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GENERIC
NAME: citalopram
BRAND NAME:
Celexa
DRUG CLASS AND MECHANISM:
Citalopram is an antidepressant medication that
affects neurotransmitters, the chemical
transmitters within the brain. Neurotransmitters
manufactured and released by nerves attach to
adjacent nerves and alter their activities.
Thus, neurotransmitters can be thought of as the
communication system of the brain. Many experts
believe that an imbalance among
neurotransmitters is the cause of depression.
Citalopram works by preventing the uptake of one
neurotransmitter, serotonin, by nerve cells
after it has been released. Such uptake is an
important mechanism for removing released
neurotransmitters and terminating their actions
on adjacent nerves. The reduced uptake caused by
citalopram results in more free serotonin in the
brain to stimulate nerve cells. Citalopram is in
the class of drugs called selective serotonin
reuptake inhibitors (SSRIs), a class that also
contains fluoxetine (Prozac), paroxetine (Paxil)
and sertraline (Zoloft). Citalopram was approved
by the FDA in July 1998.
GENERIC AVAILABLE: No
PRESCRIPTION: Yes
PREPARATIONS: Tablets
(oval): 20mg, 40mg.
STORAGE: Tablets should be
kept at room temperature, 15° to 30°C (59° to
86°F).
PRESCRIBED FOR: Citalopram
is used for the management of depression. It
also has been tested in persons with obsessive-
compulsive disorders and panic disorders.
DOSING: Citalopram is given
as a single daily dose, usually in the morning.
As with all antidepressants, it may take several
weeks of treatment before maximum effects are
seen. Doses are often adjusted slowly upwards to
find the most effective dose. Elderly patients,
debilitated persons, and patients with certain
kidney or liver diseases may need lower doses.
DRUG INTERACTIONS: All
SSRIs, including citalopram, should not be taken
with any of the mono-amine oxidase (MAO)
inhibitor-class of antidepressants, for example,
isocarboxazid (Marplan), phenelzine (Nardil),
tranylcypromine (Parnate), and procarbazine
(Matulane). Such combinations may lead to
confusion, high blood pressure, tremor, and
hyperactivity. This same type of interaction
also may occur with selegiline (Eldepryl),
fenfluramine (Pondimin), and dexfenfluramine
(Redux). Tryptophan can cause headaches, nausea,
sweating, and dizziness when taken with any
SSRI.
PREGNANCY: There are no
adequate studies of citalopram in pregnant
women.
NURSING MOTHERS: It is not
known if citalopram is secreted in breast milk.
SIDE EFFECTS: The most
commonly-noted side effects associated with
citalopram are nausea, vomiting, excessive
sweating, headache, tremor, and inability to
sleep. Overall, between 1 in 6 and 1 in 5
persons experience a side effect. Some patients
may experience withdrawal reactions upon
stopping some SSRIs such as paroxetine, and such
symptoms also may occur with citalopram.
Symptoms of withdrawal include dizziness,
tingling sensations , tiredness, vivid dreams,
irritability or poor mood.
It has been
suggested that SSRIs may cause depression to
worsen and even lead to suicide in a small
number of patients. These potential side effects
are difficult to evaluate in depressed patients
because depression can progress with or without
treatment, and suicide is itself a consequence
of depression. Moreover, the evidence supporting
these potential side effects is weak. Therefore,
no conclusions can yet be drawn about the
relationship between SSRIs and worsening
depression and suicide. Until better information
is available, patients receiving SSRIs should be
monitored for worsening depression and suicidal
tendencies.
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