Citalopram

Indications
 Oral
Depression
Adult: Initially, 20 mg daily, increased to 40 mg once daily after at least 1 wk or 60 mg daily if necessary.
Hepatic impairment: Recommended dose: 20 mg daily.
Oral
Depressive phase of bipolar disorder
Adult: Initially, 20 mg daily, increased to 40 mg once daily after at least 1 wk or 60 mg daily if necessary.
Hepatic impairment: Recommended dose: 20 mg daily.
Oral
Panic disorder with or without agoraphobia
Adult: Initially, 10 mg daily, increased to 20 mg daily after 1 wk. Max: 60 mg daily.
Hepatic impairment: Recommended dose: 20 mg daily.

Special Populations: Patients with reduced hepatic function should receive dosages of no more than 30 mg/day.
Contraindications
 Hypersensitivity, concomitant admin with MAOIs or within 14 days of discontinuing MAOI treatment; children and adolescents <18 yr; treatment of depressive illness; lactation.
Warnings / Precautions
 Gradual discontinuation of treatment if patient enters into manic phase; pregnancy. Increased risk of hyponatraemia and SIADH. May reduce convulsant threshold thus, citalopram should be used with care in epileptic patients.
Adverse Reactions
 Increased sweating, headache, tremor, fatigue, asthenia, dizziness, abnormal accommodation, somnolence, insomnia, agitation, nervousness, nausea, dry mouth, constipation, diarrhoea, palpitation, rash, pruritus, abnormal vision, decreased libido, anxiety, increased appetite, anorexia, apathy, impotence, suicide attempt, confusion, yawning, dyspepsia, vomiting, abdominal pain, flatulence, increased saliva, weight decrease or increase, postural hypotension, tachycardia, rhinitis, ejaculation failure, fatigue, extrapyramidal disorders.
Potentially Fatal: Increased risk of suicidal thinking and behaviour especially in child and adolescents. Monitor closely for signs of clinical worsening, suicidality or unusual changes in behaviour.
Overdose Reactions
 Symptoms include dizziness, sweating, nausea, vomiting, tremor, somnolence and sinus tachycardia. In rare cases, amnesia, confusion, coma, convulsions, hyperventilation, cyanosis, rhabdomyolysis and ECG changes may occur. Treatment includes maintaining airway to ensure adequate ventilation and oxygenation. Gastric evacuation by lavage and use of activated charcoal should be considered. Careful observation and cardiac and vital sign monitoring are recommended, along with general symptomatic and supportive care.
Drug Interactions
 Do not start MAOI therapy until at least 2 wk after SSRIs withdrawal; serotonergic effects are suspected to be enhanced by SSRIs. May increase anticoagulant effect when used with warfarin.
See Below for More citalopram Drug Interactions
Mechanism of Actions
 Citalopram is a selective serotonin re-uptake inhibitor, with little or no effect on noradrenaline, dopamine and γ aminobutyric acid (GABA) re-uptake. It has no or very low affinity for 5-HT1A, 5-HT2, D1 and D2 receptors, α1, α2, β-adrenoceptors, histamine H1, muscarine, cholinergic, benzodiazepine and opioid receptors.
Absorption: Readily absorbed from the GI tract (oral); peak plasma concentrations after 2-4 hr.
Distribution: Widely distributed; enters breast milk (small amounts). Protein-binding: Low.
Metabolism: Undergoes demethylation, deamination and oxidation to active and inactive metabolites.
Excretion: Urine (as unchanged drug); 33 hr (elimination half-life).
Administration
 May be taken with or without food.
Storage Conditions
 Oral: Store at 25°C.
ATC Classification
 N06AB04 - citalopram ; Belongs to the class of selective serotonin reuptake inhibitors. Used in the management of depression.
Storage
 Oral: Store at 25°C.
Available As
  • Citalopram 10 mg
  • Citalopram 20 mg
  • Citalopram 30 mg
  • Citalopram 40 mg

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