General

Pronunciation
si-TAL-oh-pram

Trade Name(s)

• Celexa

Pregnancy Category
Category C

Ther. class.
antidepressants

Pharm. class.
selective serotonin reuptake inhibitors ssris

Indications

Depression

Unlabelled Use(s):

• Premenstual dysphoric disorder (PMDD)

• Obsessive-compulsive discorder (OCD)

• Panic disorder

• Generalized anxiety disorder (GAD)

• Post-traumatic stress disorder (PTSD)

• Social anxiety disorder (social phobia)

Action

Selectively inhibits the reuptake of serotonin in the CNS

Therapeutic Effect(s):
Antidepressant action

Pharmacokinetics

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

Contraindication/Precautions

Contraindicated in:

• Hypersensitivity

• Concurrent MAO inhibitor or pimozide therapy

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

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

• Lactation: Citalopram is 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

Adverse Reactions/Side Effects

CNS: apathy, confusion, drowsiness, insomnia, weakness, agitation, amnesia, anxiety, decreased libido, dizziness, fatigue, impaired concentration, increased depression, migraine headache, suicide attempt.

EENT: abnormal accommodation.

Resp: cough.

CV: postural hypotension, tachycardia.

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

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

Derm: increased sweating, photosensitivity, pruritus, rash.

Metabolic: decreased weight, increased weight.

MS: arthralgia, myalgia.

Neuro: tremor, paresthesia.

Misc: fever, yawning.

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

Interactions

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

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

• Cimetidine blood levels of citalopram

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

• Ketoconazole, itraconazole, erythromycin, and omeprazole may blood levels

• Carbamazepine may blood levels

• May blood levels of metoprolol

• Concurrent use with tricyclic antidepressants should be undertaken with caution because of altered pharmacokinetics

• Concurrent use with 5-HT1 agonists used for migraine headaches may risk of adverse reactions (weakness, hyperreflexia, incoordination)

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

• Risk of bleeding may be with aspirin, NSAIDs, warfarin, thrombolytics, and other agents affecting coagulation and platelet function

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

Route/Dosage

• PO (Adults): 20 mg once daily initially, may be increased by 20 mg/day at weekly intervals, up to 60 mg/day (usual dose is 40 mg/day).

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

Hepatic Impairment

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

Availability

• Tablets: 10 mg, 20 mg, 40 mg

» Cost:
Generic: 10 mg $89.97/90, 20 mg $89.97/90, 40 mg $89.97/90.

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

» Cost:
Generic: 10 mg/5 ml $114.00/240 ml.

Assessment

• Monitor mood changes during therapy

» Assess for suicidal tendencies, especially during early therapy and dose changes. Restrict amount of drug available to patient

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

Potential Nursing Diagnoses

• Ineffective coping (Indications)

• Risk for injury (Side Effects)

Implementation

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

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

Patient/Family Teaching

• 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

• Advise patient to avoid alcohol or other CNS depressant drugs during therapy and to consult health care professional before taking other medications with citalopram

• Caution patient to change positions slowly to minimize dizziness

• 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 an infant. If used during pregnancy should be tapered during third trimester to avoid neontal serotinin syndrome

• Caution patients that citalopram should not be used for at least 14 days after discontinuing MAO inhibitors, and at least 14 days should be allowed after stopping citalopram before starting an MAO inhibitor

• Emphasize the importance of follow-up exams to monitor progress. Encourage patient participation in psychotherapy to improve coping skills

• Refer patient/family to local support group

Evaluation/Desired Outcomes

Increased sense of well-being

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

citalopram is a sample topic found in Davis's Drug Guide. All other sections of this record are viewable by clicking on the index in the left column, or by clicking on "Display all Sections" in the "Content Manager".

To find other Davis's Drug Guide topics, please login or purchase a subscription.