapering Lexapro is not a locked file.  It may be that you had a 2 different tabs open and thought you were posting in the Tips topic and it was the other topic which happened to be a locked topic.  It may also have been a temporary glitch in the site which does happen sometimes.  I've noticed that the site has been hanging over the last few days.

 

But yes, as Gridley stated, anything to do specifically with your own situation is best posted here in your Introduction topic, otherwise it may get overlooked because the mods mainly focus on the Introduction topics.  It's okay to ask more general questions in other topics.