Top 7 Things to Know About Citalopram

29-12-2022 7 5 0 0 Báo lỗi

Citalopram is used to treat depression. Citalopram is in a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs). It works by increasing the amount of serotonin, a natural substance in the brain that helps maintain mental balance.

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How it works

Citalopram is a drug that can be used to treat depression and other mood disorders.


Experts are unsure how citalopram works, but it was previously thought that its effects were due to its ability to rebalance chemicals in the brain, such as serotonin, that were thought to be imbalanced in people with anxiety, depression, and other mood disorders. Despite the fact that the mechanism by which citalopram works is unknown, studies show that it is still effective in treating mood disorders such as depression.


Citalopram's activity against other neurotransmitters, such as norepinephrine or dopamine, is much lower than that of other antidepressants.


Citalopram belongs to a class of drugs known as Selective Serotonin Reuptake Inhibitors (SSRIs).

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Upsides

Can be used to treat moderate-to-severe depression (also called Major Depressive Disorder).


It is less likely than other antidepressants to cause drowsiness.


Has also been used off-label for a variety of illnesses, including agitation brought on by dementia, generalized and social anxiety disorder, alcoholism, eating disorders (including binge-eating disorder), fibromyalgia, panic disorder, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD).


Citalopram may be beneficial for premature ejaculation and premenstrual dysphoric disorder, according to data from a small number of trials (off-label use).


Two studies also support its use for vasomotor symptoms associated with menopause (off-label).


Although the FDA has approved its use in adults, some studies have looked into its use in children over the age of seven, with dosage ranges ranging from 10 to 40 mg/day.


In general, SSRIs are better tolerated than many other medications used to treat depression.


Can be taken with or without food.


There is citalopram generic available.

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Downsides

If you are between the ages of 18 and 60, do not take any other medications, and have no other medical conditions, you are more likely to experience the following side effects:

  • Insomnia, dry mouth, drowsiness, nausea, increased sweating, and sexual dysfunction are all possible symptoms. When compared to escitalopram, citalopram may be associated with more side effects.
  • Suicidal thoughts or behavior in young adults may be increased (similar to other antidepressants).
  • Serotonin syndrome may result from a drug interaction or overdosage (symptoms include agitation, hallucinations, fast heart rate, dizziness, muscle tremor, nausea, vomiting, diarrhea).
  • If abruptly stopped or interrupted, it may result in a discontinuation syndrome (symptoms include nausea, vomiting, diarrhea, headaches, sweating, tremors, vivid dreams, insomnia).
  • Your judgment may be impaired, and you may be unable to drive or operate machinery. Alcohol should be avoided.
  • It may increase the risk of bleeding, especially when combined with other drugs that increase the risk of bleeding.
  • In people with undiagnosed bipolar disorder, it may trigger a manic episode.
  • This may result in a decrease in total body sodium (hyponatremia); elderly people, those taking diuretics, or those who are already dehydrated may be more vulnerable.
  • Drugs metabolized by hepatic enzymes CYP 3A4 and 2C19, other antidepressants, and medicines that cause serotonin release (such as tramadol, St John's wort, and opioids) may interact. It should not be used in conjunction with or within 14 days of a monoamine oxidase inhibitor.
  • When used in conjunction with other QT-prolonging medications, it may cause QT interval prolongation. The maximum recommended dose is 40 mg/day due to the risk of QT prolongation. People over 60, those with severe liver disease, or those taking certain interacting medications (such as cimetidine or omeprazole) should not exceed 20 mg daily.
  • In people who are sensitive to overstimulation effects such as anxiety or insomnia, a lower dose of 10 mg/day may be required.
  • Seizures are infrequent.
  • In neonates exposed to citalopram during the third trimester of pregnancy, complications such as prolonged hospitalization, respiratory support, and tube feeding have been reported. In women exposed to citalopram during the third trimester, weigh the potential benefits against the risks. Citalopram is excreted in breast milk, and reports of drowsiness, decreased feeding, and weight loss in breastfeeding infants have been reported.

