Common psychotropic medications: Approximate dose equivalents

[David Baxter PhD]

SSRIs

SSRI | Dosage equivalents
20 mg | Celexa (citalopram hydrobromide)
10 mg | Cipralex/Lexapro (escitalopram oxalate)
75 mg | Effexor (venlafaxine hydrochloride).
10 mg | Lexapro/Cipralex (escitalopram oxalate)
50 mg | Luvox (fluvoxamine maleate)
20 mg | Paxil (paroxetine hydrochloride)
20 mg | Prozac (fluoxetine hydrochloride)
50 mg | Zoloft (sertraline hydrochloride)

One study has shown that Celexa (citalopram hydrobromide) is the best intermediary drug when rotating SSRIs. Technically, Effexor (venlafaxine hydrochloride) is not an SSRI but rather a dual action SSRI/SNRI.

 

[stringbean]

does that mean that 5mg of cipralex is the same as 20mg prozac? if so I am on equivalent of 60mg and never had to take that much before !!!

 

[David Baxter PhD]

I think 10 mg Ciplralex is closer to the equivalent of 20 mg of Prozac.

I just noticed that in the table but I think it's incorrect... I think the value should be 10 mg. I'll check into this further later when I get time.

 

[Retired]

I believe intention of the chart is to show the standard therapeutic dose of each medication thereby forming an approximate equivalant therapeutic dose comparison.

My understanding of the dosing of Cipralex is:

Initial: 20 mg/day, generally with an increase to 40 mg/day; doses of more than 40 mg are not usually necessary. Should a dose increase be necessary, it should occur in 20 mg increments at intervals of no less than 1 week. Maximum dose: 60 mg/day; reduce dosage in elderly or those with hepatic impairment

Corrected information below

Dosing: Oral:
Adults: Depression, GAD: Initial: 10 mg/day; dose may be increased to 20 mg/day after at least 1 week

Prozac dosing:

Dosing (Adults): Depression, OCD, PMDD, bulimia: Initially, 20mg orally every morning - may increase after several weeks by 20 mg/day increments. Usual effective dose: 20-40mg/day. Maximum: 80mg/day.

Obsessive compulsive disorder (OCD): 40-80 mg/day.
PMDD: 20 mg/day continuously, or 20 mg/day starting 14 days prior to menstruation and through first full day of menses (repeat with each cycle).

Panic disorder: Initially, 10 mg/day. After 1 week, increase to 20 mg/day. May increase after several weeks. Doses >60 mg/day have not been evaluated

Source for the comparison table I use

These comparison tables should not be seen as absolute interchangeability of dosages for these medications, but rather guides that physicians use to switch patients from one medication to another, while achieving an approximately similar therapeutic effect. It should be kept in mind that every compound is different, requiring different dosing strategies and exhibiting different side effect profiles at each dosing level. Furthermore, it is possible for different people to respond differently to each compound, so comparison tables like these provide very general guidelines.

 

[David Baxter PhD]

I believe intention of the chart is to show the standard therapeutic dose of each medication thereby forming an approximate equivalant therapeutic dose comparison.

My understanding of the dosing of Cipralex is:

Initial: 20 mg/day, generally with an increase to 40 mg/day; doses of more than 40 mg are not usually necessary. Should a dose increase be necessary, it should occur in 20 mg increments at intervals of no less than 1 week. Maximum dose: 60 mg/day; reduce dosage in elderly or those with hepatic impairment

The 5 mg dose for Cipralex in the tablle may be an error.

I believe you're thinking of Celexa, Steve, rather than Cipralex/Lexapro, where the standard doses are half that for Celexa:

Lexapro (Escitalopram Oxalate) Drug Information: Uses, Side Effects, Drug Interactions and Warnings at RxList

The recommended dose of Lexapro is 10 mg once daily. A flexible-dose trial of Lexapro (10 to 20 mg/day) demonstrated the effectiveness of Lexapro [see Clinical Studies]. If the dose is increased to 20 mg, this should occur after a minimum of three weeks.

But the table above is definitely in error. I'll edit it.

 

[Retired]

Thanks for noticing my error, David. I've corrected and replaced the wrong quoted info.

Can't rely on those glasses I got out of a Cracker Jacks box

 

[stringbean]

sorry to put you to so much trouble, opened a can of worms

 

[Retired]

opened a can of worms

Not at all, Stringbean. You can always feels free to comment on or question any posting on the Forum. If something doesn't look right, point it out so it can be checked. In this case there appears to have been a typo in the original post.

Thanks for your concern, however.

 

[David Baxter PhD]

I agree. You drew our attention to an error in the post. Thank you for that.

 

[stringbean]

can i ask what comparison anafranil would have to these ssris, if that makes sense. What i mean is if you were on 20mg of prozac what would the equivilant be in anafranil.

Thanks

 

[David Baxter PhD]

20 mg of Prozac is the "standard" dose for most people, although 10 mg may be used in children or the elderly.

Based on that, see Anafranil (Clomipramine Hcl) Drug Information: User Reviews, Side Effects, Drug Interactions and Dosage at RxList

Treatment with Anafranil should be initiated at a dosage of 25 mg daily and gradually increased, as tolerated, to approximately 100 mg during the first 2 weeks. During initial titration, Anafranil should be given in divided doses with meals to reduce gastrointestinal side effects. Thereafter, the dosage may be increased gradually over the next several weeks, up to a maximum of 250 mg daily. After titration, the total daily dose may be given once daily at bedtime to minimize daytime sedation.