Citalopram

PANIC DISORDER (adults): a single oral dose of 10 mg is recommended for the first week before increasing to 20 mg daily; the dose may be increased in 10 mg steps according to response to a maximum of 40 mg daily, although an optimum dose of 20-30 mg daily was indicated in a clinical study. A low starting dose reduces the likelihood of a paradoxical initial anxiogenic effect. DEPRESSION: improvement generally starts after one week but may only become evident from the second week; dosage should be reviewed and adjusted within 3 to 4 weeks of initiation and thereafter as clinically appropriate; patients should be treated for at least 6 months to ensure they are free from symptoms. Maintain the patient at the lowest effective dose. HEPATIC IMPAIRMENT: an initial dose of 10 mg daily for the first two weeks is recommended in mild or moderate hepatic impairment, increasing if needed to a maximum of 20 mg daily; caution and extra careful titration in severely reduced hepatic function. CYP2C19 POOR METABOLISERS: initial dose 10 mg daily for the first two weeks, increasing if needed to a maximum of 20 mg daily. DISCONTINUATION: avoid abrupt discontinuation - reduce the dose gradually over at least one to two weeks; if intolerable symptoms occur, consider resuming the previous dose and then decreasing more gradually. CHILDREN AND ADOLESCENTS UNDER 18 YEARS: citalopram should not be used - no paediatric dose is stated. CAUTION is advised in the treatment of elderly patients and patients with reduced kidney and liver function (section 4.4). US label cross-check (may differ from UK): maximum recommended dosage is 20 mg once daily for patients over 60 years of age, patients with hepatic impairment, CYP2C19 poor metabolisers, and when used concomitantly with a CYP2C19 inhibitor.