Junglechicken

Switching from Escitalopram to Citalopram

22 posts in this topic

What are people's experiences of doing this?

 

I was anticipating not too many repercussions given how chemically similar they are.

 

My plan would be to switch from 2.5 mg Escitalopram to 5mg Citalopram.

 

Is it wise to do it this way, or should I do it differently?

 

Thanks guys,

JC

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Once my CNS had settled, then I would do my taper as before using Brass's slide technique.

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Would appreciate one of the Mod's wisdom as to how I could best X-taper safely from escitalopram to Citalopram.

 

I have the spreadsheets with which to do my dose reduction calcs.

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Why do you want to switch?  I'm not a mod but I don't follow your rationale.  Why not just do the taper with escitalopram?  What do you think the benefit of the cross taper will be?  Maybe I missed something?

 

mmt

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Hi MMT,

 

Thanks for your message.

 

Citalopram has half the strength than that of Escitalopram by 2:1.

 

My rationale for switching has been the issues I've been having with trying to get to the lower doses on escitalopram.  The liquid Lexapro concentration was too high for me to be able to taper properly (1ml / 20 mg).  I have major doubts that by diluting the solid form of Lexapro, I still wont get the accuracy I need.

 

By switching to Citalopram (which is chemically similar), I should be able to get from the equivalent of 2.5mg to 0mg more easily.

 

JC x

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Hmmmm.......possibly.  Back in the day, when I believed my AD was actually helping........I was switched to Celexa/citalopram.........due to it's being cheaper and insurance protocols/coverage.  It had a different effect completely on me.  So with my Dr.'s agreement to do the necessary paperwork to submit to insurance I got switched back to Lexapro/escitalopram.  This was also before it went generic as well.

 

Anyway........in my experience they were not the same.......in effect........on what I now know was my own fragile and medication changed neuro system.  Sure, they might be somewhat chemically similar but my guess is that you might put your nervous system through some additional stress.

 

I still have the 1ml.(cc) syringe that came with my liquid Lexapro/escitalopram and it's marked pretty good as far as doing reductions goes.........just thinking you could work on getting some decent syringes.  I also have one that came from the vet which is clearly marked in the 1.00 ml., then .9 ml and on down with gradients in between.  Either that or do your own added further liquid to what you can obtain from the pharmacy as far as the liquid Lexapro/escitalopram?  Or.........dissolve the tablets yourself in more liquid?  Why are you having major doubts about that?

 

I don't know but from my experience with the 2 drugs............I think it's possible you might get into trouble switching the excitalopram to citalopram.  Why risk it?

 

Just my 2 cents in the matter and from my experience.  Good luck in whatever you decide.

 

Best,

 

mmt

 

Oh......I think that the fact that you are maintaining on just 2.5mg. of escitalopram is great!  When I got to 3mg. of escitalopram all Hello broke loose and I checked into the hospital(it's in my signature).  I just couldn't function at all and my brain had gone haywire.  Just saying that as maybe it's not going to be so bad for you.  signed: Lexapro/escitalopram foe!!!!

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Hmmmm :unsure: 

 

ok mmt, I have to do some serious mulling........thank you very much for your input on this.

 

As it is, I'm sure the pills I have cut in half are never exactly the right dose anyway and are likely out by 1mg.

 

Its daunting contemplating continuation with the taper down to the lowest doses that's all and I'm trying to mitigate further WD symptom risk.....I now have a pack of Citalopram and a bottle of Lexapro in my medicine cabinet.

 

Best,

JC

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Hi MMT,

 

Thanks for your message.

 

Citalopram has half the strength than that of Escitalopram by 2:1.

 

My rationale for switching has been the issues I've been having with trying to get to the lower doses on escitalopram.  The liquid Lexapro concentration was too high for me to be able to taper properly (1ml / 20 mg).  I have major doubts that by diluting the solid form of Lexapro, I still wont get the accuracy I need.

 

By switching to Citalopram (which is chemically similar), I should be able to get from the equivalent of 2.5mg to 0mg more easily.

 

JC x

 

 

I understand thinking that switching might make things easier but first, have you ever taken citalopram/celexa before?

