Citalopram

What is Citalopram?

• Citalopram (Celexa) is a selective serotonin reuptake inhibitor (SSRI) used for the treatment of major depressive disorder (MDD) in adults.

Citalopram

Citalopram racemic

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Citalopram numbered

What are the uses of this medicine?

• Citalopram (Celexa) is a prescription medicine used to treat a certain type of depression called Major Depressive Disorder (MDD) in adults.

How does this medicine work?

• Citalopram (sye tal' o pram) and escitalopram (es" sye tal' oh pram) are antidepressants that belong to the class of selective serotonin reuptake inhibitors (SSRIs).
• By blocking the reuptake of serotonin in CNS synaptic clefts, SSRIs increase serotonin levels and serotonin activity which results in antidepressant effects.

What drug interactions can this medicine cause?

• Tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take.

Especially tell your doctor if you take:

• amiodarone (Nexterone, Pacerone)
• amphetamines such as amphetamine (in Adderall, in Mydayis), dextroamphetamine (Dexedrine, in Adderall), and methamphetamine (Desoxyn)
• anticoagulants ('blood thinners') such as warfarin (Coumadin, Jantoven)
• aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn)
• carbamazepine (Carbatrol, Equetro, Tegretol, others)
• chlorpromazine
• cimetidine (Tagamet)
• diuretics ('water pills)
• disopyramide (Norpace)
• dofetilide (Tikosyn)
• erythromycin (E.E.S. Ery-Tab, Erythrocin)
• fentanyl (Actiq, Duragesic, Fentora, Subsys)
• lithium (Lithobid)
• medications for anxiety, chronic pain, mental illness, and seizures
• medications for migraine headaches such as almotriptan, eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex, Tosymra, in Treximet), and zolmitriptan (Zomig)
• methadone (Methadose)
• metoprolol (Lopressor, Toprol XL)
• moxifloxacin
• omeprazole (Prilosec, Zegerid)
• pentamidine (Nebupent, Pentam)
• other SSRIs such as fluoxetine (Prozac, in Symbyax), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft)
• serotonin–norepinephrine reuptake inhibitors (SNRIs) such as duloxetine (Cymbalta)
• procainamide
• quinidine (in Nuedexta)
• sedatives
• sleeping pills
• sotalol (Betapace, Sorine, Sotylize)
• thioridazine (Mellaril)
• tramadol (Conzip, Qdolo, Ultram, in Ultracet)
• tranquilizers
• tricyclic antidepressants such as amitriptyline, amoxapine, clomipramine (Anafranil), desipramine (Norpramin), doxepin (Silenor), imipramine (Tofranil), nortriptyline (Pamelor), protriptyline, and trimipramine.
• St. John's wort or tryptophan.

Is this medicine FDA approved?

• Citalopram was approved for use in the United States in 1998 and it has become one of the most widely used antidepressant medications, with more than 16 million prescriptions being written yearly.

How should this medicine be used?

Recommended dosage:

• Initial dosage is 20 mg once daily; after one week may increase to maximum dosage of 40 mg once daily.
• Patients greater than 60 years of age, patients with hepatic impairment, and CYP2C19 poor metabolizers: maximum recommended dosage is 20 mg once daily.
• When discontinuing CELEXA, reduce dosage gradually.
• At least 14 days must elapse between discontinuation of a monoamine oxidase inhibitor (MAOI) antidepressant and initiation of therapy with CELEXA.

Administration:

• Celexa comes as a tablet and a solution (liquid) to take by mouth. It is usually taken once a day, in the morning or in the evening.
• Take Celexa 1 time each day with or without food.
• Take Celexa exactly as your healthcare provider tells you to take it. Do not change your dose or stop taking Celexawithout first talking to your healthcare provider.
• Your healthcare provider may need to change the dose of Celexauntil it is the right dose for you.

What are the dosage forms and brand names of this medicine?

This medicine is available in fallowing doasage form:

• As Tablets: 10 mg; 20 mg, scored; and 40 mg, scored

This medicine is available in fallowing brand namesː CELEXA

What side effects can this medication cause?

The most common side effects of this medicine include:

• delayed ejaculation

In severe or more sudden cases, signs and symptoms include:

• hallucinations (seeing or hearing things that are not real
• seizures
• stopping breathing
• fainting
• coma
• death
• Sexual problems (dysfunction)

Symptoms in males may include:

• Delayed ejaculation or inability to have an ejaculation
• Decreased sex drive
• Problems getting or keeping an erection

Symptoms in females may include:

• Decreased sex drive
• Delayed orgasm or inability to have an orgasm

Less common but serious side effects may include:

• Anaphylactic Reactions

Celexamay cause serious side effects, including:

• Increased risk of suicidal thoughts and actions
• Heart rhythm problems
• Serotonin syndrome
• Increased risk of bleeding
• Manic episodes
• Discontinuation syndrome
• Seizures (convulsions)
• angle-closure glaucoma
• hyponatremia

What special precautions should I follow?

