Indications and Dose:

Depressive Illness:

• • Tablets:

• • • Adult: 20 mg once daily, can increase in 20 mg steps at 3-4 week intervals; maximum 40 mg per day.
    • Elderly: 10-20 mg once daily; maximum 20 mg per day.

• • Oral Drops:

• • • Adult: 16 mg once daily, can increase in 16 mg steps at 3-4 week intervals; maximum 32 mg per day.
    • Elderly: 8-16 mg daily; maximum 16 mg per day.

Panic Disorder:

• • Tablets:

• • • Adult: Start with 10 mg daily, can increase in 10 mg steps; usual dose 20-30 mg daily; maximum 40 mg per day.
    • Elderly: Start with 10 mg daily; maximum 20 mg per day.

• • Oral Drops:

• • • Adult: Start with 8 mg once daily, can increase in 8 mg steps; usual dose 16-24 mg daily; maximum 32 mg per day.
    • Elderly: Start with 8 mg once daily; maximum 16 mg per day.

Dose Equivalence and Conversion:

• 4 oral drops (8 mg) is equivalent in therapeutic effect to a 10 mg tablet.

Contraindications:

• QT-interval prolongation.

Cautions:

• Susceptibility to QT-interval prolongation.

Side Effects:

• Common or very common: Acute angle closure glaucoma, apathy, flatulence, hypersalivation, migraine, rhinitis.
• Uncommon: Edema.
• Rare or very rare: Cough, generalized tonic-clonic seizure.
• Frequency not known: Hypokalemia.

Breastfeeding:

• Present in milk; use with caution.

Hepatic Impairment:

• Tablets: Initial dose of 10 mg daily for the first two weeks in mild to moderate impairment—may increase to max. 20 mg daily.
• Oral Drops: Initial dose of 8 mg daily for the first two weeks in mild to moderate impairment—may increase to max. 16 mg daily.

Renal Impairment:

• Use with caution; no information available for creatinine clearance less than 20 mL/minute.

Treatment Cessation:

• The dose should be reduced gradually over about 4 weeks, or longer if withdrawal symptoms emerge.

Directions for Administration:

• Cipramil oral drops should be mixed with water, orange juice, or apple juice before taking.

Medicinal Forms:

• Oral drops may contain alcohol.
• Tablets available in various dosages and packaging options.

Oral Drops:

• Citalopram, available as Citalopram hydrochloride, comes in a concentration of 40 mg per 1 ml. The oral drops are sugar-free.
• Cipramil, also formulated as Citalopram hydrochloride, is available in the same concentration and sugar-free formulation.

Tablets:

• Non-proprietary Citalopram is available in three strengths:

• • 10 mg
  • 20 mg
  • 40 mg

• Cipramil tablets are available in 20 mg strength.