 

I was on citalopram before being switched to the lexapro (Cipralex/Escitalopram) and there is a BIG difference in the side effects from these two different drugs (I mean, I was prescribed celexa/citalopram for depression but when lexapro hit the market, i was switched to that because it was supposed to be "better" with fewer side effects)

 

 

one reason I was so happy (at first!) with the lexapro/Cipralex/Escitalopram was that there were almost NO side effects compared to the citalapram.

 

Citalapram caused me constant jaw pain, nausea and a bunch of other side effects I dont' recall now.

 

lexapro caused some yawning and some mild jaw pain at first but that went away.

 

While you might be getting a lower strength, it could come along with all those added side effects, and at least initially, you might not be able to tell the side effects apart from the WD symtoms

:(

 

I totally understand your thinking but I dont know if it would work out as well in reality as it does in theory

 

sorry to be the bearer of bad news.

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Here is the full info about the two

 

http://psychopharmacologyinstitute.com/antidepressants/ssris/citalopram-escitalopram-differences-similarities/

 

the main difference

lex is twice potent as citalopram )

Citalopram also inhibits another receptor--histamine, while Lexapro only inhibits SERT.

Other stuff listed in the link such as QTc prolongation is not really accurate as Lexapro is just as bad as citalopram in affecting QTc prolongation.

 

So the main thing I would be concerned about is something new that is histamine related.

 

Otherwise, I read ppl say citalopram is indeed much easier to taper than lex.

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In your situation, Junglechicken, diluting escilatopram liquid probably would be preferable to switching to citalopram.

 

Milligram for milligram, escilatopram is stronger than citalopram, but the 2:1 proportion is only approximate. You might have to make many adjustments to find the equivalent dosage to your current escilatopram dosage.

 

I would substitute citalopram only as a last resort, or when reinstating after a period off escilatopram, where the dosage equivalence would not be as important.

 

Diluting the escilatopram liquid with water is a legitimate technique. One of the ingredients in the bottled liquid is water. If you are nervous about this, either get the pharmacy liquid (if available in your country) for the dilution, or purified water from the pharmacist.

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Citalopram also inhibits another receptor--histamine, while Lexapro only inhibits SERT.

 

 

excuse my ignorance, I keep seeing this but realized I don't know what it means, what is SERT?

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 Serotonin would be my guess. 

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Yes, it stands for serotonin transporter

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Yes, it stands for serotonin transporter

thanks!!

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Im on a ultra low dose of escitalopram. It is possible to taper If you dilute in water. Switching could be a very risky move. If you dont succeed, your symptoms might worsen and your CNS desentisized. At this point, i would take no chances.

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Thank you all for your comments, they are much appreciated.

 

I will do some further mulling and probably come back with questions.

 

Best,

JC x

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What if I was do the shaving off technique with high precision scales and a razor blade?  My plan is to do 10% cuts every 4-6 weeks, however (like many members) I am dealing with TINY amounts of pill.

 

I'm VERY nervous about diluting the 1ml / 20mg liquid Lexapro because the dose drops are so small, and my start point is already very small.  Because of this, I have VERY little faith in my ability to do an accurate titration, and don't want to go down the chemistry lab route.

 

Potentially I could dissolve the pill in purified water and then syringe up the correct dose - this could work out ok.

 

Thanks,

JC

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So you don't want to be a mad scientist? ;)

 

None of us here at SA expected to be in the situation we are in.  I've actually got it fairly easy compared to a lot of other members.  Very thankful that my compounding chemist is fairly close by, is a reasonable price and can do them in a day.  The "fun" I have is using an excel spreadsheet to calculate how what capsules I need to make up my doses, how many of each capsule dose I need and how many tablets I need to provide to be compounded.

 

Good luck with the method you decide to use.

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Chessie,

 

I'd love to be a mad scientist, just not in this subject area, lol :D 

 

The spreadsheet is done with my dose drops, its just a question of "how/which/what/when" I guess.

 

Am trying to reach a decision on how I can safely get from 2.5mg to 0mg and its taking a while to make that decision because I need all the facts I can get.

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Well you are in the right place!

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Not too mad then, lol!

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Junglechicken, if you dilute the escilatopram liquid, you would be drawing a LARGER amount into your syringe, and you would be able to measure the tiny decreases more accurately.

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