Pronunciation
si-TAL-oh-pram [Pronunciation]

Trade Name(s)

• CeleXA

Genetic Implications

Pregnancy Category
Category C

Ther. class.
antidepressants

Pharm. class.
selective serotonin reuptake inhibitors ssris

Depression.

Unlabelled Use(s):

• Premenstrual dysphoric disorder (PMDD).

• Obsessive-compulsive discorder (OCD).

• Panic disorder.

• Generalized anxiety disorder (GAD).

• Post-traumatic stress disorder (PTSD).

• Social anxiety disorder (social phobia).

Selectively inhibits the reuptake of serotonin in the CNS.

Therapeutic Effect(s):
Antidepressant action.

Absorption: 80% absorbed after oral administration.

Distribution: Enters breast milk.

Metabolism and Excretion: Mostly metabolized by the liver (10% by CYP3A4 and 2C19 enzymes); excreted unchanged in urine.

Half-life: 35 hr.

TIME/ACTION PROFILE (antidepressant effect)

ROUTE	ONSET	PEAK	DURATION
PO	1–4 wk	unknown	unknown

Contraindicated in:

• Hypersensitivity;

• Concurrent MAO inhibitor or pimozide therapy;

• Congenital long QT syndrome.

Use Cautiously in:

• History of mania;

• History of suicide attempt/ideation (↑ risk during early therapy and during dose adjustment);

• History of seizure disorder;

• Illnesses or conditions that are likely to result in altered metabolism or hemodynamic responses;

• Severe renal or hepatic impairment;

• Hypokalemia or hypomagnesemia (correct prior to initiating therapy);

• Poor metabolizers of CYP2C19 (↑ risk of QT interval prolongation);

• Concurrent use of CYP2C19 inhibitors (↑ risk of QT interval prolongation);

• OB: Use during third trimester may result in neonatal serotonin syndrome requiring prolonged hospitalization, respiratory and nutritional support;

• Lactation: Present in breast milk and may result in lethargy with ↓ feeding in infants; weigh risk/benefits;

• Pedi: May ↑ risk of suicide attempt/ideation especially during early treatment or dose adjustment in children/adolescents (unlabeled for pediatric use);

• Geri: ↓ doses recommended.

CNS: NEUROLEPTIC MALIGNANT SYNDROME, SUICIDAL THOUGHTS, apathy, confusion, drowsiness, insomnia, weakness, agitation, amnesia, anxiety, ↓ libido, dizziness, fatigue, impaired concentration, ↑ depression, migraine headache.

EENT: abnormal accommodation.

Resp: cough.

CV: TORSADE DE POINTES, postural hypotension, QT interval prolongation, tachycardia.

GI: abdominal pain, anorexia, diarrhea, dry mouth, dyspepsia, flatulence, ↑ saliva, nausea, altered taste, ↑ appetite, vomiting.

GU: amenorrhea, dysmenorrhea, ejaculatory delay, erectile dysfunction, polyuria.

Derm: sweating, photosensitivity, pruritus, rash.

Metabolic: weight loss, weight gain.

F and E: hyponatremia.

MS: arthralgia, myalgia.

Neuro: tremor, paresthesia.

Misc: SEROTONIN SYNDROME, fever, yawning.

*CAPITALS indicates life-threatening.
*italic indicates most frequent.

Drug-Drug

• May cause serious, potentially fatal reactions when used with MAO inhibitors ; allow at least 14 days between citalopram and MAO inhibitors .

• Concurrent use with pimozide may result in prolongation of the QTc interval and is contraindicated.

• QT interval prolonging drugs may ↑ the risk of QT interval prolongation and torsade de pointes; ECG monitoring recommended.

• CYP2C19 inhibitors may ↑ levels and the risk of toxicity.

• Drugs that affect serotonergic neurotransmitter systems, including linezolid , tramadol , and triptans ↑ risk of serotonin syndrome.

• Use cautiously with other centrally acting drugs (including alcohol , antihistamines , opioid analgesics , and sedative/hypnotics ; concurrent use with alcohol is not recommended).

