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Tips for tapering off Celexa (citalopram)


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18 replies to this topic

#1 Altostrata

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Posted 09 April 2012 - 11:07 AM

Aka Cipramil, Celeza, Citrol, Seropram, Talam, Citabax, Citaxin (Poland), Citalec (Slovakia), Recital (Israel), Zetalo (India), Celapram, Ciazil (Australia, New Zealand), Zentius (South America), Ciprapine (Ireland), Cilift (South Africa), Citox (Mexico), Citopam, Akarin (Denmark), Cipram (Turkey, Denmark), and Celius (Greece)

FDA Adds More Warnings to Antidepressant's Label

In a follow-up to a warning that high doses of the popular antidepressant Celexa can cause potentially fatal abnormal heart rhythms, the U.S. Food and Drug Administration has issued new dosing and use recommendations.

Last August, the FDA said doses of Celexa (citalopram hydrobromide) greater than 40 milligrams a day can cause changes in the electrical activity of the heart, which can lead to abnormal heart rhythms, including a potentially deadly arrhythmia known as Torsade de Pointes.

Patients at high risk include those with preexisting heart conditions (including congestive heart failure) and those prone to low levels of potassium and magnesium in the blood, the FDA said...

Here are the latest FDA recommendations:

Celexa should not be used at doses greater than 40 milligrams (mg)....


From official FDA information at http://www.drugs.com...am-tablets.html

Discontinuation of Treatment with Citalopram
Symptoms associated with discontinuation of citalopram and other SSRIs and SNRIs have been reported (see PRECAUTIONS). Patients should be monitored for these symptoms when discontinuing treatment. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose but at a more gradual rate.
....
PRECAUTIONS
....
Discontinuation of Treatment with Citalopram


During marketing of citalopram and other SSRIs and SNRIs (serotonin and norepinephrine reuptake inhibitors), there have been spontaneous reports of adverse events occurring upon discontinuation of these drugs, particularly when abrupt, including the following: dysphoric mood, irritability, agitation, dizziness, sensory disturbances (e.g., paresthesias such as electric shock sensations), anxiety, confusion, headache, lethargy, emotional lability, insomnia, and hypomania. While these events are generally self-limiting, there have been reports of serious discontinuation symptoms.

Patients should be monitored for these symptoms when discontinuing treatment with citalopram. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose but at a more gradual rate....


Citalopram comes in these dosages, from http://www.drugs.com...citalopram.html
- Tablets, oral 10 mg
- Tablets, oral 20 mg
- Tablets, oral 40 mg
- Solution, oral 2 mg/mL

Celexa has a half-life of about 35 hours. Liver enzymes CYP3A4 and CYP2C19 are involved in its metabolism.

Reduce by 10% per month to start
The 10% rule holds for Celexa, just like other psychiatric drugs: Reduce by 10% per month, calculated on the last dosage. (The amount of the reduction gets progressively smaller.)

See Why taper by 10% of my dosage?

Use Celexa liquid concentrate to taper
In the US, the liquid oral solution comes in 10 mg/5 mL (2 mg/mL), peppermint flavor. The bottle contains 240 mL. Pharmacy identifier is NDC 0456-4130-08

Use an oral syringe to precisely measure out doses as small as .01mg.

Tapering by cutting up tablets
The tablets are scored, which means they can be cut up.

Use a digital scale to accurately measure doses cut from tablets.

Making a Celexa solution yourself
See http://survivinganti...lution-yourself

Edited by Altostrata, 01 March 2013 - 11:45 AM.
updated information

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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#2 Nikki

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Posted 11 April 2012 - 01:46 PM

It comes in a liquid oral solution, with 10 mg/5 mL, peppermint flavor.

Alto I forgot about tapering a liquid in terms of measurement can you explain please.

Would I just fill the syringe up to the 40mg. mark and then drop out enough to have 39.50 in the syringe if I only want to drop 1/2 mg. at a time?

Thanks

Intro: http://survivinganti...ndown-with-ads/

 

Paxil 1997-2004

Crossed over to Lexapro Paxil not available

at Pharmacies GSK halted deliveries

Lexapro 40mgs

Lexapro taper (2years)

Imipramine

Imipramine and Celexa

Now Nefazadone/Imipramine 50mgs. each

45mgs. Serzone  50mgs. Imipramine


#3 Altostrata

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Posted 11 April 2012 - 04:36 PM

It comes in a liquid oral solution, with 10 mg/5 mL, peppermint flavor.

