Citalopram is an antidepressant drug used in treating depression associated with mood disorders. It is also occasionally used to treat body dysmorphic disorder and anxiety. Celexa is an orally administered selective serotonin reuptake inhibitor (SSRI) with a chemical structure which is unrelated to that of other SSRIs or tricyclic, tetracyclic, or other available antidepressant agents.
Citalopram’s mechanism of action is presumably linked to potentiation of serotonergic activity in the central nervous system as a result from its inhibition of neuronal reuptake of serotonin.
Animal studies have suggested that citalopram is a highly selective serotonin reuptake inhibitor (SSRI) having minimal effects on norepinephrine (NE) and dopamine (DA) neuronal reuptake. Tolerance to the inhibition of serotonin uptake is not induced by long-term treatment of rats with Celexa. Citalopram is a racemic mixture (50/50).
Indications and Dosage:
Celexa should be administered in an initial dose of 20mg once per day, with a general increase to 40mg per day. Certain patients may require a dose of 60mg per day, but generally doses above 40mg are not recommended. Celexa can be administered with or without food, in the morning or evening.
Most elderly patients and persons with hepatic impairment are recommended a dosage of 20mg per day, with 40mg per day only for non-responding patients. No dosage adjustment is needed for those persons with mild or moderate renal impairment. Citalopram should be administered with caution in patients with severe renal impairment.
Pregnant women should consult their physician and carefully consider the potential risks and benefits of treatment with citalopram.
The most common side effects of citalopram include fatigue or feeling ill, dry mouth, drowsiness, sweating, headache, trembling, dizziness, sleep difficulties, agitation or nervousness, blurred vision, constipation or diarrhea, missed heartbeats, feelings of weakness, and for men, side effects may often include difficulty ejaculating and/or erectile dysfunction.
Less common side effects of citalopram include itchiness, rashes, changes in taste, decreased libido or impotence, failure to orgasm, painful menstruation, migraine, strange dreams, tingling in fingers or toes, loss of memory, lack of concentration, anxiety, confusion, yawn, indigestion, changes in mood, vomiting, stomach ache, flatulence, increased saliva, weight changes, fast heartbeat, changes in blood pressure, sinusitis, runny nose, and changes in passing urine.
Rare side effects can include muscle pain, convulsions, coughing, abnormal movement of the face or body, increased libido, photosensitivity, slowing of the heartbeat, ringing in the ears, suicidality, fainting, or allergic reactions.
Drugs or substances that may interact with Celexa include:
- MAO Inhibitors (within 14 days) – serious, even life-threatening, interactions may occur
- Imipramine/desipramine – metabolism of this drug may be inhibited by citalopram
- Grapefruit juice
- BuSpar, Parlodel, Prozac, Luvox, Ultram, Desyrel, Tryptophan, Effexor, Elavil, Anafranil, Tofranil, Dextromethorphan (cough medicine), Sinemet, Lithium (Eskalith), Demerol, Manerex, Serzone, Talwin, Zoloft, LSD, MDMA (ecstasy), marijuana, Imitrex, and St. John’s Wort – these medications taken in addition to Celexa may increase the chance of developing serotonin syndrome – a very rare, but very serious unwanted side effect which exhibits such symptoms as confusion, fever, poor coordination, diarrhea, shivering, restlessness, talking or acting with uncontrollable excitement, trembling or shaking, twitching, or sweating.
Information for Parents and Kids:
Studies on citalopram have only been conducted on adults, and the effects of Celexa in children under the age of 18 have not been established.
Studies indicate that Celexa may increase the risk of birth defects when taken by pregnant women; the doses used in said studies were higher than normal therapy doses. Celexa is excreted in breast milk, and may cause excessive sleepiness and/or weight loss in a nursing infant; it is not recommended that women breastfeed while using citalopram.
Warnings and Precautions:
Celexa is not addictive; however discontinuing usage of the drug abruptly may cause withdrawal. Doses should be tapered off when Celexa therapy is discontinued.
Citalopram may cause drowsiness or difficulty thinking in some people. Patients should not drive or operate heavy machinery until they know that the drug will not affect their ability to safely engage in these activities.
As with any SSRI, cessation of citalopram may cause several withdrawal symptoms, and some may be severe. Symptoms of withdrawal include dizziness, tingling sensations, “brain shivers,” tiredness, vivid dreams, irritability or poor mood, vertigo, insomnia, abdominal cramps, chills, and anxiety. Some people have reported extreme depression, violent thoughts, and suicidality after discontinuing use of Celexa.
It is always best to consult a physician before discontinuing any SSRI treatment.
Over-dosage & Contraindications:
Citalopram is considered relatively safe in overdose; though coma at a dosage of 400mg has been observed. In clinical trials, reported overdoses of up to 2000mg had no associated fatalities. Overdoses of up to 6000mg have been reported as well in post-marketing evaluation of citalopram. If an overdose occurs, as with any over-dosage, it is important to seek medical attention.
Citalopram should not be taken by those people with kidney or liver disease, seizures or a history of seizures, mania or a history of mania.
Generic Name: citalopram or nitalapram
Chemical Formula: C20H22BrFN2O
Routes of Administration: oral
Elimination Half Life: approximately 37 hours
Legal Status: by prescription only