1. Citalopram and Escitalopram

2. Overview Citalopram and escitalopram have no significant DDI
Citalopram is linked to QTc prolongation (doses higher than 40 mg/day)
Escitalopram equivalent dose is half that of citalopram

3. Pharmacology and MOA

4. Escitalopram (2002) Citalopram (1998) One enantiomer: S-citalopram
Racemate, two enantiomers:
R-citalopram
S-citalopram
Escitalopram (2002)
One enantiomer:
S-citalopram

5. Citalopram: R and S enantiomers
R-(–)-citalopram
S-(+)-citalopram

6. Escitalopram: only the S enantiomer

7. Pharmacodynamics Citalopram Escitalopram
For more: Sánchez, C. (2006). The Pharmacology of Citalopram Enantiomers: The Antagonism by R‐Citalopram on the Effect of S‐Citalopram*. Basic & clinical pharmacology & toxicology, 99(2),

8. Clinical Uses

9. FDA-Approved Indications
Citalopram
Escitalopram
Depression X
Generalized anxiety disorder x
Celexa (Citalopram) [Prescribing Information] St. Louis, MO: Forest Pharmaceuticals, Inc. Accessed May 2014
Lexapro(Escitalopram) [Prescribing Information] St. Louis, MO: Forest Pharmaceuticals, Inc. Accessed May 2014

10. Off-label uses OCD Panic disorder PTSD Social anxiety disorder
Premenstrual dysphoric disorder

11. Pharmacokinetics

12. Pharmacokinetics: Citalopram and Escitalopram
Half-life
27-32 hours
CYP2D6
Citalopram: mild effect
Escitalopram: no significant effect
Low potential for drug-drug interactions for both

13. Adverse Effects

14. General side effects Most common side effects: Pregnancy category C
Nausea and vomiting
Increased sweating
Dry mouth
Headache
Pregnancy category C
Schatzberg, Alan F., and Charles B. Nemeroff, eds. The American psychiatric publishing textbook of psychopharmacology. American Psychiatric Pub, 2009.

15. Citalopram and QT prolongation: FDA recommendations
Dosing
General population: not recommended for use at doses greater than 40 mg/day
In patients older than 60 years: not recommended at doses greater than 20 mg/day
FDA safety information Citalopram – Accessed online:

16. Citalopram and QT prolongation: FDA recommendations
Not recommended for patients with:
Congenital long QT syndrome
Bradycardia
Hypokalemia or hypomagnesemia
Recent MI
Uncompensated heart failure
FDA safety information Citalopram – Accessed online:

17. FDA and escitalopram: no change in dosing*
QTc-prolonging effect at equivalent doses: half of citalopram
FDA did not issue change in dosing recommendations
Citalopram
Escitalopram
Dose
Change in QTc  (90% Confidence Interval) (ms)
20 mg 40 mg* 60 mg Moxifloxacin 400 mg
8.5 (6.2, 10.8) 12.6 (10.9, 14.3) 18.5 (16.0, 21.0) 13.4 (10.9, 15.9)
10 mg 20 mg* 30 mg Moxifloxacin 400 mg
4.5 (2.5, 6.4) 6.6 (5.3, 7.9) 10.7 (8.7, 12.7) 9.0 (7.3, 10.8)
FDA safety information Citalopram – Accessed online:

18. Prescribing information

19. Dosage range Citalopram Escitalopram Depression 20-40 mg/day
Elderly population:
Citalopram: mg
Escitalopram: 5-10 mg/day
Celexa (Citalopram) [Prescribing Information] St. Louis, MO: Forest Pharmaceuticals, Inc. Accessed May 2014
Lexapro(Escitalopram) [Prescribing Information] St. Louis, MO: Forest Pharmaceuticals, Inc. Accessed May 2014

20. Dosage forms Citalopram strength Escitalopram strength Tablets
10 mg, 20 mg scored, 40 mg scored
5 mg, 10 mg, 20 mg
Capsules
10 mg, 20 mg, 40 mg
Orally disintegrating tablet
N/A
Oral solution
5 mg/ 5ml