Citalopram Hydrobromide (Celexa) Drug Study

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Generic Name: citalopram hydrobromide

Brand Names: Celexa, Co Citalopram (CAN)

Drug classes: Antidepressant, SSRI

Pregnancy Category C

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: OCD, panic disorder, PMDD, social phobia, trichotillomania, PTSD

Contraindications and cautions

• Contraindicated with MAOI use; allergy to drug or any component of the drug or other SSRIs; concomitant use of pimozide.
• Use cautiously with renal or hepatic impairment, pregnancy, lactation, and in patients who are elderly or suicidal.

Available forms:  Tablets—10, 20, 40 mg; oral solution—2 mg/mL; orally disintegrating tablets—10, 20, 40 mg

Dosages

ADULTS

Initially, 20 mg/day PO as a single daily dose. May be increased to 40 mg/day if needed no less than an interval of 1 wk.

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

Metabolism: Hepatic; T_1/2: 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 TCAs, 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
• Risk of prolonged QT interval and potentially fatal cardiac arrhythmias if combined with pimozide; avoid this combination

Drug-alternative therapy

• Increased risk of severe reaction if combined with St. John’s wort.

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, the elderly, pregnancy, lactation, suicidal tendencies
• Physical: Orientation, reflexes; P, BP, perfusion; bowel sounds, normal output; urinary output; liver evaluation; LFTs, renal function tests

Interventions

• BLACK BOX WARNING: Be aware of increased risk of suicidality in children and adolescents; monitor accordingly.
• Administer once a day, in the morning; may be taken with food if desired.
• Instruct patient using orally disintegrating tablets to place tablet in mouth, wait until it dissolves, and then swallow. Do not cut, crush, or chew.
• Encourage patient to continue use for 4–6 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.

Teaching points

• 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. Place orally disintegrating tablet in mouth and allow to disintegrate; then swallow. Do not cut, crush, or chew tablets.
• This drug should not be taken during pregnancy or when nursing a baby; use of barrier contraceptives is suggested.
• You may experience these side effects: 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 frequent small meals, 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