citalopram hydrobromide

ci·tal·o·pram hy·dro·bro·mide (s-tl-prm hdr-brmd)

n.

A drug of the SSRI class that is used primarily to treat depression.

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Citalopram hydrobromide

Celexa; a SSRI that is highly specific for serotonin reuptake.

Mentioned in: Antidepressant Drugs, SSRI

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citalopram hydrobromide

Celexa

Pharmacologic class: Selective serotonin reuptake inhibitor

Therapeutic class: Antidepressant

Pregnancy risk category C

FDA Boxed Warning

• Drug may increase risk of suicidal thinking and behavior in children and adolescents with major depressive disorder and other psychiatric disorders, especially during first few months of therapy. Risk must be balanced with clinical need, as depression itself increases suicide risk. With patient of any age, observe closely for clinical worsening, suicidality, and unusual behavior changes when therapy begins. Advise family to observe patient closely and communicate with prescriber as needed.
• Drug isn't approved for use in pediatric patients.

Action

Unclear. Thought to potentiate serotonergic activity in CNS by inhibiting neuronal uptake of serotonin.

Availability

Oral solution: 10 mg/5 ml

Orally disintegrating tablets (ODT): 10 mg, 20 mg, 30 mg, 40 mg

Tablets: 10 mg, 20 mg, 40 mg

⊘Indications and dosages

➣ Depression

Adults: Initially, 20 mg P.O. daily; may increase by 20 mg/day at weekly intervals, up to 60 mg/day. Usual dosage is 40 mg/day. For ODT, start with 20 mg tablet dissolved on the tongue daily; may increase to 40 mg daily; may further increase to 60 mg daily.

Dosage adjustment

• Hepatic impairment
• Elderly patients

Off-label uses

• Alcoholism
• Panic disorder
• Premenstrual dysphoria
• Social phobia

Contraindications

• Hypersensitivity to drug
• MAO inhibitor use within 14 days

Precautions

Use cautiously in:
• severe renal impairment, hepatic impairment, conditions likely to cause altered metabolism or hemodynamic responses
• history of mania or seizure disorder
• elderly patients
• pregnant patients
• children (safety not established).

Administration

☞ Don't give within 14 days of MAO inhibitor; life-threatening interactions may occur.

Route	Onset	Peak	Duration
P.O.	1-4 wk	Unknown	Unknown

Adverse reactions

CNS: apathy, confusion, drowsiness, insomnia, migraine, weakness, agitation, amnesia, anxiety, dizziness, fatigue, poor concentration, tremor, paresthesia, deepening of depression, suicide attempt

CV: orthostatic hypotension, tachycardia

EENT: abnormal visual accommodation

GI: nausea, vomiting, diarrhea, abdominal pain, dyspepsia, flatulence, ncreased saliva, dry mouth, increased appetite, anorexia

GU: polyuria, amenorrhea, dysmenorrhea, ejaculatory delay, erectile dysfunction, decreased libido

Musculoskeletal: joint pain, myalgia

Respiratory: cough

Skin: rash, pruritus, diaphoresis, photosensitivity

Other: altered taste, fever, yawning, weight changes

Interactions

Drug-drug. Carbamazepine: decreased citalopram blood level

Centrally acting drugs (such as antihistamines, opioids, sedative-hypnotics): additive CNS effects

Erythromycin, itraconazole, ketoconazole, omeprazole: increased citalopram blood level

5-hydroxytryptamine₁ receptor agonists (such as sumatriptan, zolmitriptan): increased risk of adverse reactions

Lithium: potentiation of serotonergic effects

MAO inhibitors: life-threatening reactions

Tricyclic antidepressants (TCAs): altered TCA pharmacokinetics

Drug-herbs. St. John's wort, S-adenosylmethionine (SAM-e): increased risk of serotonergic reactions, including serotonin syndrome

Drug-behaviors. Alcohol use: additive CNS depression

Sun exposure: photosensitivity

Patient monitoring

• If patient is receiving lithium concurrently, watch closely for potentiation of serotonergic effects.
• Assess for evidence of drug efficacy.

Patient teaching

• Instruct patient to take drug with full glass of water at same time every day.
☞ Advise patient (especially child or adolescent) to immediately report suicidal thoughts or extreme depression.
• Instruct patient to move slowly when sitting up or standing, to avoid dizziness or light-headedness caused by sudden blood pressure decrease.
• Tell patient several weeks may pass before he starts to feel better.
• Advise patient to avoid alcohol during therapy.
• Tell male patient he may experience inadequate filling of penile erectile tissue. Advise him to consult prescriber if he experiences adverse sexual effects.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, herbs, and behaviors mentioned above.