Citalopram

Drug Overview

Citalopram is a selective serotonin reuptake inhibitor (SSRI) primarily used to treat mood disorders such as depression, panic disorder, and generalized anxiety disorder. This medication works by increasing serotonin levels in the brain, thereby improving symptoms such as low mood, insomnia, and concentration difficulties.

Compared to traditional antidepressants, citalopram has fewer side effects and provides quicker relief of anxiety symptoms, making it a common first-line medication in modern psychiatry. However, it should be noted that the full therapeutic effect may take 2 to 4 weeks to manifest, and patients should continue medication as prescribed and have regular follow-up visits.

Brand Names and Generic Name

The generic name is Citalopram. Major brand names include Cipram and Celexa. Different countries or regions may have different brand names, but the specific product should be identified on the medication packaging.

Drug Classification

Citalopram is classified as a Selective Serotonin Reuptake Inhibitor (SSRI). It belongs to the class of antidepressants and anti-anxiety medications. Its mechanism of action is highly specific, mainly affecting the serotonin transmission system with minimal impact on other neurotransmitters.

Indications

Main indications include:

• Major depressive disorder
• Panic disorder and generalized anxiety disorder
• Social anxiety disorder

In certain cases, physicians may also prescribe it for other mood disorders, such as obsessive-compulsive disorder or post-traumatic stress disorder, based on individual patient assessment.

Common Side Effects

Mild side effects may include:

• Nausea, diarrhea, or indigestion
• Dizziness or headache
• Dry mouth or insomnia

Serious side effects require immediate medical attention:

• Muscle twitching or involuntary movements
• Irregular heartbeat or blood pressure abnormalities
• Sudden increase in suicidal thoughts or tendencies

Warnings and Precautions

Contraindications:

• Allergy to citalopram or its components
• Use of monoamine oxidase inhibitors (MAOIs)
• Patients with severe liver or kidney impairment requiring dose adjustment

Pregnant or breastfeeding women should use cautiously, with the decision to prescribe based on a risk-benefit assessment by the physician. For patients under 18, close monitoring for changes in suicidal behavior or ideation is necessary.

Drug Interactions

Concurrent use with the following medications may increase risks:

• Other antidepressants (e.g., MAOIs): risk of serotonin syndrome, characterized by high fever, agitation, and muscle rigidity
• Anticoagulants (e.g., warfarin): increased bleeding risk
• Antiepileptic drugs (e.g., carbamazepine): may reduce efficacy or increase side effects

Patients should inform their healthcare provider of all prescription, over-the-counter, and herbal medications to avoid unassessed interactions during citalopram therapy.

Dosage and Administration

The starting dose is usually 20 mg per day (e.g., 10 mg twice daily), with adjustments made based on response to a range of 20-60 mg daily, under medical supervision. Tablets should be swallowed whole, not chewed or broken, and taken at the same time each day to maintain stable blood levels.

Oral liquid formulations should be measured accurately with a dosing device to prevent overdose. Patients with liver or kidney impairment may require dose reduction to avoid accumulation and toxicity.

Missed Dose Management

If a dose is missed and it is less than 4 hours until the next scheduled dose, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed one, as this may cause headache, nausea, or other discomforts.

Overdose Management

Overdose may lead to confusion, seizures, or respiratory difficulties. Immediate medical attention is required. Emergency measures include gastric lavage, monitoring vital signs, and supportive care. Keep medications out of reach of children and follow the physician’s instructions strictly.

 

Frequently Asked Questions

What should I do if I experience nausea or dizziness while taking the medication?

Some patients may experience gastrointestinal discomfort or dizziness when starting citalopram. It is recommended to take the medication with food to reduce stomach upset. If symptoms persist or worsen, contact your physician for dose adjustment or to consider switching treatment.

Is it safe to use citalopram with anticoagulants like warfarin?

Using citalopram with warfarin may increase bleeding risk due to potential interactions affecting blood clotting. Patients on anticoagulants should have their INR monitored closely, and the physician will adjust the anticoagulant dose accordingly to ensure safety.

What precautions should I take when discontinuing citalopram?

Do not stop citalopram abruptly. Follow your doctor’s tapering schedule to gradually reduce the dose. Sudden discontinuation may cause withdrawal symptoms such as dizziness, headache, or insomnia. Seek medical advice if severe discomfort occurs.

Can I drink alcohol while on citalopram?

It is advisable to avoid alcohol during treatment, as it may exacerbate side effects like dizziness or drowsiness and reduce medication efficacy. If social drinking is necessary, consult your physician and limit alcohol intake strictly.

Do patients with liver or kidney impairment need dose adjustments?

Patients with hepatic or renal impairment metabolize the drug more slowly, which may require dose reduction to prevent accumulation and toxicity. The physician will evaluate liver and kidney function regularly and adjust the treatment plan accordingly.