citalopram hydrobromide

(si tal' oh pram)

Celexa

 

Pregnancy Category C

 

Drug classes

Antidepressant

SSRI

 

Therapeutic actions

Potentiates serotonergic activity in the CNS by inhibiting neuronal reuptake of serotonin, resulting in antidepressant effect, with little effect on norepinephrine or dopamine reuptake.

 

Indications

·        Treatment of depression, particularly effective in major depressive disorders

·        Unlabeled uses: Obsessive-compulsive disorders, panic disorder, premenstrual dysphoric disorder (PMDD), social phobia, trichotillomania, post-traumatic stress disorder

 

Contraindications and cautions

·        Contraindicated with MAOI use; allergy to drug or any component of the drug or other SSRIs; concomitant use of pimozide.

·        Use cautiously with renal or hepatic impairment, pregnancy, lactation, and in patients who are elderly or suicidal.

 

Available forms

Tablets—10, 20, 40 mg; oral solution—10 mg/5 mL

 

Dosages

ADULTS

Initially, 20 mg/day PO as a single daily dose. May be increased to 40 mg/day if needed.

PEDIATRIC PATIENTS

Safety and efficacy not established.

GERIATRIC PATIENTS OR PATIENTS WITH RENAL OR HEPATIC IMPAIRMENT

20 mg/day PO as a single dose; increase to 40 mg/day only if clearly needed and patient is not responding.

 

Pharmacokinetics

Route

Onset

Peak

Oral

Slow

2–4 hr

 

Metabolism: Hepatic; T1/2: 35 hr

Distribution: Crosses placenta; enters breast milk

Excretion: Urine

 

Adverse effects

·        CNS: Somnolence, dizziness, insomnia, tremor, nervousness, headache, anxiety, paresthesia, blurred vision

·        CV: Palpitations, vasodilation, orthostatic hypotension, hypertension

·        Dermatologic: Sweating, rash, redness

·        GI: Nausea, dry mouth, constipation, diarrhea, anorexia, flatulence, vomiting

·        GU: Ejaculatory disorders

·        Respiratory: Sinusitis, URI, cough, rhinitis

 

Interactions

·        Increased citalopram levels and toxicity if taken with MAOIs; ensure that patient has been off the MAOI for at least 14 days before administering citalopram

·        Increased citalopram levels with azole antifungals, macrolides

·        Possible severe adverse effects if combined with tricyclic antidepressants, erythromycin; use caution

·        Possible increased effects of beta blockers; monitor patient and reduce beta blocker dose as needed

·        Possible increased bleeding with warfarin, monitor patient carefully

·        Risk of prolonged QT interval and potentially fatal cardiac arrhythmias if combined with pimozide; avoid this combination

·        Increased risk of severe reaction if combined with St. John's wort therapy.

 

Nursing considerations

CLINICAL ALERT!

Name confusion has occurred between Celexa (citalopram), Celebrex (celecoxib), Xanax (alprazolam), and Cerebyx (fosphenytoin); use caution.

 

Assessment

·        History: MAOI use; allergy to drug or any component of the drug; renal or hepatic impairment, elderly, pregnancy, lactation, suicidal tendencies

·        Physical: Orientation, reflexes; P, BP, perfusion; bowel sounds, normal output; urinary output; liver evaluation; liver and renal function tests

 

Interventions

·        Administer once a day, in the morning; may be taken with food if desired.

·        Encourage patient to continue use for 4–6 wk, as directed, to ensure adequate levels to affect depression.

·        Limit amount of drug given in prescription to potentially suicidal patients.

·        Establish appropriate safety precautions if patient experiences adverse CNS effects.

·        Institute appropriate therapy for patient suffering from depression.

 

Teaching points

·        Take this drug exactly as directed, and as long as directed; it may take a few weeks to realize the benefits of the drug. The drug may be taken with food if desired.

·        This drug should not be taken during pregnancy or when nursing a baby; using barrier contraceptives is suggested.

·        You may experience these side effects: Drowsiness, dizziness, tremor (use caution and avoid driving a car or performing other tasks that require alertness if you experience daytime drowsiness); GI upset (eat frequent small meals; perform frequent mouth care); alterations in sexual function (it may help to know that this is a drug effect, and will pass when drug therapy is ended).

·        Report severe nausea, vomiting; palpitations; blurred vision; excessive sweating.

 

Adverse effects in Italic are most common; those in Bold are life-threatening.