Dose and Dosage:
- The typical starting dose of citalopram for depression in adults is 20 mg once daily, taken either in the morning or evening.
- Your doctor may adjust the dosage based on your response to treatment, typically in increments of 10-20 mg every 1-2 weeks.
- The maximum recommended dose is 40 mg per day.
- Citalopram is available in tablet form in various strengths (e.g., 10 mg, 20 mg, 40 mg).
Frequency:
- Citalopram is usually taken once daily, with or without food.
Route of Administration (ROA):
- Citalopram is taken orally in tablet form.
Mechanism of Action (MOA):
- Citalopram is a selective serotonin reuptake inhibitor (SSRI). It works by increasing the levels of serotonin, a neurotransmitter in the brain, which helps improve mood and relieve symptoms of depression and anxiety disorders.
Pharmacokinetics (PK):
- Citalopram is well absorbed after oral administration, with peak plasma concentrations reached within 4 hours.
- It undergoes hepatic metabolism primarily via the cytochrome P450 enzyme system, particularly CYP2C19 and CYP3A4.
- The elimination half-life of citalopram is about 35 hours, but its active metabolite, desmethylcitalopram, has a longer half-life of approximately 62-68 hours.
- It is mainly excreted in urine (approximately 20-30% unchanged).
Pharmacodynamics (PD):
- Citalopram’s therapeutic effects are attributed to its inhibition of serotonin reuptake in the brain, leading to increased serotonin levels in the synaptic cleft and enhanced neurotransmission.
Pathophysiology:
- Citalopram is indicated for the treatment of major depressive disorder (MDD) and various anxiety disorders, including generalized anxiety disorder (GAD), panic disorder, social anxiety disorder (social phobia), obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD).
Indications:
- Major Depressive Disorder (MDD)
- Generalized Anxiety Disorder (GAD)
- Panic Disorder
- Social Anxiety Disorder (Social Phobia)
- Obsessive-Compulsive Disorder (OCD)
- Post-Traumatic Stress Disorder (PTSD)
Contraindications:
- Hypersensitivity to citalopram or other SSRIs
- Concurrent use of monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOI therapy
- Use of pimozide or thioridazine
- Known congenital long QT syndrome
- Concurrent use of drugs that prolong the QT interval
- Severe hepatic impairment
- Concomitant use of serotonergic drugs
Drug Interactions:
- Citalopram may interact with other medications, including other SSRIs, MAOIs, serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, antipsychotics, antiarrhythmics, certain antibiotics, and herbal supplements such as St. John’s Wort. It’s essential to inform your healthcare provider about all medications you are taking.
Monitoring and Laboratory Tests:
- Regular monitoring may include assessing therapeutic response, vital signs, mood changes, and potential adverse effects.
- Periodic monitoring of liver function tests and renal function may be warranted in some cases.
- Electrocardiogram (ECG) monitoring may be necessary in patients with risk factors for QT prolongation or those taking medications known to prolong the QT interval.
Why is this medication prescribed?
Citalopram is prescribed to treat depression and other mood disorders such as anxiety disorders. It belongs to a class of medications called selective serotonin reuptake inhibitors (SSRIs), which work by increasing the levels of serotonin, a neurotransmitter in the brain that helps regulate mood.
How should this medicine be used?
- Citalopram is typically taken once daily, with or without food.
- It is usually started at a low dose, which may be gradually increased by your doctor based on your response to treatment.
- Take citalopram exactly as prescribed by your healthcare provider. Do not take more or less of it or take it more often than prescribed.
Other uses for this medicine
Citalopram may also be used off-label to treat other conditions such as panic disorder, obsessive-compulsive disorder (OCD), social anxiety disorder, and post-traumatic stress disorder (PTSD). However, the effectiveness and safety of citalopram for these uses have not been well established.
What special precautions should I follow?
- Before taking citalopram, inform your doctor about any medical conditions you have, especially a history of seizures, bipolar disorder, liver or kidney disease, or bleeding disorders.
- Tell your doctor about all medications, vitamins, and supplements you are taking, as citalopram may interact with certain drugs.
- Avoid drinking alcohol while taking citalopram, as it can worsen certain side effects.
- Do not stop taking citalopram suddenly without consulting your doctor, as this may cause withdrawal symptoms.
What special dietary instructions should I follow?
- There are no specific dietary restrictions associated with citalopram use. However, maintaining a healthy diet and avoiding excessive alcohol consumption can support overall well-being and treatment outcomes.
What should I do if I forget a dose?
- If you miss a dose of citalopram, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one.
What side effects can this medication cause?
Common side effects of citalopram may include:
- Nausea
- Dry mouth
- Fatigue
- Headache
- Dizziness
- Insomnia
- Increased sweating
- Changes in appetite or weight
Serious side effects may include suicidal thoughts or behavior, serotonin syndrome, and abnormal bleeding. Contact your doctor immediately if you experience any severe or persistent side effects.
What should I know about storage and disposal of this medication?
- Store citalopram at room temperature away from moisture and heat.
- Keep it out of reach of children and pets.
- Dispose of any unused or expired medication properly according to local regulations.
In case of emergency/overdose
- If you suspect an overdose or experience severe symptoms such as difficulty breathing or loss of consciousness, seek emergency medical attention immediately.
- Contact a poison control center or your local emergency room for further assistance.