• Cimetidine may ↑ levels.

• Serotonergic effects may be ↑ by lithium (concurrent use should be carefully monitored).

• Ketoconazole , itraconazole , erythromycin , and omeprazole may ↑ levels.

• Carbamazepine may ↓ blood levels.

• May ↑ levels of metoprolol .

• Use cautiously with tricyclic antidepressants due to unpredictable effects on serotonin and norepinephrine reuptake.

• ↑ risk of bleeding with aspirin , NSAIDs , clopidogrel , or warfarin .

Drug-Natural Products
↑ risk of serotonergic side effects including serotonin syndrome with St. John's wort and SAMe .

• PO (Adults): 20 mg once daily initially, may be ↑ in one week to 40 mg/day (maximum dose); Poor metabolizer of CYP2C19 or concurrent use of CYP2C19 inhibitor—Do not exceed dose of 20 mg/day..

• PO (Geriatric Patients): 20 mg once daily initially, may be ↑ to 40 mg/day only in nonresponding patients..

Hepatic Impairment

• PO (Adults): 20 mg once daily initially, may be ↑ to 40 mg/day only in nonresponding patients..

• Tablets: 10 mg, 20 mg, 40 mg

» Cost:
Generic: 10 mg $37.97/90, 20 mg $10.00/90, 40 mg $10.00/90.

• Oral solution (peppermint flavor): 10 mg/5 mL

» Cost:
Generic: 10 mg/5 mL $99.99/240 mL.

• Monitor mood changes during therapy.

» Assess for suicidal tendencies, especially during early therapy and dose changes. Restrict amount of drug available to patient. Risk may be increased in children, adolescents, and adults ≤24 yr. After starting therapy, children, adolescents, and young adults should be seen by health care professional at least weekly for 4 wk, every 3 wk for the next 4 wk, and on advice of health care professional thereafter.

• Assess for sexual dysfunction (erectile dysfunction; decreased libido).

• Assess for serotonin syndrome (mental changes [agitation, hallucinations, coma], autonomic instability [tachycardia, labile BP, hyperthermia], neuromuscular aberrations [hyperreflexia, incoordination], and/or GI symptoms [nausea, vomiting, diarrhea]), especially in patients taking other serotonergic drugs (SSRIs, SNRIs, triptans).

• Ineffective coping (Indications)

• Risk for injury (Side Effects)

• Sexual dysfunction (Side Effects)

• Do not confuse with Celebrex (celecoxib), Cerebyx (fosphenytoin), or Zyprexa (olanzapine).

• PO: Administer as a single dose in the morning or evening without regard to food.

• Instruct patient to take citalopram as directed.

• May cause drowsiness, dizziness, impaired concentration, and blurred vision. Caution patient to avoid driving and other activities requiring alertness until response to the drug is known.

• Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking any other Rx, OTC, or herbal products, especially alcohol or other CNS depressants.

• Caution patient to change positions slowly to minimize dizziness.

• Advise patient, family, and caregivers to look for suicidality, especially during early therapy or dose changes. Notify health care professional immediately if thoughts about suicide or dying, attempts to commit suicide, new or worse depression or anxiety, agitation or restlessness, panic attacks, insomnia, new or worse irritability, aggressiveness, acting on dangerous impulses, mania, or other changes in mood or behavior or if symptoms of serotonin syndrome occur.

• Advise patient to use sunscreen and wear protective clothing to prevent photosensitivity reactions.

• Inform patient that frequent mouth rinses, good oral hygiene, and sugarless gum or candy may minimize dry mouth. If dry mouth persists for more than 2 wk, consult health care professional regarding use of saliva substitute.

• Instruct female patients to inform health care professional if pregnancy is planned or suspected, or if they plan to breastfeed. If used during pregnancy should be tapered during third trimester to avoid neontal serotinin syndrome.

• Emphasize the importance of follow-up exams to monitor progress.

Increased sense of well-being.

» Renewed interest in surroundings. May require 1–4 wk of therapy to obtain antidepressant effects.