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citalopram hydrobromide
Celexa

Pregnancy Risk Category C

How supplied
Tablets:
20 mg, 40 mg

Action
A selective serotonin reuptake inhibitor whose action is presumed to be linked to potentiation of serotonergic activity in the CNS resulting from inhibition of neuronal reuptake of serotonin.

Indications & dosage
Depression--

Adults:
initially, 20 mg P.O. once daily, increasing to 40 mg daily after no less than 1 week. Maximum recommended dose is 40 mg daily.
Elderly:
20 mg/day P.O. with adjustment to 40 mg/day only for nonresponding patients.
Adjust-a-dose:
For patients with hepatic impairment, use 20 mg/day P.O. with adjustment to 40 mg/day only for nonresponding patients.

Adverse reactions
CNS:
tremor, somnolence, insomnia, anxiety, agitation, dizziness, paresthesia, migraine, impaired concentration, amnesia, depression, apathy, suicide attempt, confusion, fatigue.
CV:
tachycardia, orthostatic hypotension, hypotension.
EENT:
rhinitis, sinusitis, abnormal accommodation.
GI:
dry mouth, nausea, diarrhea, anorexia, dyspepsia, vomiting, abdominal pain, taste perversion, increased saliva, flatulence, increased appetite.
GU:
dysmenorrhea, amenorrhea, ejaculation disorder, impotence, polyuria.
Metabolic:
decreased and increased weight.
Musculoskeletal:
arthralgia, myalgia.
Respiratory:
upper respiratory tract infection, coughing.
Skin:
rash, pruritus, increased sweating.
Other:
fever, yawning, decreased libido.

Interactions
Drug-drug.
Carbamazepine: may increase citalopram clearance. Monitor for effects.
CNS drugs:
additive effects. Use together cautiously.
Drugs that inhibit cytochrome P-450 isoenzymes 3A4 and 2C19:
decreased clearance of citalopram. Monitor closely.
Imipramine, other tricyclic antidepressants:
level of imipramine metabolite desipramine increased by about 50%. Use together cautiously.
MAO inhibitors:
serious, sometimes fatal, reactions may occur. Don't use drug within 14 days of MAO inhibitor use.
Lithium:
may enhance serotonergic effect of citalopram. Use with caution, and monitor lithium levels.
Warfarin:
prothrombin time increased by 5%. Monitor closely.
Drug-lifestyle.
Alcohol use: may increase CNS effects. Avoid concomitant use.

Effects on diagnostic tests
None reported.

Contraindications
Contraindicated in patients with hypersensitivity to drug or its inactive ingredients and in those also taking MAO inhibitors; also contraindicated within 14 days of stopping MAO inhibitor therapy.

Nursing considerations

Patient teaching

*Liquid contains alcohol. **May contain tartrazine.  †Canada  ‡Australia  §U.K.  OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING

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