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Tips for tapering off Celexa (citalopram)


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#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, CYP2C9, CYP2C19, and CYP2D6 are involved in its metabolism per http://www.drugbank.ca/drugs/DB00215

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.

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

 

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.

 

Using a combination of tablets and liquid

Rather than switch directly to an all-liquid dose, you may wish to take part of your dose in liquid and part in tablets, gradually converting to all-liquid as you get to lower dosages. This can be very convenient and reduce any problems switching from one form of the drug to another.


Edited by Altostrata, 23 June 2015 - 04:04 PM.
updated information

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

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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

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#4 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!!!


#5 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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#6 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



#7 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

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#8 Rhiannon

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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, the usual story. Got sicker and sicker, but believed I needed the drugs for my "underlying disease" as I was told. Long and tragic story...lost everything. Life savings, home, physical and mental health, relationships, friendships, ability to work, everything.

 

Now tapering, ironically (but not surprisingly) healthier and more functional than I ever was during the years on the "meds," even with withdrawal (usually fairly mild at this slow pace).

 

Started multidrug taper in Feb 2010.  Doing a very slow microtaper, down to low doses now and feeling SO much better, getting my old personality and my brain back! Able to work full time, have a full social life, and cope with stress better than ever. Not perfect, but much better. After 23 lost years. Big Pharma has a lot to answer for. And "medicine for profit" is just not a great idea.

 

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

Feb 10 2015:   50 Lamictal    0.875 Celexa    0.11 Xanax      1.5 Valium

Now:                49.5                  0.725                  0.09                    1.43

 

I'm not a doctor. Any advice I give is just my civilian opinion.


#9 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.

Once held for NINE months to good effect!


 

Requip - current: 1/31/16 .015 mgs.  On 9/1/215 restarted requip taper at .15 mgs (was originally .25 mgs). It's going faster than diazepam or lyrica so I'm assuming it has a lighter psychotropic 'footprint'. The two withdrawal symptoms I'm having are insomnia and tinnitus.. the tinnitus being the more troublesome. Still.. almost there after 5+ years; what a long ride this has been.

 

Lyrica: 8/16/15 ZERO after a two year taper. Highest dose was 300 mgs. No adverse symptoms to report on discontinuation.

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. Read my intro thread here, and check the about me section.

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


#10 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.

#11 Petunia

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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'm not a doctor.  My comments are not medical advise. These are my opinions based on my own experience and what I've learned. Please discuss your situation with a medical practitioner who has knowledge of tapering and withdrawal.

 

My Introduction Thread

 

Full Drug and Withdrawal History

 

Brief Summary

Several SSRIs for 13 years starting 1997 (for mild to moderate partly situational anxiety)

Xanax PRN

Various other drugs over the years for side effects

2 month 'taper' off Lexapro 2010

Short acute withdrawal, followed by 2 -3 months of improvement then delayed protracted withdrawal

DX ADHD followed by several years of stimulants and other drugs trying to manage increasing symptoms

Failed reinstatement of Lexapro and trial of Prozac (became suicidal)

May 2013 Found SA, learned about withdrawal, stopped taking drugs...healing begins.

In protracted withdrawal, with a very sensitized nervous system, slowly recovering animal25.gif

 

Supplements which are helping me:  Vitamin C, Magnesium, Taurine, Vit D3, L-Theanine and Inositol. I'm one of the rare people who react badly to fish oil.

 

VIDEO: Where did the chemical imbalance theory come from?



VIDEO: How are psychiatric diagnoses made?



VIDEO: Why do psychiatric drugs have withdrawal syndromes?



VIDEO: Can psychiatric drugs cause long-lasting negative effects?

VIDEO: Dr. Claire Weekes

 

 

 


#12 LEFin

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Posted 07 August 2015 - 01:12 PM

I wish I was there to assist people struggling with weaning off antidepressants before, but had a lot to figure out myself! I have been on several antidepressants throughout my life (seroquel,paxil,trazadone,apo-methoprazine,zoloft and finally on celexa) It's been a long road, but I want to share how I recently weaned off celexa. It was the best transition off antidepressants thus far. My naturopath assisted me greatly with giving me a solid plan to follow to avoid all the awful side effects. My biggest piece of advice is: As much as you want to be off the horrible stuff..DON'T RUSH IT. It will lead unfortuanitly to a relapse. It makes things much more difficult in the long run.