Be careful with the concentration. Here, the oral solution is concentrated 2:1, twice as strong. There are 2mg Celexa in 1mL of the liquid.

If you wanted to take 40mg Celexa, you would take 20mL of the liquid (20mL x 2mg = 40mg).

If you wanted to take 39.5mg Celexa, you would take 19.75mL of the liquid (19.75mL x 2mg = 39.5mg).

You can combine tablets and solution. For example, to take 39.5mg Celexa, you could take one 20mg tablet + 9.75mL liquid.
This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

#4 jr1985

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Posted 20 February 2013 - 05:31 AM

If you read my thread in friends and family you'll know my dads on citalopram. His doctor reluctantly prescribed more (because 10mg is apparently "nothing" - idiot), and said he'll keep giving them to him until October. I told him I'd help him do the 10% taper by making liquid citalopram. But I've no idea what dose he should take. He said he's been on 10mg every other day for while and feel fine. I know every other day dosing is a bad idea, so should he take 5mg every day, or 10mg?
2003-2005: Paroxetine
2006-2009: Citalopram
2009-2011: Effexor
Aug/Sept 11: Fast tapered Effexor to Mirtazapine
Oct: C/T Mirtazapine after bad reaction and back on Effexor
Nov/Dec: Fast Tapered Effexor - w/d hell
5/2/12: Reinstated Effexor 37.5mg
20/2/12: Updosed to 75mg
9/3/12: Dropped to 37.5mg
30/4/12: Dropped 10% to 33.8mg
1/5/12: Updosed to 37.5mg
4/5/12 Dropped 5% to 35.6mg
19/6/12: Dropped 2.5%
23/6/12: Updosed to 35.6mg
29/6/12: Updosed to 37.5mg
30/6/12: Dropped to 35.6mg

#5 Skyler

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Posted 20 February 2013 - 05:39 AM

My dad has been taking citalopram (Celexa) for about 3 years for "depression" (really grief after his dad died!). He tried to get off it using the "doctor recommended" skip a day approach, which resulted in him becoming extremely depressed - the worst he'd ever felt (he was at a funeral for someone who committed suicide and said he could understand why he did it). I managed to convince him to get back on and take it every day, but he revealed a few days ago that he'd been taking one every other day again. Now it turns out he's ran out and the doctors won't give him any more on repeat prescription until he sees the doctor in a week. In other words, they're cutting him off cold turkey for a week!

I've tried convincing him of the seriousness of it but he won't listen to me, he just tells me to leave him alone. It baffles me that he doesn't care - even after he saw what I went through with Effexor and his own experience. I'm not sure what to do tbh, I've considered printing off some horror stories from this website to try and make him see the reality of the situation...

Hi Jr.. I looked to see if you gave the history on your blog.. thought I'd seen one, but did not pull anything up.

As you know, every other day is a baddd idea. It's ranks next to ct in severity of outcome. That said, your dad may have a much easier time of it than you have. What was your dad on before he started to taper (10 mgs.?) He has not had any WD symptoms as yet?
Lyrica: 10/26 60 mgs; 10/12 63 mgs; 10/1 66 mgs; 9/21 69 mgs; 9/11 72 mgs; 8/31 75 mgs; 8/17 78 mgs; 8/3 84 mgs; 7/20 90 mgs; 7/6 96 mgs; 6/22 102 mgs; 6/8 108 mgs; 5/25 114 mgs; 5/11 120 mgs; 4/28 126 mgs; 4/18 132 mgs; 4/9 138 mgs; 3/30 144 mgs; 3/20 150 mgs; 3/7 159 mgs; 2/27 168 mgs; 2/18 177 mgs; 2/8 186 mgs; 1/25/14 192 mgs .(restart taper 1/25/14 207 mgs. (held for 18 mos at 207)) Highest dose 300 mgs.

Requip - holding: .15 mgs start hold 1/12/14 (start taper .25 mgs 4/12)
............................................................

I'm using a step wise wise taper approach. WD symptoms are tinnitus, which has been long standing, and muscle spasms in my legs and feet which are related to the most recent Lyrica taper.

