A major depressive episode (DSM-IV) implies a prominent and relatively persistent (nearly every day for at least 2 weeks) depressed or dysphoric mood that usually interferes with daily functioning, and includes at least five of the following nine
Selective Serotonin Re-uptake Inhibitor; Antidepressant
Citalopram is bicyclic phthalane derivative and a selective serotonin re-uptake inhibitor, with little or no effect on noradrenaline, dopamine and GABA re-uptake. The inhibitory activity explains the antidepressant property of citalopram. It has no or very low affinity for 5-HT1AA, 5-HT2A, D1 and D2 receptors, α1, α2, β-adrenergic, histamine H1, muscarinic, cholinergic, benzodiazepine and opioid receptors.
ORAL Depression; Depressive phase of bipolar disorder: Adult: Initially, 20 mg daily, increased to 40 mg once daily after at least 1 wk or 60 mg daily if necessary. Panic disorder w/ or w/o agoraphobia: Adult: Initially, 10 mg daily, increased to 20 mg daily after 1 wk. Max: 60 mg daily.
Citapram should not be taken cocurrently with MAOIs, Serotonin agonists, Neuroleptics, Cimetidine, Alcohol, Ketoconazole, Itraconazole, Macrolide antibiotics.
Hypersensitivity, concomitant admin w/ MAOls or w/in 14 days of discontinuing MAOI treatment; child & adolescents <18 yr; treatment of depressive illness; lactation. Gradual discontinuation of treatment If patient enters into manic phase; pregnancy. Increased risk of hyponatraemia & SIADH. May reduce convulsant threshold thus, citalopram should be used w/ care in epileptic patients.
Increased sweating, headache, tremor, fatigue, asthenia, dizziness, abnormal accommodation, somnolence, insomnia, agitation, nervousness, nausea, dry mouth, constipation, diarrhoea, palpitation, rash, pruritus, abnormal vision, decreased libido, anxiety, increased appetite, anorexia, apathy, impotence, suicide attempt, confusion, yawning, dyspepsia, vomiting, abdominal pain, flatulence, increased saliva, wt decrease or increase, postural hypotension. tachycardia, rhinitis, ejaculation failure, fatigue, extrapyramidal disorders. Increased risk of suicidal thinking & behaviour esp in child & adolescents. Monitor closely for signs of clinical worsening, suicidality or unusual changes in behaviour.
Citalopram use during the period of embryogenesis in pregnancy is not associated with an apparent major teratogenic risk. Late pregnancy use of citalopram is associated with increased risk of poor neonatal adaptation syndrome, recently described with other selective serotonin reuptake inhibitors. Infants receive citalopram in breastmilk and it is detectable in low levels in the serum of some. The dosage that the infant receives and serum level achieved are probably related to the genetic metabolic capacity of the mother and infant. A few cases of minor behavioral side effects such as drowsiness or fussiness have been reported, but no adverse effects on development have been found in infants followed for up to a year. Infants exposed in utero can have withdrawal effects postpartum despite breastfeeding and continued maternal citalopram use. If citalopram is required by the mother, it is not a reason to discontinue breastfeeding. If the mother was taking citalopram during pregnancy or if other antidepressants have been ineffective, most experts recommend against changing medications during breastfeeding. Otherwise, agents with lower excretion into breastmilk may be preferred, especially while nursing a newborn or preterm infant. The breastfed infant should be monitored for behavioral side effects such as sedation or fussiness. Mothers taking an SSRI during pregnancy and postpartum may have more difficulty breastfeeding, although this might be a reflection of their disease state. These mothers may need additional breastfeeding support. Breastfed infants exposed to an SSRI during the third trimester of pregnancy have a lower risk of poor neonatal adaptation than formula-fed infants.
Doses as high as 2000 mg have been taken without signs of alternation in cardiovascular parameters. Respiratory depression, convulsion may occur.
Keep below 30°C temperature, away from light & moisture. Keep out of the reach of children.
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