Citalopram

• relief of anxiety,
• decrease in suicidal thoughts,
• improves general quality of lifethe overall enjoyment of life, a sense of well-being, and the ability to carry out routine activities. More,
• improvements in mood ⁵.

• sexual dysfunction,
• loss of appetite,
• hypertensionhigh blood pressure,
• sleep disturbances,
• withdrawal,
• dietary restrictions (for MAOIsMAOIs may be used to treat the symptoms of depression. More) ⁵.

• By mouth as tablets, depressive illness, 20 mg once daily increased if necessary in steps of 20 mg daily at intervals of 3 – 4 weeks; max. 40 mg daily (elderly over 65 years, max. 20 mg daily).
  • Panic disorder, adult over 18 years, initially 10 mg daily increased gradually if necessary in steps of 10 mg daily, usual dose 20 – 30 mg daily; max. 40 mg daily (elderly over 65 years, max. 20 mg daily)
• By mouth as oral drops, depressive illness, 16 mg daily as a single dose increased if necessary in steps of 16 mg daily at intervals of 3 – 4 weeks; max. 32 mg daily (elderly over 65 years, max. 16 mg daily).
  • Panic disorder, adult over 18 years, initially 8 mg daily as a single dose increased gradually if necessary in steps of 8 mg, usual dose 16 – 24 mg daily; max. 32 mg daily (elderly over 65 years, max. 16 mg daily) ⁴.

Not known at present.

Citalopram is one of a class of antidepressants known as SSRIs. It is used to treat the depression associated with mood disorders. It is also used on occassion in the treatment of body dysmorphic disorder and anxiety. The antidepressant, antiobsessive-compulsive, and antibulimic actions of citalopram are presumed to be linked to its inhibition of CNSthe Central Nervous System, upon which certain drugs act neuronal uptake of serotonin. in-vitrooutside the body studies show that citalopram is a potent and selective inhibitor of neuronal serotonin reuptake and has only very weak effects on norepinephrine and dopamine neuronal reuptake. Citalopram has no significant affinity for adrenergic (α1, α2, β), cholinergic, GABAGamma-aminobutyric acid (GABA) is an inhibitory neurotransmitter in your brain, meaning it slows your brain's functions. GABA is known for producing a calming effect., dopaminergic, histaminergic, serotonergic (5HT1A, 5HT1B, 5HT2), or benzodiazepine receptorsnerve endings that sense changes in the body More; antagonism of such receptorsnerve endings that sense changes in the body More has been hypothesised to be associated with various anticholinergic, sedativeOne of a diverse group of drugs manufactured for medical purposes to relax the central nervous system. More, and cardiovascular effects for other psychotropic drugs. The chronic administration of citalopram was found to downregulate brain norepinephrine receptorsnerve endings that sense changes in the body More, as has been observed with other drugs effective in the treatment of major depressive disorder. Citalopram does not inhibit monoamine oxidase ².

The single-and multiple-dose pharmacokinetics of citalopram are linear and dose-proportional in a dose range of 10 – 60 mg/day. Biotransformation of citalopram is mainly hepatic, with a mean terminal half-lifethe amount of time required for the amount of something to fall to half its initial value of about 35 hours. With once daily dosing, steady state plasma concentrations are achieved within approximately one week. At steady state, the extent of accumulation of citalopram in plasma, based on the half-lifethe amount of time required for the amount of something to fall to half its initial value, is expected to be 2.5 times the plasma concentrations observed after a single dose ⁸.

Rapidly and well absorbed from the gastrointestinal tract. Peak plasma concentrations occur within 4 hours of a single orally administered dose. Food does not affect absorption ².

Bioavailability is 80% following oral administration ².

Citalopram is metabolised mainly in the liver via N-demethylation to its principle metabolite, demethylcitalopram. Other metabolites include didemethylcitalopram, citalopram N-oxide, and a deaminated propionic acid derivative. However, the predominant entity in plasma is unchanged citalopram. Cytochrome P450 (CYP) 3A4 and 2C19 isozymes appear to be principally involved in producing demethylcitalopram. Demethylcitalopram appears to be further N-demethylated by CYP2D6 to didemethylcitalopram. Citalopram metabolites possess little pharmacologic activity in comparison to their parent compound and do not likely contribute to the clinical effect of the drug ².

35 hours ².

12% – 23% of an oral dose of citalopram is recovered unchanged in the urine, while 10% of the dose is recovered in the faeces ².

The LD50the amount of a material, given all at once, which causes the death of 50% (one half) of a group of test animals. The LD50 is one way to measure the short-term poisoning potential (acute toxicity) of a material in rats is 2.9054 mol/kg ².