History: After 25 years (including a 3 yr 4 mo. taper), I'm BENZO FREE! Tapered from 7/2010 thru 10/13. Off benzos for the first time in 25 years. Started 4.5 mgs K. cross tapered to 20 mgs. diazepam 10-12/10. On requip .25 mgs. and on and off Lyrica 150 to 300 mgs. for several years prior to tapering, start tapers 3/12.

"No matter how cynical you get, it's almost impossible to keep up." Lily Tomlin

#6 jr1985

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Posted 20 February 2013 - 06:28 AM

He was on 10mg every day before he started tapering. He's been taking 10mg every other day for the last few months.
2003-2005: Paroxetine
2006-2009: Citalopram
2009-2011: Effexor
Aug/Sept 11: Fast tapered Effexor to Mirtazapine
Oct: C/T Mirtazapine after bad reaction and back on Effexor
Nov/Dec: Fast Tapered Effexor - w/d hell
5/2/12: Reinstated Effexor 37.5mg
20/2/12: Updosed to 75mg
9/3/12: Dropped to 37.5mg
30/4/12: Dropped 10% to 33.8mg
1/5/12: Updosed to 37.5mg
4/5/12 Dropped 5% to 35.6mg
19/6/12: Dropped 2.5%
23/6/12: Updosed to 35.6mg
29/6/12: Updosed to 37.5mg
30/6/12: Dropped to 35.6mg

#7 strawberry17

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Posted 20 February 2013 - 09:22 AM

I'm not sure on the answer to that, I'm marking my space as I'm interested to know. When I used to do the alternate day thing (and failing dismally) I used to end up reinstating the full original dose, but I had no one in my life and no web site to consult.

*** Please note this is not medical advice,discuss any decisions about your medical care with a knowledgeable medical practitioner***





http://prozacwithdrawal.blogspot.com/

Original drug was sertraline/Zoloft, switched to Prozac in 2007.

Tapering from 5mls liquid prozac since Feb 2008, got down to 0.85ml 23/09/2012, reinstated back to 1ml(4mg) 07/11/2012, didn't appear to work, upped to 1.05ml 17/11/2012, back down to 1ml 12/12/2012 didn't work, up to 1.30ml 16/3/2013 didn't work, bumped up to 2ml (8mg) 4/4/2013 didn't work, reinstated Sertraline (Zoloft) 50mg, feeling better now. Been on the antidepressant merry go round since November 1998.


#8 Altostrata

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Posted 20 February 2013 - 10:30 AM

It would be 5mg per day for daily dosing. The every-other-day dosing is supposed to "average" the dose -- which it does, very inconsistently.
This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

#9 jr1985

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Posted 20 February 2013 - 10:49 AM

Thanks Alto, that means it shouldn't take him too long to get the whole way off (hopefully).
2003-2005: Paroxetine
2006-2009: Citalopram
2009-2011: Effexor
Aug/Sept 11: Fast tapered Effexor to Mirtazapine
Oct: C/T Mirtazapine after bad reaction and back on Effexor
Nov/Dec: Fast Tapered Effexor - w/d hell
5/2/12: Reinstated Effexor 37.5mg
20/2/12: Updosed to 75mg
9/3/12: Dropped to 37.5mg
30/4/12: Dropped 10% to 33.8mg
1/5/12: Updosed to 37.5mg
4/5/12 Dropped 5% to 35.6mg
19/6/12: Dropped 2.5%
23/6/12: Updosed to 35.6mg
29/6/12: Updosed to 37.5mg
30/6/12: Dropped to 35.6mg

#10 Francis

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Posted 07 April 2013 - 02:49 PM

Hi all- Does anyone know if I can simply dilute liquid celexa with water (a given amount of each) in order to be able to reduce my intake by smaller amounts? I am down to 0.6mg and it is difficult, with the syringe I have, to reduce in smaller increments than 0.1-.2mg. I tried to go to 0.4mg and I am feeling the bad impact. If I can dilute it with water, do I have to do the mix right when I take it or can I mix up enough for 2 weeks in advance? Thanks so much for any help

2003-2010 up and down 10-40mg celexa for anxiety
2/2011 10mg
8/2011 5mg for 3 wks, then stopped completely.
middle of night waking after apx 1-2 hours of sleep (nightly), panic/jitteriness after waking
11/11 back on 30mg celexa, ambien/many supplements-insomnia/panic.
2/12 30mg celexa, many supplements (Magnesium eliminated morning tight chest/jitteriness). Off ambien!
7/12 20mg
8/12 15 mg(sleep improving,mood pos)
12/12 2.3 mg got liquid celexa!
1/13 2.1 mg
3/13 1.2 mg
4/13 down to .6 too quickly- cortisol spikes, middle of night waking, night sweats...
4/13 held at .6 for 3 weeks so far. Off most supplements as well. Withdrawal depression almost gone!

