How should citalopram and escitalopram be dosed in older adults?

In older adults, citalopram and escitalopram should generally be dosed at a reduced amount, often around half the typical starting dose used for younger populations. This reduction is due to several factors, including changes in pharmacokinetics, such as decreased liver and renal function, which can lead to prolonged drug half-lives and increased sensitivity to medication side effects in this demographic.

Furthermore, older adults are often more susceptible to the side effects of selective serotonin reuptake inhibitors (SSRIs) such as citalopram and escitalopram, including an increased risk of falls, sedation, and potential exacerbation of any cognitive decline. Consequently, starting with a lower dose can help to mitigate these risks while still allowing for therapeutic effects.

Adjusting the dose helps ensure that older patients can safely tolerate the medication while monitoring their responses and side effects closely. Dosage adjustments are a standard practice in geriatric psychopharmacology to provide the most effective care while minimizing potential adverse consequences.