Citalopram (Dosage)

Citalopram is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) group. It has no effect on noradrenaline, dopamine or GABA reuptake.

CONTRAINDICATIONS

Hypersensitivity. Citalopram is contraindicated during treatment with MAOI antidepressants including selegiline at doses >10mg/day. Treatment with citalopram can be started 14 days after discontinuation of an irreversible MAOI or the specified time after discontinuation of a reversible MAOI; and treatment with MAOI antidepressants can be started 7 days after discontinuation of treatment with citalopram. Concomitant treatment with pimozide and/or linezolid (except with close blood pressure control) is contraindicated.

The use of citalopram is contraindicated in patients with a history of elongated cardiac QT interval or congenital long QT segment syndrome, as well as in treatment with drugs that prolong the QT interval.

PRECAUTIONS

Precautions should be taken in patients with severe renal insufficiency, hepatic insufficiency, manic crisis, history of bleeding disorders, patients undergoing electroconvulsive therapy (ECT), diabetics and psychotics. Extreme caution should also be exercised if citalopram is prescribed to patients at risk of developing Torsade de Pointes, e.g., patients with congestive heart failure, myocardial infarction, bradyarrhythmias or predisposition to hypokalemia or hypomagnesemia due to disease or medication; angle-closure glaucoma or history of glaucoma.

Avoid prescribing citalopram in unstable epilepsy and monitor in controlled epilepsy. Discontinue treatment if seizures appear or their frequency increases.

Do not use in children under 18 years of age.

At the beginning of treatment may increase anxiety symptoms (paradoxical anxiety), start with lower doses. Risk of hyponatremia. Caution and monitoring in patients with history of suicide or significant degree of suicidal ideation prior to initiation of treatment. Akathisia/psychomotor agitation may appear in the first weeks, evaluate its use.

SIDE EFFECTS

Increased appetite, decreased appetite, weight gain, weight loss, anorexia; agitation, nervousness, decreased libido, anxiety, confusion, sleep disturbances, attention disturbance, abnormal orgasms (women), abnormal dreams, apathy; drowsiness, insomnia, headache, tremor, dizziness, paresthesia, migraine, amnesia; abnormal accommodation, visual disturbance; tinnitus; palpitations, tachycardia; hypertension, orthostatic hypotension; yawning, rhinitis, sinusitis; dry mouth, nausea, diarrhea, constipation, vomiting, dyspepsia, abdominal pain, flatulence, increased salivation, taste abnormalities; increased sweating, pruritus, rash, myalgia, arthralgia; urination disorder, polyuria; impotence, ejaculation disorder, ejaculatory insufficiency, dysmenorrhea (women); asthenia, fatigue.

PHARMACOLOGICAL INTERACTIONS

Warnings and precautions with buspirone At the pharmacodynamic level, cases of serotonergic syndrome have been reported.

Serotonergic effects increased with lithium or tryptophan.

Avoid taking citalopram with alcohol.

Warnings and precautions with: drugs that lower the seizure threshold, e.g. antidepressants (tricyclics, SSRIs), neuroleptics (phenothiazines, thioxanthines and butyrophenones), mefloquine, bupropion and tramadol.

Citalopram increases the concentration of: desimipramine and metoprolol; in these cases adjust the dose.

Citalopram concentration is increased with: cimetidine, omeprazole, esomeprazole, fluvoxamine, lansoprazole, ticlopidine; in these cases adjust the dose of citalopram.

Do not use citalopram together with drugs with serotonergic effect such as sumatriptan or other triptans, tramadol and tryptophan; neither together with St. John's wort. Caution in concomitant use of oral anticoagulants, drugs that affect platelet function such as NSAIDs, ASA, dipyridamole and ticlopidine, or others (e.g. atypical antipsychotics, phenothiazines, tricyclic antidepressants) that increase the risk of bleeding. Avoid abrupt discontinuation of treatment with citalopram.

COMMERCIAL NAMES

• Calton®
• Citalvir® Citalvir® Citalvir® Citalvir® Citalvir® Citalvir
• Prisdal® Prisdal® Prisdal® Prisdal® Prisdal® Prisdal® Prisdal
• Relapaz®
• Seregra®
• Seropram®