Citalopram

Mechanism :

Citalopram is an orally administered selective serotonin reuptake inhibitor (SSRI) with a chemical structure unrelated to that of other SSRIs or of tricyclic, tetracyclic, or other available antidepressant agents.

Indication :

Depression
Obsessive compulsive disorder
Anxiety

Contraindications :

Concomitant use in patients taking monoamine oxidase inhibitors (MAOIs) and pimozide is contraindicated. And in patients with a hypersensitivity to citalopram.

Dosing :

<12 years:

10 mg/day PO; every 2 weeks, may be increased by 5 mg/day to 40 mg PO/day.

≥12 years:

20 mg/day PO; every 2 weeks, may be increased by 10 mg/day to 40 mg PO/day.

Adverse Effect :

Dry mouth, nausea, headache, light headedness, restlessness, anxiety, somnolence, seizures, rash, urticaria, fever, neuroleptic malignant syndrome, social disinhibition, euphoria, mania, diminished libido, anorgasmia.

Interaction :

NSAIDs, Aspirin, Warfarin: Concurrent use of an NSAID or aspirin potentiated the risk of upper gastrointestinal bleeding.
Cimetidine: Resulted in an increase in citalopram levels.
Sumatriptan: Weakness, hyperreflexia, and incoordination following the use of a SSRI and sumatriptan.
Carbamazepine: The possibility that carbamazepine might increase the clearance of citalopram should be considered if the two drugs are coadministered.
Metoprolol: Two-fold increase in the plasma levels of the beta-adrenergic blocker metoprolol.

Renal Dose :

Dose in Renal Impairment GFR (mL/min)

20-50	Dose as in normal renal function
10-20	Dose as in normal renal function
<10	Dose as in normal renal function.Use with caution

Dose in Patients undergoing Renal Replacement Therapies

CAPD	Unlikely to be dialysed. Dose as in GFR<10 mL/min
HD	Not dialysed. Dose as in GFR<10 mL/min
HDF/High flux	Not dialysed. Dose as in GFR<10 mL/min
CAV/VVHD	Unlikely to be dialysed. Dose as in GFR=10–20 mL/min

Hepatic Dose :

Do not exceed 20 mg PO OD in hepatic impairment, due to the risk of QT prolongation. Monitor QTc and adjust the dose.