CITALOPRAM HYDROBROMIDE

CITALOPRAM HYDROBROMIDe
(cit-a-lo'pram)
Celexa
Classifications: psychotherapeu-tic agent; selective serotonin-reuptake inhibitor (ssri);
Therapeutic:antidepressant; ssri

Prototype: Fluoxetine
Pregnancy Category: C

Availability

20 mg, 40 mg tablets; 10 mg/5 mL oral solution

Action

Selective serotonin reuptake inhibitor (SSRI) in the CNS. Antidepressant effect is presumed to be linked to its inhibition of CNS presynaptic neuronal uptake of serotonin which results in antidepressant activity.

Therapeutic Effect

Does not inhibit MAO. Selective serotonin reuptake inhibition mechanism results in the antidepressant activity of citalopram.

Uses

Depression.

Contraindications

Hypersensitivity to citalopram; concurrent use of MAOIs or use within 14 d of discontinuing MAOIs; pregnancy (category C); mania; volume depleted; suicidal ideation; children <18 y.

Cautious Use

Hypersensitivity to other SSRIs; renal or hepatic insufficiency; history of potential suicide; older adults; concurrent use of diuretics, dehydration, severe renal impairment or renal failure, cardiovascular disease (e.g., dysrhythmias, conduction defects, myocardial ischemia); history of seizure disorders or suicidal tendencies; bipolar disorder; ECT treatments; lactation.

Route & Dosage

Depression
Adult: PO Start at 20 mg q.d., may increase to 40 mg q.d. if needed
Geriatric: PO 20 mg q.d.

Administration

Oral
  • Do not begin this drug within 14 d of stopping an MAOI.
  • Reduced doses are advised for the older adult and those with hepatic or renal impairment.
  • Dose increments should be separated by at least 1 wk.
  • Store at 15°–30° C (59°–86° F) in tightly closed container and protect from light.

Adverse Effects (≥1%)

Body as a Whole: Asthenia, fatigue, fever, arthralgia, myalgia. CV: Tachycardia, postural hypotension, hypotension. GI: Nausea, vomiting, diarrhea, dyspepsia, abdominal pain, dry mouth, anorexia, flatulence. CNS: Dizziness, insomnia, somnolence, agitation, tremor, anxiety, paresthesia, migraine. Respiratory: URI, rhinitis, sinusitis. Skin: Increased sweating. Urogenital: Dysmenorrhea, decreased libido, ejaculation disorder, impotence.

Interactions

Drug: Combination with maois could result in hypertensive crisis, hyperthermia, rigidity, myoclonus, autonomic instability; cimetidine may increase citalopram levels; linezolid may cause serotonin syndrome. Herbal: St. John's wort may cause serotonin syndrome.

Pharmacokinetics

Absorption: Rapidly absorbed from GI tract; approximately 80% reaches systemic circulation. Peak: Steady-state serum concentrations in 1 wk; peak blood levels at 4 h. Distribution: 80% protein bound; crosses placenta; distributed into breast milk. Metabolism: In liver by cytochrome P450 3A4 and cytochrome P450 2C9 enzymes. Elimination: 20% in urine, 80% in bile. Half-Life: 35 h.

Nursing Implications

Assessment & Drug Effects

  • Watch closely for worsening of depression or emergence of suicidal ideations.
  • Monitor for therapeutic effectiveness: Indicated by elevation of mood; 1–4 wk may be needed before improvement is noted.
  • Lab tests: Monitor periodically hepatic functions, CBC, serum sodium, and lithium levels when the two drugs are given concurrently.
  • Monitor periodically HR and BP, and carefully monitor complete cardiac status in person with known or suspected cardiac disease.
  • Monitor closely older adult patients for adverse effects especially with doses >20 mg/d.

Patient & Family Education

  • Do not engage in hazardous activities until reaction to this drug is known.
  • Avoid using alcohol while taking citalopram.
  • Inform physician of commonly used OTC drugs as there is potential for drug interactions.
  • Report distressing adverse effects including any changes in sexual functioning or response.
  • Periodic ophthalmology exams are advised with long-term treatment.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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