Citalopram Hydrobromide

Indications

Citalopram Hydrobromide is used for: Depressive illness, Bipolar disorder, Panic disorder, Substance abuse disorders, Alcohol dependence, Anxiety disorders including obsessive-compulsive disorder and social phobia, Post-traumatic stress disorder, Premenstrual syndrome, Idiopathic Parkinson's disease and Eating disorder.

Adult Dose

Oral Depression; Depressive phase of bipolar disorder Adult: Initially, 20 mg/day, increased to max 40 mg/day after at least 1 wk. Elderly: 10 mg/day. Max: 20 mg/day. Hepatic impairment: Mild to moderate: 10 mg/day for the 1st 2 wk. Max: 20 mg/day. Panic disorder with or without agoraphobia Adult: Initially, 10 mg/day, increased to 20 mg/day after 1 wk. Elderly: 10 mg/day. Max: 20 mg/day. Hepatic impairment: Mild to moderate: 10 mg/day for the 1st 2 wk. Max: 20 mg/day.

Child Dose

Child: Contraindicated.

Renal Dose

Renal impairment: No dosage adjustment needed.

Administration

May be taken with or without food.

Contra Indications

Hypersensitivity, concomitant admin with MAOIs or within 14 days of discontinuing MAOI treatment; children and adolescents <18 yr; treatment of depressive illness; lactation.

Precautions

Caution should be taken in patients with epilepsy, concurrent electroconvulsive therapy, history of mania, cardiac disease, diabetes mellitus, angle-closure glaucoma, history of bleeding disorders, hepatic and renal impairment. Abrupt withdrawal of Citalopram should be avoided. Gradual discontinuation of treatment if patient enters into manic phase; pregnancy. Increased risk of hyponatraemia and SIADH. May reduce convulsant threshold thus, citalopram should be used with care in epileptic patients. Lactation: Excreted in breast milk; use caution

Pregnancy-Lactation

Pregnancy Pregnancy category: C Use late in the third trimester associated with complications in newborns and may require prolonged hospitalization, respiratory support, and tube feeding Lactation Excreted in breast milk; use caution

Interactions

May increase anticoagulant effect w/ drugs affecting haemostatis (e.g. warfarin). Increased risk of hypomania w/ sibutramine. Increased lowering seizure threshold w/ TCAs and other SSRIs. Potentially Fatal: Increased risk of severe adverse effects (e.g. serotonin syndrome) w/ MAOI. QT interval prolongation w/ subsequent risk of torsade de pointes w/ QT-prolonging drugs (e.g. pimozide, quinidine, procainamide, chlorpromazine, thioridazine, amiodarone, sotalol, moxifloxacin, pentamidine, levomethadyl, methadone).

Adverse Effects

Side effects of Citalopram Hydrobromide : >10% Dry mouth (20%), Nausea (21%), Somnolence (18%), Insomnia (15%), Xerostomia (20%), Increased sweating (11%) 1-10% Tremor (8%), Diarrhea (8%), Ejaculation disorder (6%), Rhinitis (5%), Upper respiratory infection (5%), Dyspepsia (5%), Fatigue (5%), Vomiting (4%), Anxiety (4%), Anorexia (4%), Abdominal pain (3%), Agitation (3%), Impotence (3%), Sinusitis (3%), Dysmenorrhea (3%), Decreased libido (2%), Yawning (2%), Arthralgia (2%), Myalgia (2%), Amenorrhea (>1%), Confusion (>1%), Cough (>1%), Flatulence (>1%), Increased saliva (>1%), Migraine (>1%), Orthostatic hypotension (>1%), Paresthesia (>1%), Polyuria (>1%), Pruritus (>1%), Rash (>1%), Tachycardia (>1%), Weight change (>1%) Potentially Fatal: Increased risk of suicidal thinking and behaviour especially in child and adolescents. Monitor closely for signs of clinical worsening, suicidality or unusual changes in behaviour.

Mechanism of Action

Citalopram is bicyclic phthalane derivative and a selective serotonin re-uptake inhibitor, w/ little or no effect on noradrenaline, dopamine and GABA re-uptake. The inhibitory activity explains the antidepressant property of citalopram. It has no or very low affinity for 5-HT1AA, 5-HT2A, D1 and D2 receptors, alpha 1, alpha2, beta-adrenergic, histamine H1, muscarinic, cholinergic, benzodiazepine and opioid receptors.