Escitalopram (Lexapro) versus Citalopram (Celexa)
by eMedExpert staff
Medical references reviewed: August, 2018
Escitalopram advantages over Citalopram:
- Escitalopram generally causes side effects less frequently than does citalopram, particularly sedation and fatigue.
- Escitalopram may be more effective for severe depression.
- Escitalopram is not associated with risk of ventricular arrhythmia1.
Citalopram advantages over Escitalopram:
- The only principal advantage of citalopram is its cost. It is less expensive than escitalopram.
- Effectiveness of both antidepressants is generally equal except for rare certain situations.
Table 1. Difference between Escitalopram and Citalopram chart
Selective Serotonin Reuptake Inhibitor
|Stereochemistry||S-enantiomer of racemic citalopram. S-enantiomer is considered the active component of the racemate.||Racemic mixture of R- and S-enantiomers.|
|Common FDA approved indications||• Major depressive disorder in adults and adolescents 12-17 years of age||• Major depressive disorder
• Citalopram is not approved for patients younger than 18 years
|Other FDA-approved indications||• Generalized anxiety disorder||• Citalopram is prescribed for anxiety disorders "off-label".|
|Mechanism of action||SSRIs enhance serotonergic activity in the central nervous system via blockade of serotonin (5-HT) reuptake.|
|• Escitalopram also works as allosteric modulator of the serotonin transporter14.||• Citalopram has mild affinity for H1 histamine receptors.|
|Starting dose||10 mg||20 mg|
|Maximum dose||20 mg||40 mg|
|Half-life||27-32 hours||36 hours|
|Metabolism||• Escitalopram is metabolized to S-demethylcitalopram and S-didemethylcitalopram by the cytochrome P450 isoenzymes CYP2C19, CYP2D6 and CYP3A4.||• Citalopram is metabolized by the cytochrome P450 isoenzymes CYP2C19, CYP2D6 and CYP3A4 to its major metabolite, demethylcitalopram, and other metabolites.|
|Contraindications/ warnings||• Concomitant use with MAOIs
• Concomitant use with Pimozide
• Hypersensitivity to escitalopram or citalopram
|Side effects||Most common undesirable effects are nausea, diarrhea, insomnia, somnolence, ejaculation disorder, impotence, fatigue, dry mouth, and dizziness.|
|• Citalopram has mild antihistamine properties and may produce more sedation, fatigue, and sleepiness.
• Citalopram has been associated with a small increase in the risk of ventricular arrhythmia in older patients 1.
|Safety in overdose||• Escitalopram is less dangerous than citalopram after an acute overdose 4. Escitalopram causes fewer seizures and tremors in overdose than citalopram 3|
|Withdrawal symptoms||The incidence of adverse events and withdrawals does not differ significantly between escitalopram and citalopram 2|
|Drug interactions||Low risk|
|Cost||In most countries escitalopram is more expensive than citalopram|
Escitalopram vs Citalopram for depression
In several clinical studies escitalopram was significantly more effective than citalopram, including higher rates of response and remission6, 9. Escitalopram is more effective than citalopram in the treatment of severe depression 8.
Escitalopram may offer better treatment compliance, fewer hospitalizations, and lower total cost of healthcare in the treatment of major depression in geriatric patients 5.
Animal research shows that citalopram injected intraperitoneally is a weak antinociceptor, while escitalopram has no antinociceptive properties 11.
|Results of prospective, randomized, double-blind, active-controlled study of escitalopram versus citalopram in major depressive disorder 6.||Escitalopram||Citalopram|
|Regimen||10 mg daily for 6 weeks||20 mg daily for 6 weeks|
|Mean change from baseline in MADRS total score at the end of study||
|Mean change from baseline in MADRS total score in the severely depressed subgroup||
|Changes in the Clinical Global Impression-Severity and Improvement scores||
|Adverse effects, most frequently reported:|
|Results of randomized, double-blind study of escitalopram versus citalopram in major depressive disorder 9.||Escitalopram||Citalopram|
|Regimen||20 mg daily over 8 weeks||40 mg daily over 8 weeks|
|Premature withdrawal, number of patients||
6 of 138 patients
15 of 142 patients
|Change in the MADRS total score from baseline to last assessment||
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Published: January 02, 2017
Last updated: December 23, 2017