How should I taper off Celexa (citalopram)?

Hyperbolic reductions of ~10% per step recommended at lower doses. Oral solution (10 mg/5 mL) supports precise sub-tablet titration. QT prolongation is dose-dependent — monitor in patients with cardiac risk factors during reductions. Apply proportional reductions (~10% per step) using oral solution (10 mg/5 mL) for precision below 10 mg. Maximum dose ceiling (40 mg, or 20 mg in patients >60) should be respected throughout the taper.

Celexa Tapering Guide

Q: What are the withdrawal symptoms of Celexa (citalopram)?

Common withdrawal symptoms of Celexa (citalopram) include: brain zaps, dizziness, nausea, irritability, insomnia. Symptom severity varies by individual, dose, and duration of use.

citalopram

SSRIFDA 1998

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Boxed Warning

Suicidality risk in children, adolescents, and young adults under 25 during initial treatment.

Overview

Citalopram is a racemic SSRI approved for major depressive disorder. It is the racemic form of escitalopram and one of the most selective SSRIs for the serotonin transporter. The FDA limits maximum dose to 40mg due to dose-dependent QT prolongation.

Common Doses

10mg, 20mg, 40mg

Formulations

Tablets: 10mg, 20mg, 40mg; Oral solution: 10mg/5mL

Pregnancy

Category C (risk cannot be ruled out)

Mechanism of Action

Selective serotonin reuptake inhibitor (SSRI) that blocks the serotonin transporter (SERT) with high selectivity. The S-enantiomer is responsible for most of the therapeutic activity.

Taper Notes

Hyperbolic reductions of ~10% per step recommended at lower doses. Oral solution (10 mg/5 mL) supports precise sub-tablet titration. QT prolongation is dose-dependent — monitor in patients with cardiac risk factors during reductions.

Maudsley Deprescribing Guidance

Apply proportional reductions (~10% per step) using oral solution (10 mg/5 mL) for precision below 10 mg. Maximum dose ceiling (40 mg, or 20 mg in patients >60) should be respected throughout the taper.

Common Withdrawal Symptoms

brain zapsdizzinessnauseairritabilityinsomnia

Interactions & Safety

Drug Interactions

MAOIs — contraindicated (serotonin syndrome risk)
Pimozide — contraindicated (QT prolongation)
QT-prolonging drugs should be used cautiously

Food Interactions

No significant food effect on absorption
Avoid alcohol during treatment

Contraindications

MAOIs within 14 days
Pimozide
Congenital long QT syndrome

Toxicity

Dose-dependent QT prolongation (maximum recommended dose 40mg/day, 20mg/day in patients >60 years). Serotonin syndrome with serotonergic combinations.

Pharmacokinetics

ADME Profile

Absorption

Rapidly and well absorbed after oral administration. Bioavailability ~80%. Tmax ~4 hours. Food does not significantly affect absorption.

Distribution

~12 L/kg

Metabolism

Hepatic via CYP3A4 and CYP2C19 (primary) to demethylcitalopram (DCT) and didemethylcitalopram (DDCT), both with weak pharmacological activity.

Elimination

Renal (~10% unchanged) and hepatic metabolism. Fecal excretion minor.

Protein Binding

~80%

Clearance

~330 mL/min (oral clearance)

Build Celexa taper plans in minutes

TaperMeds turns these protocols into prescriber-ready taper schedules with hyperbolic dose curves, symptom tracking, and patient handouts — for the clinicians supervising the taper.