Pharm
Citalopram
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Citalopram
, Celexa, Escitalopram, Lexapro
Mechanism
Selective Serotonin Reuptake Inhibitor
(
SSRI
)
Minimal effects on other neurotransmitters
Pharmacokinetics
Half-life: 20 hours
Indications
Major Depression
Preparations
Citalopram (Celexa)
Tablets: 10, 20 (scored), 40 (scored)
Oral Solution: 10 mg/5 ml
Escitalopram (Lexapro)
Active isomer of racemic Citalopram
Tablets: 5, 10 (scored), 20 mg (scored)
Dosing
Citalopram (Celexa)
Starting dose: 20 mg PO qd
Most effective dose: 40 mg PO qd
Maximum Dose: 40 mg
Escitalopram (Lexapro)
Starting Dose: 10 mg qd (equivalent to 40 mg Celexa)
Higher dose at 20 mg is not more effective than 10 mg
Adverse Effects
No increased weight gain
Midway on spectrum between
Anxiolytic
and anxiogenic
Similar to
Zoloft
on this spectrum
Well tolerated
Nausea
May occur initially but is transient
Consider decreasing dose to 10 mg initially
Less
Sexual Dysfunction
than
Prozac
,
Zoloft
,
Paxil
Sexual Dysfunction
in 10-15% of cases
Similar to
Luvox
and
Effexor
in terms of this effect
See
Antidepressant Induced Sexual Dysfunction
Drug Interactions
Cytochrome P450
2C19 Inhibitors
Arrhythmia
risk:
Prolonged QT
interval and
Torsades de Pointes
risk
Most significant agents
Proton Pump Inhibitor
s:
Omeprazole
,
Esomeprazole
Ethinyl Estradiol
(
Oral Contraceptive
s)
Agents that do not appear to have significant interactions
Proton Pump Inhibitor
s:
Pantoprazole
,
Lansoprazole
,
Dexlansoprazole
Precautions
Limit Citalopram to 20 mg daily in those on
Omeprazole
,
Esomeprazole
,
Oral Contraceptive
s
Consider Escitalopram (Lexapro) instead which appears safe to at least 20 mg daily with these agents
Resources
FDA Drug Safety Notice
http://www.fda.gov/Drugs/DrugSafety/ucm269086.htm
Resources
Celexa Website (Forest Pharmaceuticals)
http://www.celexa.com
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