Citalopram
Citalopram is an antidepressant medication that affects neurotransmitters, the chemical transmitters within the brain. Citalopram works by preventing the uptake of one neurotransmitter, serotonin, by nerve cells after it has been released.
Citalopram ®
DRUG CLASS AND MECHANISM
Neurotransmitters manufactured and released by nerves attach to adjacent nerves and alter their activities. 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. Such 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: No
PRESCRIPTION: Yes
PREPARATIONS: Tablets (oval): 20mg, 40mg.
STORAGE: Tablets should be kept at room temperature, 15° to 30°C (59° to 86°F).
PRESCRIBED FOR
Citalopram is used for the management of depression. It also has been tested in persons with obsessive- compulsive disorders and panic disorders.
DOSING
Citalopram is given as a single daily dose, usually in the morning. As with all antidepressants, it may take several weeks of treatment before maximum effects are seen. Doses are often adjusted slowly upwards to find the most effective dose. Elderly patients, debilitated persons, and patients with certain kidney or liver diseases may need lower doses.
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), and procarbazine (Matulane). Such combinations may lead to confusion, high blood pressure, tremor, and hyperactivity. This same type of interaction also may occur with selegiline (Eldepryl), fenfluramine (Pondimin), and dexfenfluramine (Redux). Tryptophan can cause headaches, nausea, sweating, and dizziness when taken with any SSRI.
PREGNANCY
There are no adequate studies of citalopram in pregnant women.
NURSING MOTHERS: It is not known if citalopram is secreted in breast milk.
SIDE EFFECTS
The most commonly-noted side effects associated with citalopram are nausea, vomiting, excessive sweating, headache, tremor, and inability to sleep. Overall, between 1 in 6 and 1 in 5 persons experience a side effect. Some patients may experience withdrawal reactions upon stopping some SSRIs such as paroxetine, and such symptoms also may occur with citalopram. Symptoms of withdrawal include dizziness, tingling sensations , tiredness, vivid dreams, irritability or poor mood.
It has been suggested that SSRIs may cause depression to worsen and even lead to suicide in a small number of patients. These potential side effects are difficult to evaluate in depressed patients because depression can progress with or without treatment, and suicide is itself a consequence of depression. Moreover, the evidence supporting these potential side effects is weak. Therefore, no conclusions can yet be drawn about the relationship between SSRIs and worsening depression and suicide. Until better information is available, patients receiving SSRIs should be monitored for worsening depression and suicidal tendencies.
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