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Citalopram

citalopramCitalopram is available by prescription in the United States.

Addictive Potential: Low more…

Emergency Room Visits Yearly: Unknown

Mandatory Minimum Sentence: Not Scheduled, Does Not Apply; Legal by Prescription

Mechanism of Action: (SSRI) Increases the Neurotransmitter Serotonin

Overview:

Citalopram (Celexa) is an antidepressant drug used to treat depression associated with mood disorders. It is also used on occasion in the “off-label” treatment of body dysmorphic disorder and anxiety.

Citalopram belongs to a class of drugs known as selective serotonin reuptake inhibitors (SSRIs). It is sold under the brand-names Celexa (U.S. and Canada, Forest Laboratories, Inc.), Cipramil (Australia, Brazil, Finland, Germany, Ireland, Norway, Sweden, United Kingdom), Citrol, Seropram, Talam (Europe and Australia), Citabax, Citaxin (Poland), Citalec (Slovakia), Recital (Israel, Thrima Inc. for Unipharm Ltd.), Zetalo (India), Celapram, Ciazil (Australia, New Zealand), Zentius (South America, Roemmers), Ciprapine (Ireland), Cilift (South Africa), Citox (Mexico), Citopam, Akarin (Denmark, Nycomed), Cipram (Turkey, Denmark, H. Lundbeck A/S), and Celius (Greece).

Side Effects and Drug Interactions:

Citalopram is generally considered safe and well-tolerated in the therapeutic dose range of 20 to 60 mg/day. A doctor must always monitor a patient taking an SSRI like citalopram. Distinct from some other agents in its class, citalopram exhibits linear pharmacokinetics and minimal drug interaction potential, making it a better choice for the elderly or comorbid patients.

Citalopram should be taken with caution when using St John’s wort, as resulting drug interactions could be adverse. This may be caused by compounds in the plant extract reducing the efficacy of the hepatic cytochrome P450 enzymes that process citalopram. It has also been suggested that such compounds, including hypericin, hyperforin and flavonoids, could have SSRI-mimetic effects on the nervous system, although this is still subject to debate. One study found that Hypericum extracts had similar effects in treating moderate depression as citalopram, with fewer side effects.

Citalopram can have a number of adverse effects. In clinical trials, over 10% of patients reported one or more of the following side effects: fatigue, drowsiness, dry mouth, increased sweating (hyperhidrosis), trembling, headache, dizziness, sleep disturbances, insomnia, cardiac arrhythmia, hallucinations, blood pressure changes, nausea and/or vomiting, diarrhea, heightened anorgasmia in females, impotence and ejaculatory problems in males. In rare cases (around over 1% of cases), some allergic reactions, convulsions, mood swings, anxiety and confusion have been reported.

One rare side effect of antidepressant medications is bruxism (teeth grinding). However there is no evidence directly implicating citalopram with teeth grinding.

When taken with Prilosec, the clearance of citalopram may be reduced, leading to higher blood levels of citalopram. Prilosec inhibits the CYP450 2C19 enzyme, one of the two primary enzymes responsible for the metabolism of citalopram. Dosage adjustments may be needed due to this effect.

Citalopram is contraindicated in individuals taking MAOIs. The drug is considered relatively safe in overdose, although fatal cases of dosages 840 mg to 1960 mg have been reported.

SSRI discontinuation syndrome has been reported when treatment is stopped. Tapering off citalopram therapy, as opposed to abrupt discontinuation, is recommended in order to diminish the occurrence and severity of discontinuation symptoms.

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