Citalopram; Uses, Dosage, Side Effects, Interactions, Pregnancy Citalopram is a bicyclic naphthalene derivative and selective serotonin reuptake inhibitor (SSRI), with antidepressant and anxiolytic activities. Citalopramselectively inhibits the neuronal reuptake of the neurotransmitter serotonin (5-HT) in presynaptic cells in the central nervous system, thereby increasing levels of 5-HT within the synaptic cleft and enhancing the actions of serotonin on its receptors. Increased serotonergic neurotransmission results in antidepressive and anxiolytic effects. Citalopram is an antidepressant medication belonging to a group of drugs called selective serotonin reuptake inhibitors (SSRIs) that affects neurotransmitters, the chemicals that nerves within the brain use to communicate with each other. Neurotransmitters are manufactured and released by nerves and then travel and attach to nearby nerves. Thus, neurotransmitters can be thought of as the communication. Mechanism of Action of Citalopram The antidepressant, antiobsessive-compulsive, and antibulimic actions of citalopram are presumed to be linked to its inhibition of CNS neuronal uptake of serotonin. Citalopram blocks the reuptake of serotonin at the serotonin reuptake pump of the neuronal membrane, enhancing the actions of serotonin on 5HT1A autoreceptors. SSRIs bind with significantly less affinity to histamine, acetylcholine, and norepinephrine receptors than tricyclic antidepressant drugs. The antidepressant, antiobsessive-compulsive, and antibulimic actions of citalopram are presumed to be linked to its inhibition of CNS neuronal uptake of serotonin. In vitro studies show that citalopram is a potent and selective inhibitor of neuronal serotonin reuptake and has only very weak effects on norepinephrine and dopamine neuronal reuptake. Citalopram has no significant affinity for adrenergic (α1, α2, β), cholinergic, GABA, dopaminergic, histaminergic, serotonergic (5HT1A, 5HT1B, 5HT2), or benzodiazepine receptors; antagonism of such receptors has been hypothesized to be associated with various anticholinergic, sedative, and cardiovascular effects for other psychotropic drugs. Indications of Citalopram Anxiety and Stress Body Dysmorphic Disorder Depression Bipolar Disorder Postpartum Depression Agitation Borderline Personality Disorder Dissociative Identity Disorder Generalized Anxiety Disorder Neuralgia Anorexia Nervosa (AN) Bulimia Nervosa (BN) Diabetic Neuropathies Major Depressive Disorder (MDD) Obsessive Compulsive Disorder (OCD) Panic Disorders Post-Traumatic Stress Disorder (PTSD) Premature Ejaculation Premenstrual Dysphoric Disorder Social Anxiety Disorder (SAD) Obsessive Compulsive Disorder Occipital Neuralgia Panic Disorder Persistent Depressive Disorder Premenstrual Dysphoric Disorder Severe Mood Dysregulation Somatoform Pain Disorder Trichotillomania For the treatment of depression. Off-label indications include: treatment of mild dementia-associated agitation in nonpsychotic patients, smoking cessation, ethanol abuse, obsessive-compulsive disorder (OCD) in children, and diabetic neuropathy You Might Also Read Nadolol; Indications/Uses, Dosage, Side Effects, Interaction ,Pregnancy CatagoryContra-Indications of Citalopram Syndrome of Inappropriate Antidiuretic Hormone Secretion low amount of magnesium in the blood low amount of sodium in the blood low amount of potassium in the blood increased risk of bleeding Manic-Depression Having Thoughts of Suicide Neuroleptic Malignant Syndrome serotonin syndrome – adverse drug interaction closed angle glaucoma heart attack within the last 30 days Very Rapid Heartbeat – Torsades de Pointes Slow Heartbeat prolonged QT interval on EKG chronic heart failure chronic heart failure suddenly not controlled by medication Heart Disease Abnormal EKG with QT changes from Birth liver problems Bleeding from Stomach Esophagus or Duodenum severe renal impairment seizures Dosages of Citalopram Strengths: 10 mg/5 mL; 10 mg; 20 mg; 40 mg Depression Initial dose: 20 mg orally once a day Maintenance dose: 20 to 40 mg orally once a day Maximum dose: 40 mg orally per day Geriatric Dose for Depression Over 60 years of age Recommended dose: 20 mg orally once a day Side Effects of Citalopram The most common The decrease in sexual desire or ability sleepiness or unusual drowsiness clumsiness or unsteadiness dizziness drowsiness dry mouth false sense of well-being increased watering of mouth lightheadedness constipation; vision changes; breast swelling (in men or women); or decreased sex drive, impotence, or difficulty having an orgasm. blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights; restless muscle movements in your eyes, tongue, jaw, or neck; a light-headed feeling, like you, might pass out; Common Drowsiness and lightheadedness the day after taking the medicine. Confusion. Numbed emotions. Visual disturbances such as blurred vision or double vision. Shaky movements and unsteady walk (ataxia). Loss of memory (amnesia). Muscle