citalopram CELEXA

Class: SSRI
FDA Indications: MDD
Off-Label Use: Binge Eating Disorder, GAD, Vasomotor Symptoms Of Menopause, OCD, Pathological Gambling, Premature Ejaculation, Fibromyalgia, Agitation In Alzheimers Disease
Prescribing
Forms: 10, 20, 40mg tablet; 10mg/5mL po soln
Dose Range: 10-60 mg/day
Starting: Start at 20 mg qd, ↑ dose by 20 mg q3 weeks; efficacy with doses >40 mg has not been demonstrated in clinical trials and doses >40 mg not recommended due to risk of ↑ QT interval
Stopping: Gradually taper the dose to minimize the incidence of withdrawal symptoms and allow for the detection of re-emerging symptoms

NAMI drug fact sheet

Precautions
Contraindications: Concomitant use of MAOIs, patients with congenital long QT, Concomitant use in patients taking pimozide
Serious Side Effects: Serotonin syndrome; ↑ risk of SI in children and young adults; may impair platelet aggregation; SIADH
Known Risk of TdP
Side Effects: sedation/somnolence, anorgasmia, xerostomia, increased sweating, tremor, diarrhea, nausea
Pharmacodynamics
1° MOA: Selective serotonin reuptake inhibitor
Target: SERT
Pharmacokinetics
t½: 35 (23-45)° TMAX: 2-4°
Substrate of: 3A4, 2C19; 2D6
Inhibits: 1A2, 2D2 (both weakly); Induces:
Active Metabolites:
DDIs
  • - DO NOT CO-PRESCRIBE WITH MAOIs (need a 14-day washout period)
  • - 3A4 & 2C19 inhibitors can ↑ serum levels
Misc
  • - generally less side effects than its predecessors in SSRI class
  • - consider ECG when prescribing doses >40 mg
  • - most remit at doses ranging from 40-60mg
  • - linear & dose-proportional pharmacokinetics
Special Populations

Category C—No ↑ risk of major congenital malformations (0.9% in exposed group vs. 2.6% in control). There is an ↑ risk of admission to neonatal ICU

RID 3-10.9%


Pharmacokinetics are altered (~30% ↓ clearance) in patients >60; max dose of 20 mg/day is recommended due to risk of QT prolongation

Moderate renal disease ↑'d t½ from 37° to 49°

Maximum dose 20 mg qd due to ↓ clearance & ↑ QT risk (avg t½ 83° in cirrhotic patients)

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Last updated April 20 2018 09:28:33. Disclaimer: This website does not provide medical advice, nor is it a substitute for clinical judgment.