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citalopram (Rx)Brand and Other Names:Celexa

 
 
 

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablet

  • 10mg
  • 20mg
  • 40mg

oral solution

  • 10mg/5mL
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Depression

Depression in patients whose diagnosis corresponds most closely to the DSM-III and DSM-III-R category of major depressive disorder

Initial dose: 20 mg PO qDay

If needed, may increase to 40 mg/day after at least 1 week

Doses above 40 mg/day are not recommended, because of risk for QT prolongation without additional benefit for treating depression

Dosing Modifications

Poor CYP2C19 metabolizers or coadministration with CYP2C19 inhibitors (eg, cimetidine, fluconazole, omeprazole): Do not exceed 20 mg/day

Hepatic impairment decreases clearance and therefore increases risk of QT prolongation; do not exceed 20 mg/day

MAO inhibitors

  • Not for administration within 14 days of administering a MAO inhibitor

Linezolid or Methylene Blue Therapy

  • Not for administration to patients that are receiving linezolid or IV methylene blue; consider other forms of therapy; if therapy required and benefits outweigh risks discontinue citalopram therapy, administer linezolid or methylene blue and monitor for serotonin syndrome for 2 weeks or 24 hr after last dose of linezolid or methylene blue

Renal impairment

  • Mild to moderate renal impairment: No dosage adjustment required
  • Severe renal impairment (CrCl <20 mL/min): Not studied; use with caution

Alcoholism (Off-label)

20-40 mg PO qDay

Binge-eating Disorder (Off-label)

20-60 PO qDay

Generalized Anxiety Disorder (Off-label)

Initial: 10 mg PO qDay; may titrate to 40 mg/day

Panic Disorder (Off-label)

20 mg PO qDay initially; after 1 week, may increase to 40 mg/day if warranted

Not to exceed 40 mg/day because of increased risk for QT prolongation

Hot Flashes (Off-label)

Initial: 10 mg PO qDay; may increase to 20 mg/day after 1 week

Obsessive-Compulsive Disorder (Off-label)

Initial: 20 mg PO qDay; may titrate to 40-60 mg/day; improvement may be seen 4-6 weeks after initiating therapy

Premenstrual Dysphoric Disorder (Off-label)

5 mg PO on the estimated day of ovulation; increase dose by 5 mg each day thereafter to maximum 30 mg; continue thereafter until menstruation begins; decrease dose to 20 mg on the first day of menstruation; the next day, decrease to 10 mg; stop the treatment from day 3 until ovulation begins

Dosage Forms & Strengths

tablet

  • 10mg
  • 20mg
  • 40mg

oral solution

  • 10mg/5mL
more...

Depression (Off-label)

<12 years

  • 10 mg PO qDay; may increase by 5 mg/day every 2 weeks  to 40 mg PO qDay; doses >40 mg not recommended (may increase risk of QT prolongation)

≥12 years

  • 20 mg PO qDay; may increase by 10 mg/day every 2 weeks  to 40 mg PO qDay; doses >40 mg not recommended (may increase risk of QT prolongation)

Impulsive Aggresive Behavior (Off-label)

10 mg PO qDay; titrate by 10 mg/week, as tolerated to maximum 40 mg/day

Depression

>60 years: Do not exceed 20 mg PO qDay

Dosing Considerations

-The elderly are more prone to SSRI/SNRI-induced hyponatremia and risk for QT prolongation

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Interactions

Interaction Checker

citalopram and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Dry mouth (20%)

            Nausea (21%)

            Somnolence (18%)

            Insomnia (15%)

            Xerostomia (20%)

            Increased sweating (11%)

            1-10%

            Tremor (8%)

            Diarrhea (8%)

            Ejaculation disorder (6%)

            Rhinitis (5%)

            Upper respiratory infection (5%)

            Dyspepsia (5%)

            Fatigue (5%)

            Vomiting (4%)

            Anxiety (4%)

            Anorexia (4%)

            Abdominal pain (3%)

            Agitation (3%)

            Impotence (3%)

            Sinusitis (3%)

            Dysmenorrhea (3%)

            Decreased libido (2%)

            Yawning (2%)

            Arthralgia (2%)

            Myalgia (2%)

            Amenorrhea (>1%)

            Confusion (>1%)

            Cough (>1%)

            Flatulence (>1%)

            Increased saliva (>1%)

            Migraine (>1%)

            Orthostatic hypotension (>1%)

            Paresthesia (>1%)

            Polyuria (>1%)

            Pruritus (>1%)

            Rash (>1%)

            Tachycardia (>1%)

            Weight change (>1%)

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            Warnings

            Black Box Warnings

            In short-term studies, antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults (<24 years) taking antidepressants for major depressive disorders and other psychiatric illnesses

            This increase was not seen in patients >24 years; a slight decrease in suicidal thinking was seen in adults >65 years

            In children and young adults, the risks must be weighed against the benefits of taking antidepressants

            Patients should be monitored closely for changes in behavior, clinical worsening, and suicidal tendencies; this should be done during initial 1-2 months of therapy and dosage adjustments

            The patient’s family should communicate any abrupt changes in behavior to the health-care provider

