Citalopram (Celexa)

Question 1

Brand

Answer 1

Celexa

Question 2

Class

Answer 2

SSRI (Serotonin 1A)

Question 3

MOA

Answer 3

• Serotonin 1A desensitization and reuptake inhibition
• Mild H1 histamine antagonism
• inactive R enantiomer may interfere with therapeutic action of active S enantiomer at serotonin reuptake pumps

Question 4

Onset

Answer 4

2-4 weeks

Question 5

S/Es

Answer 5

Same as Sertraline

Unique to Citalopram-
-Antihistaminic - sedation, fatigue

Question 6

Dose

Answer 6

20-40 mg/day once daily, morning or evening
Over 40 mg causes cardiac rhythm abnormalities

Start at 20, inc by 20 after 1 or more weeks, max 40.

Question 7

OD

Answer 7

• Rare fatalities have been reported
• Vomiting, sedation, cardiac rhythm abn, dizziness, sweating, nausea, tremors
• Rare- amnesia, confusion, coma, convulsions

Question 8

Taper or not

Answer 8

Reduce 50% dose for 3 days, then 50% for 3 days, then stop

Question 9

half life parent drug

Answer 9

23-45 hours

Question 10

CYP action

Answer 10

• Weakly inhibits CYP 2D6

* Metabolized by CYP 3A4, 2C19

Question 11

Drug interactions

Answer 11

Same as sertraline

Unique-
*Don’t use more than 20 mg/day if pt taking CYP 2C19 inhibitor like Cimetidine - QT prolongation

Question 12

C/I with

Answer 12

• MAOIs
• Thioridazine
• Pimozide
• Allergy to citalopram or escitalopram

Question 13

Special populations

Answer 13

• Max 20 mg/day in hepatic pts
• Careful in severe renal failure
• Max 40 mg in cardiac pts
• Max 20 mg in elderly above 60 years

Question 14

Advantages

Answer 14

• Elderly pts

* Pt excessively activated or sedated by other SSRIs

Question 15

Disadvantages

Answer 15

• can be sedating

* need dose titration

Question 16

Of note

Answer 16

• May have less sexual S/Es than some other SSRIs
• Especially well tolerated in elderly; if no response - consider cognitive impairment or Alzheimers.
• Less well tolerated than escitalopram