Citalopram

Source: UK SPC (eMC) for Cipramil 20 mg film-coated tablets, §4.2 (https://www.medicines.org.uk/emc/product/992/smpc). MAJOR DEPRESSIVE EPISODES: 20 mg daily as a single oral dose; dependent on individual patient response the dose may be increased to a maximum of 40 mg daily. In general improvement starts after one week but may only become evident from the second week of therapy; dosage should be reviewed and adjusted if necessary within 3 to 4 weeks of initiation and thereafter as judged clinically appropriate. Although there may be an increased potential for undesirable effects at higher doses, if after some weeks on the recommended dose insufficient response is seen, some patients may benefit from an increase up to a maximum of 40 mg a day. Dosage adjustments should be made carefully on an individual patient basis, to maintain the patient at the lowest effective dose. Patients with depression should be treated for a sufficient period of at least 6 months to ensure they are free from symptoms. PANIC DISORDER: a single oral dose of 10 mg is recommended for the first week before increasing to 20 mg daily; dependent on response the dose may be increased to a maximum of 40 mg daily, gradually in 10 mg steps. A low initial starting dose is recommended to minimise the potential worsening of panic symptoms, which is generally recognised to occur early in treatment of this disorder. Patients with panic disorder should be treated for a sufficient period to ensure they are free from symptoms — this period may be several months or even longer. ELDERLY (>65 years): the dose should be decreased to half of the recommended dose, e.g. 10-20 mg daily, with a recommended maximum of 20 mg daily. HEPATIC IMPAIRMENT: an initial dose of 10 mg daily for the first two weeks is recommended in mild or moderate impairment, which may be increased to a maximum of 20 mg daily depending on response; caution and extra careful dose titration in severely reduced hepatic function. CYP2C19 POOR METABOLISERS: an initial dose of 10 mg daily during the first two weeks is recommended, which may be increased to a maximum of 20 mg daily depending on response. PAEDIATRIC: citalopram should NOT be used in the treatment of children and adolescents under the age of 18 years — hence paedDose is null. Verify any under-18 use against a children's formulary. WITHDRAWAL: abrupt discontinuation should be avoided; the dose should be gradually reduced over a period of at least one to two weeks to reduce the risk of withdrawal reactions; if intolerable symptoms occur, resuming the previously prescribed dose may be considered, then decreasing at a more gradual rate. Note: §4.5 was not retrieved in this bundle — the interactions listed below are taken from §4.3 of the UK SPC and from the US label; verify the full §4.5.