Citalopram

Overview

Racemic SSRI. Very effective and highly tolerable, but strictly dose-capped worldwide due to a high, dose-dependent risk of fatal QTc prolongation.

Maximum Dose

Max 40 mg/day (Adults) • Max 20 mg/day (Elderly >65 yrs).

Clinical Focus

Do not exceed 20 mg in the elderly. Historically, doses of 60mg were used, but this is now heavily contraindicated due to sudden cardiac death.

Bottom Line

Citalopram is an SSRI for depression and anxiety disorders, but has a dose-dependent QTc prolongation risk with a maximum dose of 40 mg/day (20 mg in elderly).

Brand Names

Celapram, Cipramil

Oral Routes

Tablets (20 mg, 40 mg). Oral liquid.

Prescribing & PBS

Unrestricted General Benefit (S4).

Primary

Major Depressive Disorder, Panic Disorder.

Clinical Place

First-line SSRI option, though increasingly superseded by Escitalopram (which isolates the active S-enantiomer and has a slightly better safety profile).