Citapram

Indications

Citalopram is an antidepressant used to treat depression and to prevent it from coming back. Doctors also use it for panic disorder, with or without fear of open or crowded places (agoraphobia).

How It Works

Citalopram belongs to the selective serotonin reuptake inhibitor (SSRI) group. It increases the amount of serotonin, a chemical messenger in the brain that helps regulate mood and anxiety, by slowing its reabsorption into nerve cells. Improvement usually starts after 2 to 4 weeks.

Dosage and Administration

Take by mouth once a day, morning or evening, with or without food, as prescribed. Treatment for depression is commonly started at 20 mg a day and adjusted by the doctor; lower doses are used in panic disorder at the start, in people over 65 and in liver disease, and there is a maximum dose the doctor will not exceed because of heart rhythm risk. Continue for several months after you feel better. Do not stop suddenly: the doctor will reduce the dose gradually.

Interactions

• Never take with MAO inhibitors such as Selegiline or Linezolid, or within 14 days of stopping an MAO inhibitor.
• Medicines that prolong the QT interval, such as some antipsychotics, Erythromycin, Methadone or Hydroxychloroquine, must be avoided.
• Other serotonin medicines such as Tramadol, Triptans, other antidepressants, Lithium and St John's Wort increase the risk of serotonin syndrome.
• Aspirin, NSAIDs such as Ibuprofen, Warfarin and Clopidogrel increase bleeding risk.
• Omeprazole and Cimetidine can raise citalopram levels.

Contraindications

• Allergy to citalopram or Escitalopram.
• Known long QT syndrome or use with QT-prolonging medicines.
• Use with MAO inhibitors or Pimozide.

Side Effects

Common effects include nausea, dry mouth, sweating, sleepiness or trouble sleeping, headache, tremor, loss of appetite, diarrhoea and sexual problems. These often settle in the first weeks.

Get urgent medical help for thoughts of suicide or self-harm, especially in young people at the start of treatment; fainting or a fast, irregular heartbeat; seizures; high fever with agitation, muscle stiffness or confusion (possible serotonin syndrome); unusual bleeding; or a severe allergic reaction.

Pregnancy and Lactation

Discuss with your doctor if you are pregnant or planning pregnancy: the benefits and risks will be weighed, and use late in pregnancy may affect the newborn. Citalopram passes into breast milk; the doctor will advise whether breastfeeding is suitable.

Precautions and Warnings

• May cause drowsiness: avoid driving until you know how it affects you, and avoid alcohol.
• Use with care in heart disease, low potassium or magnesium, epilepsy, bipolar disorder, glaucoma, diabetes and bleeding disorders.
• Elderly people may develop low sodium: report confusion or weakness.
• Not usually used in children and adolescents under 18.

Overdose

Overdose can cause drowsiness, vomiting, fast heartbeat, seizures and dangerous heart rhythm changes. Seek emergency medical help immediately.

Therapeutic Class

Antidepressant, selective serotonin reuptake inhibitor (SSRI).

Storage

Store below 30°C in a dry place, away from light and out of the reach of children.