Classifications: psychotherapeu-tic agent; selective serotonin-reuptake inhibitor (ssri); Therapeutic:antidepressant; ssri
Pregnancy Category: C
20 mg, 40 mg tablets; 10 mg/5 mL oral solution
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.
Does not inhibit MAO. Selective serotonin reuptake inhibition mechanism results in the antidepressant activity of citalopram.
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.
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
Adult: PO Start at 20 mg q.d., may increase to 40 mg q.d. if needed
Geriatric: PO 20 mg q.d.
- 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:
, 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
Increased sweating. Urogenital:
Dysmenorrhea, decreased libido, ejaculation disorder, impotence.
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
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:
Assessment & Drug Effects
- Watch closely for worsening of depression or emergence of suicidal ideations.
- Monitor for therapeutic effectiveness: Indicated by elevation of mood; 14 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
- 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.