Note:
People over the age of 65, children, people with certain medical conditions (such as liver or kidney disease, heart disease, diabetes, seizures), or people who take other medications are more likely to experience a broader range of side effects.
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Bottom Line

Citalopram may be used to treat depression as well as other conditions such as anxiety and OCD off-label. Insomnia, drowsiness, dry mouth, nausea, and increased sweating may be more common with citalopram than with the related drug escitalopram.

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Tips

It is safe to take with or without food.


Before treatment, blood tests may be required to check electrolyte levels (for example, potassium, magnesium), and these may need to be corrected if necessary.


Dosages higher than 40mg/day are not advised.


Report any signs of worsening depression or suicidal ideation to your doctor, especially during the first few months of therapy.


Stopping abruptly may cause withdrawal symptoms; instead, taper off gradually under medical supervision.


Do not drive or operate machinery until you understand the full effects of citalopram, as it may impair your judgment and ability to drive or operate machinery.


Report any bleeding or bruising issues to your doctor, as well as any unexplained skin changes (such as blisters or rashes), urination issues, eye pain or swelling, and vision changes.

If symptoms of serotonin syndrome (such as agitation, hallucinations, fast heart rate, dizziness, flushing, nausea, and diarrhea) develop, seek immediate medical attention.

If you are pregnant or become pregnant while taking citalopram, notify your doctor. In neonates exposed to Citalopram during the third trimester of pregnancy, complications such as prolonged hospitalization, respiratory support, and tube feeding have been reported. Citalopram is also excreted in breastmilk, and breastfeeding infants have been reported to experience drowsiness, decreased feeding, and weight loss.
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Response and effectiveness

Peak citalopram blood levels occur within 1 to 6 hours, with an average of 4 hours.


Initial improvements may be seen within 1 to 2 weeks; however, the maximum antidepressant effects may take up to 4-6 weeks of regular dosing.


Initial effects for anxiety disorders (such as generalized anxiety, obsessive compulsive disorder, panic disorder, and posttraumatic stress disorder) may be seen within two weeks, with ongoing improvements seen after four to six weeks.


Citalopram's effects last one to two days after a single dose. The half-life ranges from 24 to 48 hours (average 35 hours). With liver disease, the half-life doubles and increases by 30% to 50% in patients over the age of 60.

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Interactions

Medicines that interact with citalopram may reduce its effect, shorten its duration of action, increase side effects, or have no effect when combined. An interaction between two medications does not always necessitate the discontinuation of one of them; however, it can. Consult your doctor about how to handle drug interactions.


Citalopram may interact with the following medications:

  • anticoagulants (blood thinners), such as warfarin, or other drugs that have blood-thinning effects such as aspirin or NSAIDs
  • anticonvulsants, such as phenytoin, phenobarbital, or primidone
  • antipsychotics (such as butyrophenones, phenothiazines, or thioxanthenes) and atypical antipsychotics (eg, olanzapine, quetiapine, ziprasidone)
  • any medication that may cause drowsiness, such as benzodiazepines (eg, diazepam, lorazepam), first-generation antihistamines (such as doxylamine or promethazine), metoclopramide, or opioids (such as codeine, morphine)
  • bupropion
  • duloxetine
  • herbs with bleeding as a side effect, such as anise, alfalfa, or bilberry
  • hydroxychloroquine
  • lithium
  • medications that may affect the heartbeat by prolonging the QT interval, such as amiodarone, encainide, or flecainide
  • pimozide
  • other antidepressants, such as tricyclic antidepressants (eg, amitriptyline), monoamine oxidase inhibitors (eg, isocarboxazid, phenelzine, and tranylcypromine), and SSRIs (eg, paroxetine, sertraline)
  • other medications that affect serotonin, such as amphetamines, fentanyl, lithium, tramadol, triptans (eg, almotriptan, eletriptan, or sumatriptan), or St. John's Wort
  • other medications that are metabolized by the same enzymes (CYP2C19 or CYP3A4)
  • others, such as HIV medications (fosamprenavir, ritonavir)
  • voriconazole.
While taking citalopram, avoid drinking alcohol or using illegal or recreational drugs.

It should be noted that this list is not exhaustive and only includes common medications that may interact with citalopram. For a complete list of interactions, consult the citalopram prescribing information.
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