Cipram

Citalopram

Treatment of depression & prevention of relapse/recurrence. Panic disorder w/ or w/o agoraphobia. Obsessive-compulsive disorder (OCD).

Adult Max: 40 mg daily. Depression/OCD Single dose of 20 mg daily. Panic disorder Initially 10 mg for the 1st wk before increasing to 20 mg daily. Elderly >65 yr May be increased to max 40 mg daily. Patient w/ hepatic impairment Max: 30 mg daily. CYP2C19 poor metabolisers Initially 10 mg daily for the 1st 2 wk, may be increased to max 20 mg daily.

May be taken with or without food.

Hypersensitivity. Concomitant use w/ MAOIs. Citalopram must not be used in combination w/ MAOI including selegiline in dose >10 mg daily. Treatment w/ citalopram may be instituted 14 days after discontinuation of non-selective MAOIs & min 1 day after discontinuation of moclobemide. Treatment w/ MAOIs may be introduced 7 days after discontinuation of citalopram. Combination w/ linezolid. Patients w/ known QT interval prolongation or congenital long QT syndrome.

Suicide-related behaviours & hostility were more frequently observed in childn & adolescents treated w/ antidepressants. Some patients w/ panic disorder may experience intensified anxiety symptoms at the start of treatment; a low starting dose is advised. Hyponatraemia has been reported as a rare adverse reaction. Patients being treated w/ antidepressants should be monitored carefully especially at the beginning of treatment for clinical worsening &/or the emergence of suicidality (suicidal ideation & behaviour). This precaution should also be observed when treating other psychiatric disorders because of the possibility of co-morbidity w/ major depressive disorder. In patients w/ manic-depressive illness, a change towards the manic phase may occur. Discontinue once patient enters manic phase. Should be used w/ caution in patients w/ a history of seizures. May modify insulin & glucose responses; adjust antidiabetic therapy in diabetic patients. Serotonin syndrome has been reported rarely. There have been reports of cutaneous bleeding abnormalities (eg, ecchymoses & purpura); may increase risk of postpartum haemorrhage. Citalopram has been found to cause a dose-dependent prolongation of the QT interval. Dose escalations >20 mg/day in CYP2C19 poor metabolizers or patients taking concomitant cimetidine or another CYP2C19 inhibitor are not recommended. Caution is advised in patients w/ significant bradycardia or patients w/ recent acute MI or uncompensated heart failure. Electrolyte disturbances should be corrected before treatment is started. ECG review should be considered before treatment for patient w/ stable cardiac disease. If signs of cardiac arrhythmia occur during treatment w/ citalopram, the treatment should be w/drawn & an ECG should be performed. After prolonged administration abrupt cessation of SSRIs may produce w/drawal symptoms eg, dizziness, paraesthesia, tremor, anxiety, nausea & palpitation in some patients. It is recommended that w/drawal of treatment should proceed by tapering off the dosage over 1-2 wk to avoid occurrence of discontinuation symptoms. Should be used w/ caution in patients w/ angle-closure glaucoma or history of glaucoma. Reports of long-lasting sexual dysfunction. Contains lactose monohydrate. Should not be given to patients w/ rare hereditary problems of galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption. Patients should be cautioned about their ability to drive a car & operate machinery. Caution is advised in patients w/ severely reduced renal function (CrCl <20 mL/min). Should not be used during pregnancy unless clearly necessary & only after careful consideration of risk/benefit. Using in the 3rd trimester may result in neurobehavioral disturbances in newborn infant. Caution is recommended during lactation. Should not be used in childn & adolescents <18 yr.

Agitation, nervousness; somnolence, insomnia, tremor, dizziness, headache; abnormal accommodation; palpitations; dry mouth, nausea, constipation; increased sweating; asthenia. Decreased appetite & wt, increased appetite; decreased libido, anorgasmia (female), anxiety, confusion, apathy, impaired concentration, abnormal dreams, memory impairment; paraesthesia, sleep disorders, migraine, dysgeusia, disturbance in attention; abnormal vision; tachycardia; hypotension, HTN, orthostatic hypotension; yawning, rhinitis, sinusitis; diarrhoea, vomiting, dyspepsia, stomachache, flatulence; pruritus, rash; myalgia, arthralgia; dysuria; impotence, ejaculation disorders & failure, dysmenorrhea; fatigue, pyrexia.

Should not be used in combination w/ MAOIs due to risk of serotonin syndrome. Caution is advised when taken in combination w/ selegiline, serotonergic drugs, St. John's wort, oral anticoagulants, drugs known to affect platelet function (eg, atypical antipsychotics & phenothiazines, most TCAs, ASA & NSAIDs, ticlopidine & dipyridamole), electroconvulsive therapy, alcohol, linezolid, medicinal products that prolong QT interval, or cimetidine.

Antidepressants

N06AB04 - citalopram ; Belongs to the class of selective serotonin reuptake inhibitors. Used in the management of depression.

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