Symptoms most often accompanying citalopram overdose, alone or in combination with other drugs and/or alcohol, included dizziness, sweating, nausea, vomiting, tremor, somnolenceis a state of near-sleep, a strong desire for sleep, or sleeping for unusually long periods. More, and sinus tachycardiarapid pulse rate. In more rare cases, observed symptoms included amnesiainability to remember, confusiontrouble focusing, slow or disorganised thinking, poor short-term memory, unsure of time or place, or having difficulty following a conversation, coma, convulsionswhen your body shakes violently without you meaning it to, hyperventilation, cyanosisbluish tinge to fingers and lips, caused by inadequate blood supply, rhabdomyolysisa condition that may occur when muscle tissue is damaged due to an injury in which muscle in the body is damaged More, and ECGelectrocardiogram, a machine that makes a record of the electrical conductivity of the heart. More changes (including QTc prolongation, nodal rhythm, ventricular arrhythmiavariation or irregularity of the rhythm of the heart More, and very rare cases of torsade de pointes). Acute renal failure has been very rarely reported accompanying overdose. Withdrawal symptoms include flu-like symptoms, insomniadifficulty in going to sleep or in getting enough sleep, nausea, imbalance, sensory changes and hyperactivity ².

The antidepressant, antiobsessive-compulsive, and antibulimic actions of citalopram are presumed to be linked to its inhibition of CNSthe Central Nervous System, upon which certain drugs act neuronal uptake of serotonin. Citalopram blocks the reuptake of serotonin at the serotonin reuptake pump of the neuronal membrane, enhancing the actions of serotonin on 5HT1A autoreceptors. SSRIs bind with significantly less affinity to histamine, acetylcholine, and norepinephrine receptorsnerve endings that sense changes in the body More than tricyclic antidepressant drugs ².

There was no evidence of carcinogenesis in mice given 20 times the recommended human dose. There was an increased risk of small intestine carcinomaa cancer that begins in a tissue that lines the inner or outer surfaces of the body. More in rats given 1.3 to 4 times the recommended human dose. Certain in-vitrooutside the body studies found evidence of mutagenicityhaving the capacity to induce mutations. More while others did not.

Rats fed citalopram experienced decreased mating and fertility. It is not known what implication these animal studies have for humans ⁹.

• drowsiness,
• dryness of mouth,
• nausea,
• trouble in sleeping ¹¹.

• abdominal pain,
• anxiety,
• change in sense of taste,
• diarrhoeaWhere you frequently pass watery or loose faeces,
• wind,
• headache,
• heartburn,
• increased sweating,
• increased yawning,
• loss of appetite,
• pain in muscles or jointsmarijuana cigarettes More,
• stuffy or runny nose,
• tingling, burning, or prickly feelings on skin,
• tooth grinding,
• trembling or shaking,
• unusual increase or decrease in weight,
• unusual tiredness or weakness,
• vomiting,
• excessive salivation ¹¹.

Some of the side-effects that can occur with citalopram may not need medical attention. As your body adjusts to the medicine during treatment these side-effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side-effects ¹². If any of the following side-effects continue, are bothersome or if you have any questions about them, check with your health care professional –

You should check with your doctor immediately if any of these side-effects occur when taking citalopram –

• dizziness,
• drowsiness,
• fast heartbeat,
• nausea,
• sweating,
• trembling or shaking,
• vomiting,
• cyanosisbluish tinge to fingers and lips, caused by inadequate blood supply,
• confusiontrouble focusing, slow or disorganised thinking, poor short-term memory, unsure of time or place, or having difficulty following a conversation,
• convulsionswhen your body shakes violently without you meaning it to (seizuresthe outward effect can vary from uncontrolled jerking movement (tonic-clonic seizure) to as subtle as a momentary loss of awareness More),
• coma,
• deep or fast breathing with dizziness,
• fainting,
• general feeling of discomfort or illness,
• loss of memory,
• muscle pain,
• slow or irregular heartbeat,
• weakness ¹¹.

The FDAUS Food and Drug Administration released a black box warningA black box warning is the strictest warning put in the labeling of prescription drugs or drug products by the Food and Drug Administration (FDA) when there is reasonable evidence of an association of a serious hazard with the drug. It is basically a warning with a black box around it, hence the name. Having the black box around the warning means that an adverse reaction to the drug may lead to death or serious injury. More in 2007, cautioning that the usage of SSRIs may lead to increased suicidal thoughts and behaviours. The FDAUS Food and Drug Administration warned that this problem can be especially problematic for adolescents and young adults who are on SSRIs. Doctors who prescribe SSRIs, including Celexa, must be cautious and observe patients for declining mood or thoughts of suicide, especially for young people just beginning their prescription ¹¹.

• Alcohol – Alcohol consumption should be avoided while taking Celexa. Alcohol has the potential to interfere with the effectiveness of Celexa ¹¹.