7/13 OFF OF CELEXA!!!


#11 Altostrata

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Posted 08 April 2013 - 11:39 AM

Here is the product insert sheet (PDF) for liquid Celexa from the US National Institutes of Health:
http://dailymed.nlm....?archiveid=6278

Celexa oral solution contains citalopram HBr equivalent to 2 mg/mL citalopram base. It also
contains the following inactive ingredients: sorbitol, purified water, propylene glycol,
methylparaben, natural peppermint flavor, and propylparaben.

As it already contains water, this suggests it can be diluted.

You may wish to check with a pharmacist.
This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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#12 AmberV

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Posted 11 August 2013 - 02:04 AM

Hello

I have been on 20mg Celexa for 4 weeks.

The celexa is making me extremely tired, lazy and almost catatonic and I want to get off it as soon as possible.

 

As I have been on it only such a short period of time, what would a recommended tapering period look like please? Thankyou



#13 Altostrata

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Posted 11 August 2013 - 08:28 AM

You might want to try a fast taper, 5mg every 2 weeks. If you get withdrawal symptoms, reinstate and reduce slower and by smaller decrements.
This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

#14 Selig

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Posted 21 December 2013 - 07:40 PM

Thanks, great thread. I went down to 2.5mg of Celexa today. 


0.25 Clonazepam- down from 1.5mg

2.5 mg Citalopram as of 22/13/13- down from 20mg, 10mg, 5mg. 

5mg Citalopram and holding 27/12/13


#15 Altostrata

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Posted 22 December 2013 - 01:27 PM

That would be a 50% decrease? We recommend a 10% decrease based on the last dosage. If you were taking 5mg, the amount of decrease would be 0.5mg and the dosage 4.5mg.


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

#16 Rhi

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Posted 28 February 2014 - 06:22 PM

I'm down to about 1 mg out of a 10 mg tablet so I wanted to see how many doses I could get out of that and how long I could keep them safely. Found this article below. It sounds like citalopram is pretty stable in aqueous (water) solution ("d" stands for days).

Good news for me, I can probably pre-make and keep doses as long as I want, which means not having to deal with doctors and refills.

http://www.ncbi.nlm....pubmed/16050577

Started on Prozac and Xanax in 1992 for PTSD after an assault. One drug led to more, due to side effects and attempted withdrawal. Got sicker and sicker, but believed I needed the drugs for my "underlying disease" as I was told. Long and tragic story...lost everything.

Now tapering, healthier and more functional than I ever was during the years on the "meds" and getting gradually better all the time. On an extremely slow multidrug taper, as below.

 

Started multidrug taper in Feb 2010.  March 2010 added 2 mg Valium in (failed) attempt to cross over from Xanax.

 

Feb 15 2010:  300 mg Neurontin  200 Lamictal   10 Celexa      0.65 Xanax   and 5 mg Ambien 

Feb 14 2011:   86 mg Neurontin   144 Lamictal,    5.5 Celexa   0.42 Xanax      1.9 mg Valium

Feb 16 2012:   10 mg Neurontin   115 Lamictal     3.7 Celexa   0.285 Xanax     2.0 Valium

Feb 22 2013:   86 Lamictal    2.05 Celexa    0.23 Xanax     1.8 Valium

Feb 10 2014:   62 Lamictal    1.1 Celexa      0.135 Xanax   1.8 Valium

Now:                53                   0.912              0.115              1.6


#17 Skyler

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Posted 28 February 2014 - 06:37 PM

