Citalopram

is an antidepressant drug used to treat depression, obsessive compulsive disorder (OCD), panic disorder, premenstrual dysphoric syndrome (PMDD), anxiety disorder, and posttraumatic stress disorder. Side effects, drug interactions, warnings and precautions, and patient safety information should be reviewed prior to taking any medication.
[1]

History

Citalopram was originally created in 1989 by the pharmaceutical company Lundbeck. The patent expired in 2003, allowing other companies to legally produce generic versions.
[2]

Uses

Citalopram is an antidepressant (selective serotonin reuptake inhibitor-SSRI) used to treat depression. It works by restoring the balance of certain natural substances (neurotransmitters such as serotonin) in the brain. Citalopram may improve your feelings of well-being and energy level. This drug is also used to treat other mental conditions (obsessive-compulsive disorder, panic disorder)
[1]

Pharmacology

The mechanism of action of citalopram HBr as an antidepressant is presumed to be linked to potentiation of serotonergic activity in the central nervous system (CNS) resulting from its inhibition of CNS neuronal reuptake of serotonin (5-HT).
Following a single oral dose (40 mg tablet) of citalopram, peak blood levels occur at about 4 hours. The absolute bioavailability of citalopram was about 80% relative to an intravenous dose, and absorption is not affected by food. The volume of distribution of citalopram is about 12 L/kg and the binding of citalopram (CT), demethylcitalopram (DCT) and didemethylcitalopram (DDCT) to human plasma proteins is about 80%.
Citalopram is metabolized to demethylcitalopram (DCT), didemethylcitalopram (DDCT), citalopram-N-oxide, and a deaminated propionic acid derivative. In humans, unchanged citalopram is the predominant compound in plasma. At steady state, the concentrations of citalopram's metabolites, DCT and DDCT, in plasma are approximately one-half and one-tenth, respectively, that of the parent drug.
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Dosage

Initial dose: 20 mg PO qDay.

If needed, may increase to 40 mg/day after at least 1 week.

Doses above 40 mg/day are not recommended because of risk for QT prolongation without additional benefit for treating depression.

Coadministration with CYP2C19 inhibitors (eg, cimetidine, fluconazole, omeprazole) or poor metabolizers: Do not exceed 20 mg PO qDay.

60 years or older: Do not exceed 20 mg PO qDay.
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Drug Interactions

Most doctors or pharmacists may already be aware of any possible drug interactions and may be monitoring them. A patient is not supposed to start, stop, or change the dosage of any medicine before checking with the doctor or pharmacist first.
The following drugs have contradictory interactions with Citalopram:

dronedarone
isocarboxazid
phenelzine
pimozide
procarbazine
selegiline
selegiline transdermal
tranylcypromine

There are numerous drugs that also have serious interactions with Citalopram. Some of them are mentioned below:

almotriptan
amitriptyline
cocaine
desipramine
fluoxetine
fluvoxamine
vilazodone
zolmitriptan

[5]

Adverse Effects

The following are the possible adverse effects on taking Citalopram. The percentage in brackets indicate the average chance of that individual adverse effect.


Dry mouth (20%)
Nausea (21%)
Somnolence (18%)
Insomnia (15%)
Incr sweating (11%)
Tremor (8%)
Diarrhea (8%)
Ejaculation disorder (6%)
Rhinitis (5%)
Upper respiratory infection (5%)
Dyspepsia (5%)
Fatigue (5%)
omiting (4%)
Anxiety (4%)
Anorexia (4%)
Abdominal pain (3%)
Agitation (3%)
Impotence (3%)
Sinusitis (3%)
Dysmenorrhea (3%)
Decr libido (2%)
Yawning (2%)
Arthralgia (2%)
Myalgia (2%)
Amenorrhea (>1%)
Confusion (>1%)
Cough (>1%)
Flatulence (>1%)
Incr saliva (>1%)
Migraine (>1%)
Orthostatic hypotension (>1%)
Paresthesia (>1%)
Polyuria (>1%)
Pruritus (>1%)
Rash (>1%)
Tachycardia (>1%)
Weight change (>1%)
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Contraindications

Hypersensitivity

Concomitant use with MAOIs is contraindicated; at least 14 days should elapse between use of citalopram and MAOIs

Coadministration with pimozide is contraindicated

Congenital long QT syndrome.
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Cautions

In neonates exposed to SNRIs/SSRIs late in third trimester: Risk of complications such as feeding difficulties, irritability, and respiratory problems

Clinical worsening and suicide ideation may occur despite medication in adolescents and young adults (18-24 yr)

Risks of: hyponatremia; abnormal bleeding (increased if concomitant aspirin, NSAIDs or anticoagulants, or hemorrhagic diathesis); impairment of cognitive and motor functions

Risk of serotonin syndrome or neuroleptic malignant syndrome (NMS)-like reactions have been reported with SSRIs alone, or with concomitant use of serotonergic drugs, with drugs which impair metabolism of serotonin, or with antipsychotics or other dopamine antagonists

Activation of mania/hypomania has been reported; use caution when treating patients with history of mania

Use caution when treating patients with history of seizure disorder.
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Pricing

The pricing varies depending on what form one would like to buy and the brand.
The 10mg/5 ml solution is priced in between $0.61 to $0.71. The prices of 10mg tablet vary from $0.09 to $6.41, while the prices for 20mg tablet vary from $0.17 to $8.41. The 40mg tablet, which is the heaviest of the available dosages ranges in between $0.25 to $10