citalopram hydrobromide

(si tal' oh pram)

Celexa

Pregnancy Category C

Drug classes
Antidepressant
SSRI

Therapeutic actions
Potentiates serotonergic activity in the CNS by inhibiting neuronal reuptake of serotonin,
resulting in antidepressant effect, with little effect on norepinephrine or dopamine
reuptake.

Indications
• Treatment of depression, particularly effective in major depressive disorders
• Unlabeled uses: Obsessive-compulsive disorders, panic disorder, PMDD, social
phobia, trichotillomania.

Contraindications and cautions

• Contraindicated with MAOI use; allergy to drug or any component of the drug or
other SSRIs.
• Use cautiously with renal or hepatic impairment, pregnancy, lactation, and in
patients who are elderly or suicidal.

Available forms
Tablets—10, 20, 40 mg; oral solution—10 mg/5 mL

Dosages
ADULTS
Initially, 20 mg/day PO as a single daily dose. May be increased to 40 mg/day if needed.
PEDIATRIC PATIENTS
Safety and efficacy not established.
GERIATRIC PATIENTS OR PATIENTS WITH RENAL OR HEPATIC IMPAIRMENT
20 mg/day PO as a single dose; increase to 40 mg/day only if clearly needed and patient
is not responding.

Pharmacokinetics
Route Onset Peak
Oral Slow 2–4 hr

Metabolism: Hepatic; T1/2: 35 hr

Distribution: Crosses placenta; enters breast milk
Excretion: Urine

Adverse effects
 • CNS: Somnolence, dizziness, insomnia, tremor, nervousness, headache, anxiety,
paresthesia, blurred vision
• CV: Palpitations, vasodilation, orthostatic hypotension, hypertension
• Dermatologic: Sweating, rash, redness
• GI: Nausea, dry mouth, constipation, diarrhea, anorexia, flatulence, vomiting
• GU: Ejaculatory disorders
• Respiratory: Sinusitis, URI, cough, rhinitis

Interactions
Drug-drug
• Increased citalopram levels and toxicity if taken with MAOIs; ensure that patient
has been off the MAOI for at least 14 days before administering citalopram
• Increased citalopram levels with azole antifungals, macrolides
• Possible severe adverse effects if combined with tricyclic antidepressants,
erythromycin; use caution
• Possible increased effects of beta blockers; monitor patient and reduce beta
blocker dose as needed
• Possible increased bleeding with warfarin, monitor patient carefully
Drug-alternative therapy
• Increased risk of severe reaction if combined with St. John's wort therapy.

Nursing considerations
CLINICAL ALERT!
Name confusion has occurred between Celexa (citalopram), Celebrex
(celecoxib), Xanax (alprazolam), and Cerebyx (fosphenytoin); use caution.

Assessment
• History: MAOI use; allergy to drug or any component of the drug; renal or
hepatic impairment, elderly, pregnancy, lactation, suicidal tendencies
• Physical: Orientation, reflexes; P, BP, perfusion; bowel sounds, normal output;
urinary output; liver evaluation; liver and renal function tests

Interventions
• Administer once a day, in the morning; may be taken with food if desired.
• Encourage patient to continue use for 4–6 wk, as directed, to ensure adequate
levels to affect depression.
• Limit amount of drug given in prescription to potentially suicidal patients.
• Establish appropriate safety precautions if patient experiences adverse CNS
effects.
• Institute appropriate therapy for patient suffering from depression.

Teaching points
• Take this drug exactly as directed, and as long as directed; it may take a few
weeks to realize the benefits of the drug. The drug may be taken with food if
desired.
 • This drug should not be taken during pregnancy or when nursing a baby; use of
barrier contraceptives is suggested.
• These side effects may occur: Drowsiness, dizziness, tremor (use caution and
avoid driving a car or performing other tasks that require alertness if you
experience daytime drowsiness); GI upset (eat small, frequent meals; perform
frequent mouth care); alterations in sexual function (it may help to know that this
is a drug effect, and will pass when drug therapy is ended).
• Report severe nausea, vomiting; palpitations; blurred vision; excessive sweating.

Adverse effects in Italic are most common; those in Bold are life-threatening.