Hi Rhi.. speaking of the length of time one can keep a suspension... I've been meaning to let you know how much I appreciated your comments on my issue with Lyrica... I had no idea the drug was dissolved by the H2O (as opposed to being a suspension) and this might affect the length of time it could be kept in the fridge. Thanks so much for your input! You solved my mystery.. and I've stopped beating myself up for not realizing more quickly what the problem was.. Now I'm confident about keeping the solution for 3 days.. but no longer.
Lyrica: 10/26 60 mgs; 10/12 63 mgs; 10/1 66 mgs; 9/21 69 mgs; 9/11 72 mgs; 8/31 75 mgs; 8/17 78 mgs; 8/3 84 mgs; 7/20 90 mgs; 7/6 96 mgs; 6/22 102 mgs; 6/8 108 mgs; 5/25 114 mgs; 5/11 120 mgs; 4/28 126 mgs; 4/18 132 mgs; 4/9 138 mgs; 3/30 144 mgs; 3/20 150 mgs; 3/7 159 mgs; 2/27 168 mgs; 2/18 177 mgs; 2/8 186 mgs; 1/25/14 192 mgs .(restart taper 1/25/14 207 mgs. (held for 18 mos at 207)) Highest dose 300 mgs.

Requip - holding: .15 mgs start hold 1/12/14 (start taper .25 mgs 4/12)
............................................................

I'm using a step wise wise taper approach. WD symptoms are tinnitus, which has been long standing, and muscle spasms in my legs and feet which are related to the most recent Lyrica taper.

History: After 25 years (including a 3 yr 4 mo. taper), I'm BENZO FREE! Tapered from 7/2010 thru 10/13. Off benzos for the first time in 25 years. Started 4.5 mgs K. cross tapered to 20 mgs. diazepam 10-12/10. On requip .25 mgs. and on and off Lyrica 150 to 300 mgs. for several years prior to tapering, start tapers 3/12.

"No matter how cynical you get, it's almost impossible to keep up." Lily Tomlin

#18 Esther

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Posted 24 March 2014 - 08:20 PM

I'm from New Zealand and I'm on 20 mg of citalopram/celexa i don't know if I can get a liquid solution. I really want to start tapering I am a bit confused. Can someone explain how i can start? Doctors over here want me to come off too fast.

#19 Petu

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Posted 25 March 2014 - 12:46 AM

Hi Esther,

If you read through this topic, it will explain how to taper.  Your pharmacy will be able to tell you if liquid citalopram is available there, but if not, you can taper by cutting up the tablets.  You will need to weigh them to be accurate.  I think most people use an electronic digital scale.

 

Or you can make your own liquid from the tablets, instructions for doing that are here:

 

http://survivinganti...ts-or-capsules/


Edited by Altostrata, 25 March 2014 - 10:45 AM.
added "liquid"

I am not a doctor.  Please discuss treatment with a medical practitioner who has knowledge of medication withdrawal and tapering.  To find out if one is available in your area see here:  http://survivinganti...sts-or-clinics/

 

My Medication History:

1997 Zoloft 50mg
2002 changed to Serzone
2003 changed to Lexapro 10mg
2005 – 2008 4 unsuccessful attempts to quit
2007 - 2010 5mg Lexapro + Phentermine 40mg (major drug interaction)

2 years on codeine for nerve pain

PPI and steroid inhaler for various symptoms (side effects)
2009 Two months on BuSpar (for increasing anxiety)
August 2010 Tapered for 2 months and quit Lexapro
Nov 2010 dx with ADHD - Dexamphetamine
Feb 2011 – July 2011 Med free
August 2011, back on Dexamphetamine
Switched from Dex to Ritalin
2012 Xanax or propranolol as needed

Tried Buspar again

Took St Johns Wort for a week, crashed Nov 2011 (Interaction with Dexamphetamine)

Dec 2012 - Symptoms got worse,
Jan 2013 Tried Prozac (suicidal in 5 days)
Feb 2013 Tried Lexapro again 2.5mg – (suicidal in 3 days)
Feb 2013 Dexamphetamine for 2 weeks – increased temperature dysregulation and hot/cold flashes

May 2013 Found this site and started learning how the drugs were my problem

Supplements: VitC 1000mg, Black Cohosh,  Magnesium Citrate, Probiotics Taurine

Symptoms of a destabilized nervous system continue

August 2014 Starting to notice some unmistakable improvements.
event.png

 

My Introduction Thread