Cipram

Citalopram

Treatment of depression & prevention of relapse/recurrence. Panic disorder w/ or w/o agoraphobia. Obsessive-compulsive disorder (OCD).

Adult Max: 40 mg daily. Depression/OCD Single dose of 20 mg daily. Panic disorder Initially 10 mg for the 1st wk before increasing to 20 mg daily. Elderly >65 yr May be increased to max 40 mg daily. Patient w/ hepatic impairment Max: 30 mg daily. CYP2C19 poor metabolisers Initially 10 mg daily for the 1st 2 wk, may be increased to max 20 mg daily.

May be taken with or without food.

Hypersensitivity. Patients w/ known QT interval prolongation or congenital long QT syndrome. Concomitant use w/ MAOIs, including selegiline. Treatment w/ citalopram may be instituted 14 days after discontinuation of non-selective MAOIs & min 1 day after discontinuation of moclobemide. Treatment w/ MAOIs may be introduced 7 days after discontinuation of citalopram.

Suicide-related behaviours & hostility were more frequently observed in childn & adolescents treated w/ antidepressants. Close supervision of patients should accompany drug therapy. Some patients w/ panic disorder may experience intensified anxiety symptoms at the start of treatment. Hyponatraemia has been reported as a rare adverse reaction. Patients being treated w/ antidepressants should be monitored carefully especially at the beginning of treatment for clinical worsening &/or the emergence of suicidality (suicidal ideation & behaviour). This precaution should also be observed when treating other psychiatric disorders because of the possibility of co-morbidity w/ major depressive disorder. In patients w/ manic-depressive illness a change towards the manic phase may occur. Should be used w/ caution in patients w/ a history of seizures. In patients w/ diabetes, treatment may alter glycaemic control. Serotonin syndrome has been reported rarely. There have been reports of cutaneous bleeding time &/or bleeding abnormalities. Citalopram has been found to cause a dose-dependent prolongation of the QT interval. Caution is advised in patients w/ significant bradycardia or patients w/ recent acute MI or uncompensated heart failure. Electrolyte disturbances should be corrected before treatment is started. ECG review should be considered before treatment for patient w/ stable cardiac disease. If signs of cardiac arrhythmia occur during treatment w/ citalopram, the treatment should be w/drawn & an ECG should be performed. After prolonged administration abrupt cessation of SSRIs may produce w/drawal symptoms eg, dizziness, paraesthesia, tremor, anxiety, nausea & palpitation in some patients. It is recommended that w/drawal of treatment should proceed by tapering off the dosage over 1-2 wk to avoid occurrence of discontinuation symptoms. Should be used w/ caution in patients w/ angle-closure glaucoma or history of glaucoma. Patients should be cautioned about their ability to drive a car & operate machinery. Caution is advised in patients w/ severe renal impairment. Pregnancy & lactation. Should not be used in childn & adolescents <18 yr.

Increased sweating, dry mouth, agitation, decreased appetite, impotence, decreased libido, somnolence, yawning, nausea, ejaculation disorder, ejaculation failure, abnormal orgasm (female).

Should not be used in combination w/ MAOIs due to risk of serotonin syndrome. Caution is advised when taken in combination w/ selegiline, serotonergic medicinal products, St. John's wort, anticoagulants, medicinal products that affect the platelet function, other medicines that can increase the risk of haemorrhage, ECT, alcohol, linezolid, QT interval prolongation & cimetidine, medicinal products lowering the seizure threshold.

Antidepressants

N06AB04 - citalopram ; Belongs to the class of selective serotonin reuptake inhibitors. Used in the management of depression.

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