Citalopram-hypericum

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Citalopram
Type Antidepressant
Group SSRI
links
ATC-code N06AB04
Medscape Citalopram
PubChem 2771
PubMed Citalopram
Kompas (Dutch) citalopram
Wikipedia citalopram
Hypericum
Type Antidepressant
Group other
links
EMEA 10130408en
PubMed Hypericum
Kompas (Dutch) hypericum extract
Wikipedia St John's wort

Switch medication from citalopram to hypericum.[1] [2]

Nietinrijdenbord.png Stop citalopram
  • Before day 1: gradually reduce dosage of citalopram to a maximum of 20 mg/day, when this dosage is > 20 mg/day.
  • Day 1: reduce dosage of citalopram to a maximum of 10 mg/day.
  • Day 8: stop administration of citalopram
  • Before day 1: gradually reduce dosage of citalopram/escitalopram to a maximum of 20 mg/day, resp. 10 mg/day.
  • Day 1: reduce dosage of citalopram/escitalopram to 10 mg/day, resp. 5 mg/day.
  • Day 8: stop administration of citalopram/escitalopram.
Eenrichtingbord.png Start hypericum
  • Day 8-22: a wash-out period of 2 weeks is necessary.
  • Day 23: start administration of hypericum in a dosage of 300 mg three times a day (900 mg/day).
Letopbord.png Cave
  • Occurrence of the serotonin syndrome is possible without wash-out period.
Infobord.png More information
  • Hypericum induces enzymes of the CYP P-450 type and P-gp type.
  • Hypericum might have MAO-inhibiting and/or COMT-inhibiting properties.
  • Many studies reported that hypericin is the main source of pharmacological effects of hypericum. However the IC50 of hypericin to inhibit MAO A and MAO B is 100- to 1000-fold higher than accessible Cmax values of hypericin after oral administration of hypericum.[3]
  1. Switches are based on literature references on this page and expert opinions of the authors. The authors have used pharmacokinetic and receptor affinity properties to determine the switch schedules
  2. Stahl, S. M. (2013). Stahl's essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). Cambridge University Press.
  3. Wurglics M, Schubert-Zsilavecz M.Hypericum perforatum: a 'modern' herbal antidepressant: pharmacokinetics of active ingredients. Clin Pharmacokinet. 2006;45(5):449-68.
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