citalopram

citalopram

DRUG CLASS AND MECHANISM: Citalopram is an antidepressant medication that affects neurotransmitters, the chemicals that nerves within the brain use to communicate with each other. Neurotransmitters are manufactured and released by nerves and then travel and attach to nearby nerves. Thus, neurotransmitters can be thought of as the communication system of the brain. Many experts believe that an imbalance among neurotransmitters is the cause of depression. Citalopram works by preventing the uptake of one neurotransmitter, serotonin, by nerve cells after it has been released. Since uptake is an important mechanism for removing released neurotransmitters and terminating their actions on adjacent nerves, the reduced uptake caused by citalopram results in more free serotonin in the brain to stimulate nerve cells. Citalopram is in the class of drugs called selective serotonin reuptake inhibitors (SSRIs), a class that also contains fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft). Citalopram was approved by the FDA in July 1998.

GENERIC AVAILABLE: Yes

PRESCRIPTION: Yes

PREPARATIONS: Tablets: 10, 20, and 40 mg. Solution: 10 mg/5 ml

STORAGE: Citalopram should be stored at room temperature, 15 to 30 C (59 to 86 F).

PRESCRIBED FOR: Citalopram is used for the management of depression. Citalopram also is used for treating obsessive compulsive disorder (OCD), panic disorder, premenstrual dysphoric syndrome (PMDD), anxiety disorder, and posttraumatic stress disorder.

DOSING: The usual starting dose is 20 mg in the morning or evening. The dose may be increased to 40 mg daily after one week. A dose of 60 mg has not been shown to be more effective than 40 mg. As with all antidepressants, it may take several weeks of treatment before maximum effects are seen. Doses are often slowly adjusted upwards to find the most effective dose.

DRUG INTERACTIONS: All SSRIs, including citalopram, should not be taken with any of the mono-amine oxidase (MAO) inhibitor-class of antidepressants, for example, isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), selegiline (Eldepryl), and procarbazine (Matulane). Such combinations may lead to confusion, high blood pressure, tremor, and hyperactivity. If treatment is to be changed from citalopram to an MAOI or vice-versa, there should be a 14 day period without either drug before the alternative drug is started. Tryptophan, a common dietary supplement, can cause headaches, nausea, sweating, and dizziness when taken with any SSRI.

Use of an SSRI with aspirin, nonsteroidal anti-inflammatory drugs or other drugs that affect bleeding may increase the likelihood of upper gastrointestinal bleeding.

PREGNANCY: Exposure of neonates to citalopram in the third trimester may cause complications.

NURSING MOTHERS: Citalopram is excreted in breast milk. Breastfeeding by a citalopram treated woman may cause adverse effects in the infant.

SIDE EFFECTS: The most common side effects associated with citalopram are nausea, dry mouth, vomiting, excessive sweating, headache, tremor, drowsiness, and inability to sleep. Overall, between 1 in 6 and 1 in 5 persons experience a side effect. Citalopram is also associated with sexual dysfunction. Some patients may experience withdrawal reactions upon stopping citalopram. Symptoms of withdrawal include dizziness, tingling sensations, tiredness, vivid dreams, and irritability or poor mood.

Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of citalopram or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be closely observed for clinical worsening, suicidality, or unusual changes in behavior.