Citalopram

Antidepressant · SSRIs

Indications

Depressive disorders (endogenous and non- endogenous).

Dosage

Adults: Initially 20 mg daily as a single dose, increasing if necessary to max 60 mg daily according to response. Elderly: Initially 20 mg daily as a single dose, increasing if necessary to max 40 mg daily according to response. Children: Not recommended.

Adverse Effects

GI upset, tremor, somnolence, dry mouth, anorexia, agitation, decreased lipid, anxiety, confusion, sleep disorders, tinnitus, yawning, pruritus, myalgia, arthralgia, impotence, ejaculation disorders, abnormal orgasm (female), fatigue, dizziness, paraesthesia, dysgeusia, impaired concentration, amnesia, apathy, increases salivation, rhinitis, increased sweating, wt loss, rhinitis, abnormal accommodation. Hyponatraemia, bleeding disorders, serotonin syndrome.

Risk Factor (Pregnancy/Lactation)

Pregnancy: Risk cannot be ruled out. Lactation: Contraindicated or not recommended. Contraindications: Unstable epilepsy. Within 2 weeks of stopping MAOIs or 1 day of stopping moclobemide. Precautions: Hepatic or severe renal impairment, diabetes, cardiac disease, stable epilepsy, psychosis, ECT, mania, risk of bleeding, narrow-angle glaucoma, or history of glaucoma. Monitor for suicidal ideation. Risk factors for QT prolongation or torsade de pointes. Dose increases may be detrimental in patients who develop akathisia. Poor CYP2C19 metabolisers. Elderly. Withdraw gradually.

Interactions

MAOIs, lithium, tryptophan, pimozide, other neuroleptics, St. John's Wort, other SSRls, SNRIs, 5HT1 agonists, triptans, other serotonergic drugs, linezolid, drugs that prolong QT interval, tramadol, anticoagulants, NSAIDs and other drugs affecting platelet function. CYP2D6 substrates (e.g., metoprolol), CYP2C19 inhibitors (e.g., PPIs), cimetidine, drugs that reduce seizure threshold. Drugs that induce hypokalaemia or hypomagnesaemia. Alcohol.

Advice to Patient

Take with or without meals. Do not stop taking medication abruptly, gradually lower the dose and then stop. Contact prescriber if there is severe headache, change in personality, muscle weakness or tremors, increased sweating, change in gait, confusion, loss of concentration, palpitations, skin rash, lack of sleep, nightmares, symptoms of respiratory infection. Avoid alcohol, caffeine and CNS stimulants during therapy. Do not take NSAIDs, aspirin, or other remedies (including herbal products, such as St. John’s wort) during therapy. Change position slowly from sitting or lying to standing.

Pharmacokinetics

Onset of action: Depression: The onset of action is 1-4 weeks; however, individual response varies greatly and full response may not be seen until 8-12 weeks after initiation of treatment. Duration: 1-2 days. Metabolism: Extensively hepatic. Bioavailability: 80%; tablets and oral solution are bioequivalent. Half-life elimination: 24-48 hours (average: 35 hours); doubled with hepatic impairment and increased by 30% (following multiple doses) to 50% (following single dose) in elderly patients (=60 years). Time to peak, serum: 1-6 hours, average within 4 hours. Excretion: Urine (citalopram 10% and DCT 5%).

Unlicensed Use

Children: Major depression: Tablets: 12-18 yr, initially 10 mg once daily increased if necessary to 20 mg once daily over 2-4 wk, max 40 mg once daily. Oral Drops: 12-18 yr, initially 8 mg once daily increased if necessary to 16 mg once daily over 2-4 wk, max 32 mg once daily.

Brands with this active ingredient

• 5HRI
• Abenol
• Abgenix
• Alopra
• Avail
• Brainese
• Celexa
• Cetopress
• Cheer
• Cilopram
• Cipam
• Cipram
• Ciprat
• Citalo
• Citalocit

Compiled by Healify Pharmacy from published drug references. How we compile it →

Always consult a pharmacist or doctor.