Indications for: CELEXA
Major depressive disorder (MDD).
Initially 20mg once daily; after ≥1 week may increase to 40mg once daily. Doses >40mg/day: not recommended. Elderly (>60yrs), hepatic impairment, CYP2C19 poor metabolizers, concomitant cimetidine or other CYP2C19 inhibitors: max 20mg/day.
Concomitant pimozide, linezolid, IV methylene blue. During or within 14 days of MAOIs; do not start an MAOI during or within 14 days of citalopram.
Suicidal thoughts and behaviors.
Increased risk of suicidal thinking and behavior in children, adolescents and young adults; monitor for clinical worsening and unusual changes in all patients. Avoid in congenital long QT syndrome, bradycardia, hypokalemia, hypomagnesemia, recent MI, uncompensated heart failure; monitor ECG if therapy is considered. Discontinue therapy if persistent QTc measurements >500ms. Correct hypokalemia, hypomagnesemia before starting and periodically monitor. Monitor for serotonin syndrome; discontinue and treat if occurs. Screen for bipolar disorder, mania, or hypomania prior to initiation. Seizure disorder. Angle-closure glaucoma. Avoid in untreated anatomically narrow angles. Volume-depleted. Hyponatremia (esp. in elderly). Sexual dysfunction. Avoid abrupt cessation. Write ℞ for smallest practical amount. Reevaluate periodically. Hepatic or severe renal impairment (CrCl <20mL/min). Elderly. Pregnancy: effects on neonates exposed in 3rd trimester (see full labeling). Nursing mothers: monitor infants.
See Contraindications. Increased risk of serotonin syndrome with other serotonergic drugs (eg, triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, amphetamines, St. John's Wort) or with drugs that impair serotonin metabolism (eg, MAOIs, linezolid, IV methylene blue). Avoid drugs that prolong QT interval including Class 1A (eg, quinidine, procainamide) or Class III antiarrhythmics (eg, amiodarone, sotalol), antipsychotics (eg, chlorpromazine, thioridazine), antibiotics (eg, gatifloxacin, moxifloxacin), and others (eg, pentamidine, methadone, levomethadyl acetate). Avoid alcohol. Increased risk of bleeding with NSAIDs, aspirin, warfarin, and others that affect coagulation. May be potentiated by cimetidine, lithium, potent inhibitors of CYP2C19 or CYP3A4 (eg, azole antifungals). May be antagonized by carbamazepine. Increases metoprolol levels.
Nausea, diarrhea, dry mouth, somnolence, insomnia, increased sweating, ejaculation disorder, rhinitis, agitation, fatigue, anxiety, anorexia, arthralgia, myalgia; dose-dependent QT prolongation, mania/hypomania, discontinuation syndrome.
Renal. Half-life: ~35 hours.
Generic Drug Availability:
Tabs—100; Soln—Contact supplier