Drug information of Citalopram

Mechanism of effect

The mechanism of action of citalopram hydrobromide as an antidepressant is presumed to be linked to potentiation of serotonergic activity in the central nervous system (CNS) resulting from its inhibition of CNS neuronal reuptake of serotonin (5-HT).

Pharmacodynamic

Citalopram is one of a class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs). It is used to treat the depression associated with mood disorders

Pharmacokinetics

Rapidly and well absorbed from the GI tract. Peak plasma concentrations occur within 4 hours of a single orally administered dose. Bioavailability is 80% following oral administration. Food does not affect absorption. Citalopram, dimethylcitalopram, and didemethylcitalopram is 80% bound to plasma proteins. Citalopram is metabolized mainly in the liver via N-demethylation to its principle metabolite, demethylcitalopram. 12-23% of an oral dose of citalopram is recovered unchanged in the urine, while 10% of the dose is recovered in the feces. Half life: 35 hours

Dosage

Usual Adult Dose for Depression Initial dose: 20 mg orally once a day Maintenance dose: 20 to 40 mg orally once a day Maximum dose: 40 mg orally per day Usual Geriatric Dose for Depression Over 60 years of age: Recommended dose: 20 mg orally once a day

Interactions

Alerts

1-Patients with major depressive disorder (MDD), both adult and pediatric, may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior 2- citalopram is not approved for use in treating bipolar depression. 3-Cases of hyponatremia and SIADH (syndrome of inappropriate antidiuretic hormone secretion) have been reported in association with citalopram treatment. 4-citalopram should be used cautiously in patients with a history of mania. 5- citalopram has not been systematically evaluated in patients with a seizure disorder

Points of recommendation

1-Patients should be monitored for these symptoms when discontinuing treatment with citalopram. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. 2-Patients should be cautioned regarding the risk of bleeding associated with the concomitant use of citalopram with NSAIDs, aspirin, or other drugs that affect coagulation.

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