citalopram hydrobromide

(si tal' oh pram)

Celexa Pregnancy Category C
Drug classes

Antidepressant SSRI
Therapeutic actions

Potentiates serotonergic activity in the CNS by inhibiting neuronal reuptake of serotonin, resulting in antidepressant effect, with little effect on norepinephrine or dopamine reuptake.
Indications

Treatment of depression, particularly effective in major depressive disorders Unlabeled uses: Obsessive-compulsive disorders, panic disorder, PMDD, social phobia, trichotillomania. Contraindicated with MAOI use; allergy to drug or any component of the drug or other SSRIs. Use cautiously with renal or hepatic impairment, pregnancy, lactation, and in patients who are elderly or suicidal.

Contraindications and cautions

Available forms

Tablets10, 20, 40 mg; oral solution10 mg/5 mL

Dosages ADULTS

Initially, 20 mg/day PO as a single daily dose. May be increased to 40 mg/day if needed.

PEDIATRIC PATIENTS

Safety and efficacy not established.

GERIATRIC PATIENTS OR PATIENTS WITH RENAL OR HEPATIC IMPAIRMENT

20 mg/day PO as a single dose; increase to 40 mg/day only if clearly needed and patient is not responding.
Pharmacokinetics
Route Oral Onset Slow Peak 24 hr

Metabolism: Hepatic; T1/2: 35 hr Distribution: Crosses placenta; enters breast milk Excretion: Urine
Adverse effects

CNS: Somnolence, dizziness, insomnia, tremor, nervousness, headache, anxiety, paresthesia, blurred vision CV: Palpitations, vasodilation, orthostatic hypotension, hypertension Dermatologic: Sweating, rash, redness GI: Nausea, dry mouth, constipation, diarrhea, anorexia, flatulence, vomiting GU: Ejaculatory disorders Respiratory: Sinusitis, URI, cough, rhinitis

Interactions

Drug-drug Increased citalopram levels and toxicity if taken with MAOIs; ensure that patient has been off the MAOI for at least 14 days before administering citalopram Increased citalopram levels with azole antifungals, macrolides Possible severe adverse effects if combined with tricyclic antidepressants, erythromycin; use caution Possible increased effects of beta blockers; monitor patient and reduce beta blocker dose as needed Possible increased bleeding with warfarin, monitor patient carefully Drug-alternative therapy Increased risk of severe reaction if combined with St. John's wort therapy.
Nursing considerations CLINICAL ALERT!

Name confusion has occurred between Celexa (citalopram), Celebrex (celecoxib), Xanax (alprazolam), and Cerebyx (fosphenytoin); use caution.
Assessment

History: MAOI use; allergy to drug or any component of the drug; renal or hepatic impairment, elderly, pregnancy, lactation, suicidal tendencies Physical: Orientation, reflexes; P, BP, perfusion; bowel sounds, normal output; urinary output; liver evaluation; liver and renal function tests Administer once a day, in the morning; may be taken with food if desired. Encourage patient to continue use for 46 wk, as directed, to ensure adequate levels to affect depression. Limit amount of drug given in prescription to potentially suicidal patients. Establish appropriate safety precautions if patient experiences adverse CNS effects. Institute appropriate therapy for patient suffering from depression. Take this drug exactly as directed, and as long as directed; it may take a few weeks to realize the benefits of the drug. The drug may be taken with food if desired.

Interventions

Teaching points

This drug should not be taken during pregnancy or when nursing a baby; use of barrier contraceptives is suggested. These side effects may occur: Drowsiness, dizziness, tremor (use caution and avoid driving a car or performing other tasks that require alertness if you experience daytime drowsiness); GI upset (eat small, frequent meals; perform frequent mouth care); alterations in sexual function (it may help to know that this is a drug effect, and will pass when drug therapy is ended). Report severe nausea, vomiting; palpitations; blurred vision; excessive sweating.

Adverse effects in Italic are most common; those in Bold are life-threatening.