Celexa (Citalopram). Dosage, Side Effects, Interactions
Celexa (Citalopram) is an antidepressant from the serotonin reuptake inhibitor (SSRI) class. The active substance is used in mental illnesses, especially for the treatment of depression, personality disorders and anxiety disorders.
Celexa (Citalopram) is used, inter alia, for the treatment of depression , borderline personality disorder , bipolar disorder , mania , anxiety and panic disorders.
How Celexa (Citalopram) works
Citalopram has a stereocenter, which means that two enantiomers of the drug exist. If citalopram is prescribed, it is a mixture of S and R enantiomers, of which the S enantiomer ( escitalopram ) is mainly responsible for the antidepressant effects. The effect is based on a competitive inhibition of the serotonin transporter. This inhibition increases the concentration of serotonin in the presynapse and thus contributes to the effect.
After a few weeks of SSRI intake, serotonin neurons become desensitized to the excess amount of serotonin. Since the transporters are still blocked, this causes more serotonin to accumulate in the synapse. The time required for autoreceptors and postsynaptic receptors to desensitize is consistent with the delayed clinical effects of SSRIs and with the gradual tolerance of side effects.
Citalopram is metabolized by the liver. The cytochrome P450 enzymes CYP2D6, CYP2C19 and CYP3A4 in particular play an important role in metabolism. Desmethylcitalopram is the main metabolite demethylated by CYP2D6 to didemethylcitalopram. The systemic clearance of citalopram decreases with age due to a decrease in metabolic activity. In healthy elderly, the elimination half-life increases by an average of 30 percent compared to a young population. The half-life of citalopram is about 35 hours.
Dosage of Celexa (Citalopram)
Drugs containing the active ingredient citalopram should be gradually dosed at the beginning of treatment for depression. This usually starts with a dose of 10 mg per day and increases slowly over several weeks.
The active substance is also available in drop form, so that the dose can be increased in very small steps (e.g. 1 drop per day).
A dosage of 40 mg per day should not be exceeded.
Side effects of Celexa (Citalopram)
Possible side effects include sexual dysfunction, nausea, vomiting, fatigue, weight changes, dizziness, increased sweating, tinnitus, diarrhea, excessive yawning.
Rare side effects include seizures, hallucinations, and sensitivity to light.
If patients suffer from fatigue when taking citalopram, the active substance should be taken in the evening rather than in the morning.
- Citalopram should not be taken together with St. John’s Wort (or Hypericin , Hyperforin) or other active ingredients that increase serotonin levels. With this combination, there is an increased risk of serotonin syndrome , which can even be life-threatening.
- Since citalopram increases the risk of gastrointestinal bleeding, it should also not be taken together with oral anticoagulants (e.g. warfarin ) or NSAIDs (non-seroidal anti-inflammatory drugs such as acetylsalicylic acid , ibuprofen , diclofenac , naproxen ).
- Concomitant use with omeprazole can increase the plasma levels of citalopram and thus lead to increased side effects. A dose adjustment is therefore necessary.
A combination with monoamine oxidase inhibitors (MAO inhibitors), such as moclobemide , tranylcypromine , selegiline , rasagiline represents a contraindication.
Citalopram should not be used during pregnancy. Published data in pregnant women show neither a malformative nor a foetotoxic effect, and no neonatal toxicity, but citalopram should only be used when clearly necessary and after careful benefit-risk assessment.
Newborns should be monitored if maternal use of citalopram is continued into late pregnancy (particularly the last trimester) and abrupt discontinuation should be avoided during pregnancy. Less than 24 hours after delivery, neonates may experience symptoms such as shortness of breath, cyanosis, apnea, seizures, body temperature unstable, difficulty drinking, vomiting, hypoglycemia, muscular hypertension, hypotonia, hyperreflexia, tremor, nervous tremors, irritability, lethargy, constant crying, Drowsiness and trouble sleeping occur.
Likewise, the use of citalopram in the last trimester may increase the risk of developing primary pulmonary hypertension in newborns.
Citalopram passes into breast milk. No or only minor effects were observed in breastfed infants. As the information available is insufficient, caution should be exercised when administering to breast-feeding women.
Since any psychotropic drug can impair judgment and dexterity, the potential risk that escitalopram therapy may impair the ability to drive vehicles or operate machines should also be pointed out.
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