• Dose-dependent QTc prolongation, Torsade de pointes, ventricular tachycardia, and sudden death have occurred. Avoid use of Celexain patients with congenital long QT syndrome, bradycardia, hypokalemia or hypomagnesemia, recent acute myocardial infarction, or uncompensated heart failure and patients taking other drugs that prolong the QTc interval. Monitor electrolytes in patients at high risk for hypokalemia or hypomagnesemia. Discontinue Celexain patients with persistent QTc measurements > 500 ms.
• SSRIs, including CELEXA, can precipitate serotonin syndrome, a potentially life-threatening condition.
• Drugs that interfere with serotonin reuptake inhibition, including CELEXA, increase the risk of bleeding events. Inform patients about the increased risk of bleeding associated with the concomitant use of Celexa and antiplatelet agents or anticoagulants. For patients taking warfarin, carefully monitor the international normalized ratio.
• In patients with bipolar disorder, treating a depressive episode with Celexa or another antidepressant may precipitate a mixed/manic episode. Prior to initiating treatment with CELEXA, screen patients for any personal or family history of bipolar disorder, mania, or hypomania.
• Adverse reactions after discontinuation of serotonergic antidepressants, particularly after abrupt discontinuation, include: nausea, sweating, dysphoric mood, irritability, agitation, dizziness, sensory disturbances (e.g., paresthesia, such as electric shock sensations), tremor, anxiety, confusion, headache, lethargy, emotional lability, insomnia, hypomania, tinnitus, and seizures. A gradual reduction in dosage rather than abrupt cessation is recommended whenever possible.
• Celexa has not been systematically evaluated in patients with seizure disorders. Celexa should be prescribed with caution in patients with a seizure disorder.
• Avoid use of antidepressants, including CELEXA, in patients with untreated anatomically narrow angles.
• Hyponatremia may occur as a result of treatment with SSRIs, including CELEXA. Elderly patients, patients taking diuretics, and those who are volume-depleted may be at greater risk of developing hyponatremia with SSRIs.
• Use of SSRIs, including CELEXA, may cause symptoms of sexual dysfunction. Discuss potential management strategies to support patients in making informed decisions about treatment.
• Advise breastfeeding women to monitor infants for excess sedation, restlessness, agitation, poor feeding and poor weight gain and to seek medical care if they notice these signs.
• Tell your doctor if you drink or have ever drunk large amounts of alcohol or use or have ever used street drugs or have ever overused prescription medications.
• Citalopram may make you drowsy and may affect your judgment, thinking, and movements. Do not drive a car or operate machinery until you know how this medication affects you.
• Talk to your doctor about the safe use of alcoholic beverages during your treatment with citalopram. Alcohol can make the side effects of citalopram worse.
• Celexa is associated with rare instances of clinically apparent acute liver injury.

What to do in case of emergency/overdose?

Symptoms of overdosage may include:

• Seizures, which may be delayed, and altered mental status including coma.
• Cardiovascular toxicity, which may be delayed, including QRS and QTc interval prolongation, wide complex tachyarrhythmias, and torsade de pointes.
• Hypertension most commonly seen, but rarely can see hypotension alone or with co‐ingestants including alcohol.
• Serotonin syndrome.

Management of overdosage:

• In case of overdose, call the poison control helpline of your country. In the United States, call 1-800-222-1222.

• Overdose related information is also available online at poisonhelp.org/help.
• In the event that the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services. In the United States, call 911.
• Prolonged cardiac monitoring is recommended in Celexa overdosage ingestions due to the arrhythmia risk.
• Gastrointestinal decontamination with activated charcoal should be considered in patients who present early after a Celexaoverdose.

Can this medicine be used in pregnancy?

• Celexa may harm your unborn baby. Taking Celexalate in pregnancy may lead to an increased risk of certain problems in your newborn. Talk to your healthcare provider about the risks and benefits of treating depression during pregnancy.
• Tell your healthcare provider right away if you become pregnant or think you may be pregnant during treatment with CELEXA.
• There is a pregnancy registry for females who are exposed to Celexaduring pregnancy.
• If you become pregnant during treatment with CELEXA, talk to your healthcare provider about registering with the National Pregnancy Registry for Antidepressants. You can register by calling 1-844-405-6185 or visiting online at https://womensmentalhealth.org/research/pregnancyregistry/antidepressants.

Can this medicine be used in children?

• The safety and effectiveness of Celexa have not been established in pediatric patients.

What are the active and inactive ingredients in this medicine?

• Active ingredient: citalopram hydrobromide
• Inactive ingredients: copolyvidone, corn starch, crosscarmellose sodium, glycerin, lactose monohydrate, magnesium stearate, hypromellose, microcrystalline cellulose, polyethylene glycol, titanium dioxide and iron dioxide for coloring.

Who manufactures and distributes this medicine?

Distributed by:

• Allergan USA, Inc.
• Madison, NJ

What should I know about storage and disposal of this medication?

• Store Celexa at room temperature between 68°F to 77°F (20°C to 25°C).
• Keep Celexa and all medicines out of the reach of children.

The following are antidepressant subclasses and drugs

MAO Inhibitors Isocarboxazid, Phenelzine, Tranylcypromine

SNRIs Duloxetine, Levomilnacipran, Venlafaxine

SSRIs Citalopram, Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline, Vilazodone, Vortioxetine

Tricyclics Amitriptyline, Amoxapine, Clomipramine, Desipramine, Doxepin, Imipramine, Nortriptyline, Protriptyline, Trimipramine

Miscellaneous Bupropion, Flibanserin, Mirtazapine, Nefazodone, Trazodone

• Dailymed label info on Citalopram
• FDA Citalopram

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