Citalopram (Dosage)

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

CONTRAINDICATIONS

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

The use of citalopram is contraindicated in patients with a history of prolonged QT cardiac interval or congenital long QT syndrome, as well as in treatments with medications that prolong the QT interval.

PRECAUTIONS

Precautions should be taken in patients with severe renal impairment, hepatic failure, manic crisis, history of bleeding disorders, patients undergoing electroconvulsive therapy (ECT), diabetics and psychotics. 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 hypomagnesiemia due to illness or medication; angle-closure glaucoma or a history of glaucoma.

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

Do not use in children under 18 years old.

At the beginning of the treatment symptoms of anxiety can be increased (paradoxical anxiety), start the treatment with lower doses. There exists risk of hyponatremia. Caution and monitoring in patients with a history of suicide or significant degree of suicidal ideation prior to the start of treatment. Akathisia / psychomotor agitation may appear in the first weeks, assess benefits/risks.

SIDE EFFECTS

Increased appetite, decreased appetite, weight gain, weight loss, anorexia; agitation, nervousness, decreased libido, anxiety, confusion, sleep disturbances, disturbed attention, abnormal orgasms (women), abnormal dreams, apathy; drowsiness, insomnia, headache, tremor, dizziness, paresthesias, migraine, amnesia; abnormal accommodation, visual disorder; 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

PHARMACOLOGIC INTERACTIONS

Warnings and precautions with buspirone at the pharmacodynamic level, serotonin syndrome has been reported.

Increased serotonergic effects with lithium or tryptophan.

Avoid taking citalopram with alcohol.

Warnings and precautions with: medications that lower the convulsive threshold, e.g. Antidepressants (tricyclics, SSRIs), neuroleptics (phenothiazines, thioxanthenes and butyrophenones), mefloquine, bupropion and tramadol.

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

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

Do not use citalopram together with serotoninergic drugs such as sumatriptan or other triptans, tramadol and tryptophan; nor together with St. John's wort. Caution in concomitant use of oral anticoagulants, with drugs that affect platelet function such as NSAIDs, ASAs, dipyridamole and ticlopidine, or others (e.g., atypical antipsychotics, phenothiazines, tricyclic antidepressants) that increase the risk of hemorrhage. Avoid abrupt withdrawal of treatment with citalopram.

BRAND NAMES

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