Citalopram hydrobromide
Citalopram hydrobromide (Celexa)
Citalopram hydrobromide
(sigh- TAL-oh-pram)
Pregnancy Category: C Celexa (Rx)

Classification: Antidepressant, selective serotonin-reuptake inhibitor

See Also: See also Antidepressants.

Action/Kinetics: Acts to inhibit reuptake of serotonin into CNS neurons resulting in increased levels of serotonin in synapses. Has minimal effects on reuptake of norepinephrine and dopamine. Peak plasma levels: 120-150 nmol/L after 2-4 hr. t 1/2, terminal: 35 hr. Half-life is increased in geriatric clients. Steady state plasma levels: About 1 week. Metabolized in the liver and excreted in the urine (35%) and feces (65%).

Uses: Treatment of depression in those with DSM-IV category of major depressive disorder.

Contraindications: Use with MAO inhibitors or with alcohol. Lactation.

Special Concerns: Use with caution in severe renal impairment, a history of seizure disorders, or in diseases or conditions that produce altered metabolism or hemodynamic responses. Safety and efficacy have not been determined in children. Do not confuse citalopram with Celebrex (celecoxib used as a NSAID) or Cerebyx (fosphenytoin sodium injection used to treat seizures).

Side Effects: CNS: Activation of mania/hypomania, dizziness, insomnia, agitation, somnolence, insomnia, anorexia, paresthesia, migraine, hyperkinesia, vertigo, hypertonia, extrapyramidal disorder, neuralgia, dystonia, abnormal gait, hypesthesia, ataxia, aggravated depression, suicide attempt, confusion, aggressive reaction, drug dependence, depersonalization, hallucinations, euphoria, psychotic depression, delusions, paranoid reaction, emotional lability, panic reaction, psychosis. GI: N&V, dry mouth, diarrhea, dyspepsia, abdominal pain, increased salivation, flatulence, gastritis, gastroenteritis, stomatitis, eructation, hemorrhoids, dysphagia, teeth grinding, gingivitis, esophagitis. CV: Tachycardia, postural hypotension, hypertension, bradycardia, edema of extremities, angina pectoris, extrasystoles, cardiac failure, MI, CVA flushing, myocardial ischemia. Musculoskeletal: Arthralgia, myalgia, arthritis, muscle weakness, skeletal pain, leg cramps, involuntary muscle contraction. Hematologic: Purpura, anemia, leukocytosis, lymphadenopathy. Metabolic/nutritional: Decreased or increased weight, thirst. GU: Ejaculation disorder, impotence, dysmenorrhea, decreased or increased libido, amenorrhea, galactorrhea, breast pain, breast enlargement, vaginal hemorrhage, polyuria, frequent micturition, urinary incontinence, urinary retention, dysuria. Respiratory: Coughing, epistaxis, bronchitis, dyspnea, pneumonia. Dermatologic: Rash, pruritus, photosensitivity reaction, urticaria, acne, skin discoloration, eczema, dermatitis, dry skin, psoriasis. Ophthalmic: Abnormal accommodation, conjunctivitis, eye pain. Body as a whole: Asthenia, fatigue, fever. Miscellaneous: Hyponatremia, increased sweating, yawning, hot flushes, rigors, alcohol intolerance, syncope, flu-like symptoms, taste perversion, tinnitus.

Laboratory Test Alterations: Hepatic enzymes, alkaline phosphatase. Abnormal glucose tolerance.

Overdose Management: Symptoms: Dizziness, sweating, N&V, tremor, somnolence, sinus tachycardia. Rarely, amnesia, confusion, coma, convulsions, hyperventilation, cyanosis, rhabdomyolysis, ECG changes (including QTc prolongation, nodal rhythm, ventricular arrhythmias). Treatment: Establish and maintain an airway. Gastric lavage with use of activated charcoal. Monitor cardiac and vital signs. General symptomatic and supportive care.

Drug Interactions: See also Drug Interactions for Selective Serotonin Reuptake Inhibitors. Azole antifungals / Citalopram plasma levels Beta blockers / Effect of beta blocker; reduce initial beta blocker dose Carbamazepine / Citalopram plasma levels; serum carbamazepine levels Imipramine / Drug metabolite (desimpramine) by 50% Lithium / Possible serotonergic effects of citalopram Macrolide antibiotics (e.g., erythromycin)/ Citalopram plasma levels MAO inhibitors / Possible serious and sometimes fatal reactions, including hyperthermia, rigidity, myoclonus, autonomic instability, mental status changes (extreme agitation, delirium, coma)

How Supplied: Tablets: 20 mg, 40 mg

Dosage
?Tablets Depression.
Adults, initial: 20 mg once daily in the a.m. or p.m. with or without food. Increase the dose in increments of 20 mg at intervals of no less than 1 week. Doses greater than 40 mg/day are not recommended. For the elderly or those with hepatic impairment, 20 mg/day is recommended; titrate to 40 mg/day only for nonresponders. Initial treatment is continued for 6 or 8 weeks. Maintenance: Up to 24 weeks following 6 or 8 weeks of initial treatment.