            Worsening behavior and suicidal tendencies that are not part of the presenting symptoms may require discontinuation of therapy

            Not FDA approved for the treatment of bipolar disorder

            This drug is not FDA approved for use in pediatric patients

            Contraindications

            Hypersensitivity

            Coadministration with pimozide

            Coadministration with serotonergic drugs

            • Concomitant use or within 14 days of MAOIs increases risk of serotonin syndrome
            • Symptoms include tremor, myoclonus, diaphoresis, nausea, vomiting, flushing, dizziness, hyperthermia with features resembling neuroleptic malignant syndrome, seizures, rigidity, autonomic instability with possible rapid fluctuations of vital signs, and mental status changes that include extreme agitation progressing to delirium and coma
            • Starting citalopram in a patient who is being treated with linezolid or IV methylene blue is contraindicated because of an increased risk of serotonin syndrome
            • If linezolid or IV methylene blue must be administered, discontinue SSRI immediately and monitor for CNS toxicity; may resume 24 hr after last linezolid or methylene blue dose, or after 2 weeks of monitoring (5 weeks for fluoxetine), whichever comes first

            Cautions

            Pregnancy: Conflicting evidence regarding use of SSRIs during pregnancy and increased risk of persistent pulmonary hypertension of the newborn, or PPHN (see Pregnancy)

            Neonates exposed to SNRIs/SSRIs late in third trimester: Risk of complications such as feeding difficulties, irritability, and respiratory problems

            Clinical worsening and suicide ideation may occur despite medication in adolescents and young adults (18-24 years)

            Risk of mydriasis; may trigger angle closure attack in patients with angle closure glaucoma with anatomically narrow angles without a patent iridectomy

            Risk of hyponatremia, abnormal bleeding (increased if concomitant aspirin, NSAIDs, or anticoagulants, or hemorrhagic diathesis), and impairment of cognitive and motor functions

            Risk of serotonin syndrome or neuroleptic malignant syndrome (NMS)-like reactions have been reported with SSRIs alone or with concomitant use of serotonergic drugs, with drugs that impair metabolism of serotonin, or with antipsychotics or other dopamine antagonists

            Activation of mania/hypomania has been reported; use caution when treating patients with history of mania

            Increased risk of bone fractures reported with antidepressant use; use caution; consider possibility of fracture it patient presents with bone pain

            May cause or exacerbate sexual dysfunction

            Use caution when treating patients with history of seizure disorder

            Rare cases of hyponatremia and development of SIADH reported with either SSRI or SNRI use

            QT prolongation

            • Dose-dependent QT prolongation reported; do not exceed dose of 40 mg/day
            • Correct hypokalemia and hypomagnesemia before initiating and monitor periodically
            • ECG monitoring recommended in patients with CHF, bradyarrhythmias, or concomitant medications known to prolong QT interval
            • Do not exceed 20 mg/day if administered in CYP2C19 poor metabolizers, or in patients taking concomitant cimetidine or another CYP2C19 inhibitor (eg, fluconazole, omeprazole)
            • Do not exceed 20 mg/day in individuals aged 60 yr or older, or those with hepatic impairment
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            Pregnancy & Lactation

            Pregnancy

            Pregnancy category: C

            Use late in the third trimester associated with complications in newborns and may require prolonged hospitalization, respiratory support, and tube feeding

            Persistent pulmonary hypertension of the newborn

            • Potential risk of PPHN when used during pregnancy
            • Initial public health advisory, in 2006, was based on a single published study; since then, there have been conflicting findings from new studies, making it unclear whether use of SSRIs during pregnancy can cause PPHN
            • FDA has reviewed the additional new study results and has concluded that, given the conflicting results from different studies, it is premature to reach any conclusion about a possible link between SSRI use in pregnancy and PPHN
            • FDA recommendation: FDA advises health care professionals not to alter their current clinical practice of treating depression during pregnancy and to report any adverse events to the FDA MedWatch program
            • A meta-analysis of 7 observational studies, found exposure to SSRIs in late pregnancy (ie, >20 weeks' gestation) more than doubled the risk of PPHN that could not be explained by other etiologies (eg, congenital malformations, meconium aspiration) (BMJ 2014;348:f6932)

            Lactation

            Excreted in breast milk; use caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
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            Pharmacology

            Mechanism of Action

            Inhibits the reuptake of serotonin in presynaptic neurons; little or no affinity for dopamine, alpha-adrenergic histamine, or cholinergic receptor

            Absorption

            Bioavailability: 80%

            Peak serum time: 1-6 hr (4 hr average)

            Onset: 1-4 weeks for depression; full response may not be seen until 8-12 weeks after initiating treatment

            Distribution

            Protein bound: 80%

            Vd: 12 L/kg

            Metabolism

            Mainly via hepatic P450 enzymes CYP3A4 and CYP2C19

            Metabolites: Insignificant potency

            Elimination

            Half-life: 24-48 hr

            Dialyzable: No

            Renal clearance: 66 mL/min

            Total body clearance: 330 mL/min

            Excretion: Urine (10%)

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            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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