 

My naturopath suggested in order for my body/mind to properly adjust follow this schedule:

Reduce daily intake by 5mg (eg. first 2 weeks drop to 15mg...then if feeling alright after minimum two weeks, you can drop another 5mg to 10mg dosages/day,etc.)

Continue this process till off celexa ( It took me 3 months to get off celexa)

Most importantly you need to have something effective to replace your serotonin levels, etc. changing through this process.

I was taking a product called Neuropass by a brand called Pascoe ( available at a lot of health food stores/or online) fairly expensive (approx. $60/100 tabs) but worth it!!

Also a supplement called Gaba (tablet) or Glycine (powder to mix with water)

Ashwaganda root is also a great supplement to assist with calming/mood swings

 

Just to give a quick reference :

started at 20mg/day....reduced to 15mg/day - take 1 tablet of neuropass morning and night - 1 tablet gaba, ashwaganda root and vit.D in the morning with food

15mg/day..-10mg/day - take 1 tablet neuropass 3 times per day (morning, lunch, dinner) - 1 tablet gaba, ashwaganda root and vit. D in the morning with food

10mg/day...-5mg/day - take 2 tablets neuropass twice daily ( morning/night) - 1 tablet gaba, ashwaganda root and vit. D in the morning with food

5mg..-discontinued use of celexa - take 2 tablets 3 times per day (morning, lunch, dinner) - 1 tablet gaba, ashwaganda root and vit D in the morning with food.

 

I know this is long, but I sincerely hope it has helped someone struggling and trying to feel hopeful to get off celexa!

Be patient. :)

 

Laura



#13 Altostrata

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Posted 07 August 2015 - 07:11 PM

Good to hear you tapered gradually, LEFin. You got good advice there.

 

I don't know what the expensive supplement Neuropass might have done to help. It does not support serotonin -- it contains some herbs that are supposed to be calming.

 

"Replacing serotonin levels" wouldn't help anyway; contrary to what many doctors believe, withdrawal symptoms are not due to a lack of serotonin but a lack of the specific drug. See What is withdrawal syndrome?

 

Psychiatric drugs establish an artificial balance among all the hormones of the body. When they are reduced, the balance is thrown off and the autonomic nervous system in particular throws off alarm signals we sense as withdrawal symptoms.

 

Most likely, your rate of taper was appropriate for you and it was coincidental that you were taking Neuropass and the other supplements. I hope you will be cautious about taking any other psychiatric drugs. Thank you for stopping by and sharing your information.

 

Please start a topic for yourself in the Introductions forum, which is also a collection of case histories, and post there now and then and let us know how you are doing.


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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#14 Gibby

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Posted 30 September 2015 - 10:42 AM

I'm pretty glad that citalopram comes in a liquid form! Trying to measure out those little jumps would be maddening without it. 

 

Is the liquid form more expensive than the regular tablets?


-Started on Citalopram 20mg & Zopiclone 7.5mg in August 2010

-Given olanzapine 2.5mg due to not sleeping through the night with zopiclone

-Went up to 40mg Citalopram sometime in 2011 after disastrous flirtation with Wellbutrin

-Went down to 1.25mg olanzapine sometime in 2011 as well

-Tapered off zopiclone by January 2013 (take as PRN sometimes)

-Went up to 5mg olanzapine for one day due to a weird crash in June 2013, could not taper down past 1.8mg subsequent to that

-Attempted CT of olanzapine in June 2015

-Latest CT of olanzapine Aug 31st-September 4th 2015, went back on, re-evaluating everything

-Late Nov 2015: Dropped from 5ml liquid citalopram to 4.875ml. A window and currently a wave

 

 

 


#15 Altostrata

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Posted 30 September 2015 - 11:01 AM

The cost of the liquid form depends on your insurance coverage and availability in your area. Generally, if you have to pay out of pocket, it is more expensive, but if you are tapering and taking small doses, it will last a long time.


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.