Differences between citalopram and escitalopram

Citalopram and escitalopram are both useful SSRIs (Selective Serotonin Reuptake Inhibitors) for the treatment of adult depression. Escitalopram is the s-enantiomer, and active part of citalopram, which is a mix of s- and r-enantiomers. There is increasing evidence to suggest that escitalopram is more clinically effective than citalopram.

The optimal dose for the treatment of moderate depression is: citalopram 20mg daily or escitalopram 10mg daily. It is important that prescribers are aware that there is a dose difference, because confusion between these medicines could lead to escitalopram overdosing.

A small proportion of patients may eventually require the maximum dose of citalopram 40mg or escitalopram 20 mg. There is no clinical benefit of using higher doses than this, but a greater risk of adverse effects including QT prolongation.

Citalopram is associated with a dose-dependent increase in QT interval prolongation, which could potentially lead to Torsade de Pointes. For this reason, the recommended maximum dose is 40mg per day. Citalopram is contraindicated if patients have congenital long QT syndrome, or if they are taking other medicines that prolong the QT interval.

There is also a risk of dose-dependent QT prolongation with escitalopram; the maximum daily dose of escitalopram must therefore not exceed 20mg per day.

Reference: saferx.co.nz

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