Citalopram (Celexa)
SSRI antidepressant
- Major Depression3
- Generalized Anxiety3
- QTc risks limit dosing
Features
Dosing
Depression (20-40 mg/d), Anxiety disorders (40-60 mg/d), Menopausal symptoms (10-20 mg qhs). Do not use for OCD as the high dose required could prolong QTc (FDA limits dose to 40 mg/d and – in some – 20 mg/d).
INTERACTIONS: Does not alter other med levels but its own levels are raised by 2C19 inhibitors like common proton pump inhibitors (ranitidine/Zantac), and FDA limits dose to 20 mg/d in those on 2C19 inhibitors, 2C19 slow metabolizers, and the elderly. Raise dose by x1.3 if using with carbamazepine.
Management
FDA limits dosing of citalopram, so escitalopram is preferable as it has fewer cardiac risks and may be a little more effective.
AVOID: Due to QTc, avoid in elderly, poor metabolizers or taking inhibitors at CYP2C19 (proton pump inhibiors, omeprazole, pantoprazole, cimetidine).
TOLERABILITY: Apathy, sexual dysfunction, sleep disruption, nausea, restless legs, akathisia, sweating, yawning, withdrawal syndrome.
RISKS: Suicidality in age < 25, mania, osteopenia in post-menopausal women, increased bleeding, hyponatremia (mainly in elderly).
EMR Text
Depression
Citalopram use based on FDA approval in major depressive disorder.
SSRI side effects reviewed with patient.
Anxiety Disorder
Citalopram use based on efficacy of this class in anxiety disorders (Generalized Anxiety Disorder, Panic Disorder, PTSD, and Social Anxiety Disorder).
SSRI side effects reviewed with patient.
OCD
Citalopram use based on efficacy of this class in OCD.
SSRI side effects reviewed with patient.
Binge Eating & Bulimia
Citalopram use based on efficacy of this class in binge eating and bulimia.
SSRI side effects reviewed with patient.
Premenstrual Syndrome
Citalopram use based on efficacy of this class in Premenstrual Syndrome.
SSRI side effects reviewed with patient.
Menopausal Symptoms
Citalopram use based on controlled trials in menopausal symptoms (vasomotor and mood).
SSRI side effects reviewed with patient.