Medications and Drugs
Pharmacy Author: Omudhome Ogbru, PharmD
Medical and Pharmacy Editor: Jay W. Marks, MD
GENERIC NAME: citalopram
BRAND NAME: Celexa
DRUG CLASS AND MECHANISM: Citalopram is an
antidepressant medication
that affects neurotransmitters, the chemicals that nerves within the brain use
to communicate with each other. Neurotransmitters are manufactured and released
by nerves and then travel and attach to nearby nerves. Thus, neurotransmitters
can be thought of as the communication system of the brain. Many experts believe
that an imbalance among neurotransmitters is the cause of
depression. Citalopram
works by preventing the uptake of one neurotransmitter, serotonin, by nerve
cells after it has been released. Since uptake is an important mechanism for
removing released neurotransmitters and terminating their actions on adjacent
nerves, the reduced uptake caused by citalopram results in more free serotonin
in the brain to stimulate nerve cells. Citalopram is in the class of drugs
called selective serotonin reuptake inhibitors (SSRIs), a class that also
contains fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft).
Citalopram was approved by the FDA in July 1998.
GENERIC AVAILABLE: Yes
PRESCRIPTION: Yes
PREPARATIONS: Tablets: 10, 20, and 40 mg. Solution: 10 mg/5 ml
STORAGE: Citalopram should be stored at room temperature, 15 to 30 C
(59 to 86 F).
PRESCRIBED FOR: Citalopram is used for the management of depression.
Citalopram also is used for treating obsessive compulsive disorder (OCD),
panic
disorder, premenstrual dysphoric syndrome
(PMDD), anxiety disorder, and
posttraumatic stress disorder.
DOSING: The usual starting dose is 20 mg in the morning or evening.
The dose may be increased to 40 mg daily after one week. A dose of 60 mg has not
been shown to be more effective than 40 mg. As with all antidepressants, it may
take several weeks of treatment before maximum effects are seen. Doses are often
slowly adjusted upwards to find the most effective dose.
DRUG INTERACTIONS: All SSRIs, including citalopram, should not be
taken with any of the mono-amine oxidase (MAO) inhibitor-class of
antidepressants, for example, isocarboxazid (Marplan), phenelzine (Nardil),
tranylcypromine (Parnate), selegiline (Eldepryl), and
procarbazine (Matulane).
Such combinations may lead to confusion, high blood pressure, tremor, and
hyperactivity. If treatment is to be changed from citalopram to an MAOI or
vice-versa, there should be a 14 day period without either drug before the
alternative drug is started. Tryptophan, a common dietary supplement, can cause
headaches,
nausea, sweating, and
dizziness when taken with any SSRI.
Use of an SSRI with aspirin, nonsteroidal anti-inflammatory drugs or other
drugs that affect bleeding may increase the likelihood of upper gastrointestinal
bleeding.
PREGNANCY: Exposure of neonates to citalopram in the
third trimester
may cause complications.
NURSING MOTHERS: Citalopram is excreted in breast milk.
Breastfeeding
by a citalopram treated woman may cause adverse effects in the infant.
SIDE EFFECTS: The most common side effects associated with citalopram
are nausea, dry mouth,
vomiting, excessive sweating, headache,
tremor,
drowsiness, and inability to sleep. Overall, between 1 in 6 and 1 in 5 persons
experience a side effect. Citalopram is also associated with sexual dysfunction.
Some patients may experience withdrawal reactions upon stopping citalopram.
Symptoms of withdrawal include dizziness, tingling sensations, tiredness, vivid
dreams, and irritability or poor mood.
Antidepressants increased the risk of suicidal thinking and behavior
(suicidality) in short-term studies in children and adolescents with depression
and other psychiatric disorders. Anyone considering the use of citalopram or any
other antidepressant in a child or adolescent must balance this risk with the
clinical need. Patients who are started on therapy should be closely observed
for clinical worsening, suicidality, or unusual changes in behavior.
Reference: FDA Prescribing Information
Last Editorial Review: 10/17/2007
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
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