Celexa Indications… Dosage
Celexa (Citalopram) Indications… Dosage
- anxiety
- depression
- obsessive-compulsive disorder (OCD)
- panic disorder
- posttraumatic stress disorder (PTSD)
- premenstrual dysphoric disorder (PMDD)
- schizophrenia
- social phobia (social anxiety disorder)
Celexa (Citalopram) Indications… Dosage
For the treatment of depression, including the treatment of inconsolable crying following stroke, brain injury or dementia:
NOTE: Acute episodes of depression usually require several months or longer of sustained pharmacologic therapy. Whether the dose needed to induce remission is identical to the dose needed for maintenance is unknown. Antidepressant efficacy of SSRIs is maintained for up to 1 year of active treatment. The risk of suicide is inherent in any patient with depression, whether or not they are receiving an antidepressant. The clinician should be vigilant in assessing patients for suicidal ideation.
Oral dosage:
Adults: Initially, 20 mg PO once daily; may increase to 40 mg PO once daily after one week. Titrate in increments of 20 mg at intervals of no less than one week, to a maximum of 60 mg PO once daily. However, doses above 40 mg are not ordinarily recommended.
Elderly: 20 mg PO once daily is recommended. Titrate in increments of no more than 20 mg at no less than weekly intervals, up to 40 mg PO once daily only for nonresponding patients.
Adolescents and children >= 9 years: Citalopram is not approved for use in pediatric patients. Anectdotal evidence suggests that dosages of 10-40 mg/day PO are effective, but no well-controlled data are available. If used, titrate from low dosage to effective dosage gradually. More study is needed.
Children < 9 years: Safe and effective usage has not been established.
For the treatment of certain anxiety disorders:
- for generalized anxiety disorder (GAD) or for social phobia (social anxiety disorder):
Oral dosage:
Adults: 20-60 mg/day PO has been used; follow recommended dosage titration schedules.
- for obsessive-compulsive disorder (OCD):
Oral dosage:
Adults: Initially, 20 mg PO once daily; may increase to 40 mg PO once daily after 1 week. Titrate in increments of no more than 20 mg at weekly intervals, to a maximum of 60 mg PO once daily. However, doses above 40 mg are not ordinarily recommended. In an open pilot study, dosages of 40-60 mg PO once daily alleviated symptoms of OCD in 76% of patients.
Elderly: 20 mg PO once daily is recommended. Titrate in increments of no more than 20 mg at weekly intervals, up to 40 mg PO once daily only for nonresponding patients.
Adolescents and children >= 9 years: Citalopram is not approved for use in pediatric patients. Data are limited. One open study of 23 patients has suggested that dosages of 10-40 mg/day PO are effective. Titrate from low dosage to effective dosage gradually. None of the 23 patients discontinued the medication due to side effects in this 10-week study; more data are needed.
Children < 9 years: Safe and effective usage has not been established.
- for panic disorder (with or without agoraphobia):
Oral dosage:
Adults: 20-60 mg PO once daily has been effective. Higher dosages (i.e., 40-60 mg/day) appear to be no more effective than lower dosages (i.e., 20-30 mg/day).
Elderly: 20 mg PO once daily is recommended. Titrate in increments of no more than 20 mg at weekly intervals, up to 40 mg PO once daily only for nonresponding patients.
- for posttraumatic stress disorder (PTSD):
Oral dosage:
Adults: 20-60 mg/day PO has been used; follow recommended dosage titration schedules. Pilot studies indicate that citalopram may be effective for a wide variety of traumatic stressors, including combat.
Adolescents: Data are limited. One open study has suggested that 20 mg/day PO is effective.
For adjuvant treatment of chronic schizophrenia:
Oral dosage:
Adults: In one placebo-controlled study, 20 mg PO once daily for 1 week, then 40 mg PO once daily thereafter was given to patients with chronic schizophrenia who were receiving a stable neuroleptic regimen. At the end of 12 weeks, there were no significant differences in psychopathologic symptoms (i.e., Positive and Negative Symptom Scale) between the citalopram and the placebo groups. However, compared with placebo, patients who received citalopram had an improvement in general clinical condition and subjective well-being.
Elderly: 20 mg PO once daily is recommended. Titrate in increments of no more than 20 mg at weekly intervals, up to 40 mg PO once daily only for nonresponding patients.
For the treatment of premenstrual dysphoric disorder (PMDD) according to the criteria of the DSM-IV:
Oral dosage:
Adult females: 10-30 mg PO once daily throughout the menstrual cycle has been used. Alternatively, cyclic administration during the luteal phase (i.e., for the 14 days prior to menses) has been effective for some women.
Maximum Dosage Limits:
- Adults: 60 mg/day PO. However, doses above 40 mg/day PO are not ordinarily recommended.
- Elderly: 40 mg/day PO.
- Adolescents: Citalopram is not approved for use in pediatric patients. Data are very limited; a maximum dosage of 40 mg/day PO has been suggested.
- Children >= 9 years: Citalopram is not approved for use in pediatric patients. Data are very limited; a maximum dosage of 40 mg/day PO has been suggested.
- Children < 9 years: Safe and effective use has not been established.
Patients with hepatic impairment:
Citalopram 20 mg PO once daily is the recommended initial dose, with titration to 40 mg PO once daily only for nonresponding patients. NOTE: Child-Pugh classification is a poor predictor of the need for dosage adjustment based on data from clinical trials.
Patients with renal impairment:
CrCl >= 20 ml/min: No dosage adjustment is necessary (manufacturer).
CrCl < 20 ml/min: Specific guidelines for dosage adjustments are not available; the manufacturer recommends caution.
Intermittent hemodialysis:
Citalopram is unlikely to be significantly removed by hemodialysis given its large volume of distribution. The manufacturer recommends caution when administering citalopram to patients with CrCl < 20 ml/min.
[ Last revised: 7/2/2004 6:12:00 PM ]
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