weakness. Dizziness. Headache. Skin rashes. Disturbances of the gut such as diarrhoea, constipation, nausea, vomiting or abdominal pain. Difficulty in passing urine (urinary retention). Changes in sex drive. Low blood pressure (hypotension). Blood disorders. Jaundice. Unexpected aggression, restlessness or irritability (tell your doctor if you experience this). Nightmares or hallucinations (tell your doctor if you experience this). You Might Also Read Carisoprodol - Uses, Dosage, Side Effects, InteractionsSerious agitation anxiety behavioral changes, including aggressiveness, angry outbursts, bizarre behavior, or decreased inhibitions confusion increased trouble sleeping memory problems muscle spasms shortness of breath signs of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide) sleepwalking Drug Interactions of Citalopram Citalopram may interact with following drugs, supplements & may change the efficacy of drugs amlodipine general anesthetics antihistamines (e.g., cetirizine, doxylamine, diphenhydramine, hydroxyzine, loratadine) antipsychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone) aripiprazole baclofen barbiturates (e.g., butalbital, pentobarbital, phenobarbital) benzodiazepines (e.g., alprazolam, diazepam, lorazepam) bupropion celecoxib cilostazol clopidogrel cyclosporine diabetes medications (e.g., chlorpropamide, metformin, nateglinide, rosiglitazone) diltiazem estrogens (e.g., conjugated estrogen, ) glucosamine heparin low molecular weight heparins mirtazapine monoamine oxidase inhibitors (MAOIs; e.g. rasagiline, selegiline, ) multivitamins muscle relaxants nifedipine non-steroidal anti-inflammatory medications (NSAIDs; e.g., diclofenac, ibuprofen, naproxen) omega-3 fatty acids pentoxifylline propranolol quinolone antibiotics (e.g., ciprofloxacin, norfloxacin, ofloxacin) rasagiline seizure medications ( phenobarbital, phenytoin, valproic acid, ) selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, duloxetine, fluoxetine, paroxetine, sertraline) serotonin antagonists (anti-emetic medications; e.g., granisetron, ondansetron) tapentadol theophyllines (e.g., aminophylline, oxtriphylline, theophylline) thiazide diuretics (water pills; e.g., hydrochlorothiazide, ) thyroid replacements (e.g., desiccated thyroid, levothyroxine) tizanidine tramadol tricyclic antidepressants (e.g., desipramine, nortriptyline) triptans (e.g., sumatriptan, rizatriptan) Pregnancy & Lactation of Citalopram FDA Pregnancy Category C Pregnancy This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately. You Might Also Read Which Drugs Interact With Naproxen SodiumLactation This medication passes into breast milk. If you are a breastfeeding mother and are taking citalopram, it may affect your baby. Talk to your doctor about whether you should continue breastfeeding. The safety and effectiveness of using this medication have not been established for children and is not indicated for use in children under the age of 18. References DrugBank http://www.drugbank.ca/drugs/DB00215 http://www.drugbank.ca/drugs/DB00215#transporters http://www.drugbank.ca/drugs/DB00215#targets http://www.drugbank.ca/drugs/DB00215#enzymes https://www.drugs.com/citalopram.html EPA DSStox https://comptox.epa.gov/dashboard/dsstoxdb/results?search=DTXSID8022826 European Chemicals Agency (ECHA) https://echa.europa.eu/substance-information/-/substanceinfo/100.056.247 https://echa.europa.eu/information-on-chemicals/cl-inventory-database/-/discli/details/35229 https://www.webmd.com/drugs/2/drug-1701/citalopram-oral/details/list-contraindications Human Metabolome Database (HMDB) http://www.hmdb.ca/metabolites/HMDB0005038 ClinicalTrials.gov https://clinicaltrials.gov/ LiverTox https://livertox.nlm.nih.gov/CitalopramEscitalopram.htm NCIt https://ncit.nci.nih.gov/ncitbrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&ns=NCI_Thesaurus&code=C61680 FDA Medication Guides https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/020822s047lbl.pdf#page=33 FDA Orange Book https://www.fda.gov/Drugs/InformationOnDrugs/ucm129662.htm MassBank of North America (MoNA) http://mona.fiehnlab.ucdavis.edu/spectra/browse?inchikey=WSEQXVZVJXJVFP-UHFFFAOYSA-N SpectraBase https://spectrabase.com/compound/FvO5kVmRCwJ#IKB23ROaLuR https://spectrabase.com/compound/FvO5kVmRCwJ#Hsj0G05zjp5 https://spectrabase.com/compound/FvO5kVmRCwJ#HigRD2qpEVg https://spectrabase.com/compound/FvO5kVmRCwJ#9efj0K41h03 https://spectrabase.com/compound/FvO5kVmRCwJ#Kc6FBaSZKiE https://spectrabase.com/compound/FvO5kVmRCwJ#AcSeYf8fR0y NIST http://www.nist.gov/srd/nist1a.cfm PubMed Health http://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0009639/ Springer Nature Read more … WHO ATC https://www.whocc.no/atc/ https://www.whocc.no/atc_ddd_index/ Wikipedia https://en.wikipedia.org/wiki/Citalopram https://pubchem.ncbi.nlm.nih.gov MeSH https://www.ncbi.nlm.nih.gov/mesh/68015283 http://www.nlm.nih.gov/mesh/meshhome.html https://www.ncbi.nlm.nih.gov/mesh/68018687 https://www.ncbi.nlm.nih.gov/mesh/68017367 Show More