Citalopram

Citalopram

[20mg tablet 5 cents]

ADMINISTRATION ROUTES:

  • IV, PO

ALTERNATIVE NAMES:

  • Celapram, Cipramil

ICU INDICATIONS:

  1. treatment of depression

    Note: citalopram is usually used in ICU patients with a pre-existing diagnosis of depression who are already taking the medication at admission. Anti-depressants are rarely, if ever, indicated in patients who become depressed whilst in ICU. In these patients, depression is usually situational and the risks of medications outweigh the benefits. It is often appropriate to withhold Citalopram in the critically ill (see WARNINGS)

PRESENTATION AND ADMINISTRATION:

  • PO:
    Celapram 20mg tablets (white), Cipramil 20mg tablets (white), Citalopram 20mg tablets (white)

DOSAGE:

  • PO:
    Initially 20mg daily (10mg in the elderly); increasing to maximum of 60mg daily (40mg in the elderly’ 30mg in hepatic impairment)

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

  • Dose in renal impairment [GFR (ml/min)]
    <10: Dose as in normal renal function (use with caution)
    10-20: Dose as in normal renal function (use with caution)
    >20-50: Dose as in normal renal function
  • Dose in renal replacement therapy
    CAPD: Dose as in normal renal function (use with caution)
    HD: Dose as in normal renal function
    CVVHDF: Dose as in normal renal function

DOSAGE IN PAEDIATRICS:

  • PO:
    0.4mg/kg daily (see PRECAUTIONS: Paediatric use)

CLINICAL PHARMACOLOGY:

  • Citalopram is an orally administered selective serotonin reuptake inhibitor (SSRI).

CONTRAINDICATIONS:

  1. concomitant use in patients taking monoamine oxidase inhibitors (MAOI’s)
  2. hypersensitivity to citalopram

WARNINGS

  • Use in Patients With Concomitant Illness Citalopram
    Clinical experience with Citalopram in patients with severe systemic illnesses is limited. Caution is advisable in using Citalopram in patients with diseases or conditions that produce altered metabolism or hemodynamic responses.
  • Clinical Worsening and Suicide Risk
    Patients with major depressive disorder (MDD), both adult and paediatric, may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior, whether or not they are taking antidepressant medications, and this risk may persist until significant remission occurs

PRECAUTIONS

  • General:
    Abnormal Bleeding
    Epidemiological studies, both of the case-control and cohort design, have demonstrated an association between use of psychotropic drugs that interfere with serotonin reuptake and the occurrence of upper gastrointestinal bleeding.
    Hyponatremia

    Cases of hyponatremia and SIADH (syndrome of inappropriate antidiuretic hormone secretion) have been reported. All patients with these events have recovered with discontinuation of citalopram and/or medical intervention.
    Seizures
    Although anticonvulsant effects of citalopram have been observed in animal studies, citalopram has not been systematically evaluated in patients with a seizure disorder. Citalopram should be introduced with care in patients with a history of seizure disorder.
  • Laboratory Tests:
    No tests in addition to routine ICU tests are required
  • Drug/Laboratory Test Interactions:
    None of note

IMPORTANT DRUG INTERACTIONS FOR THE ICU

  • CNS Drugs:
    Given the primary CNS effects of citalopram, caution should be used when it is taken in combination with other centrally acting drugs.
  • Monoamine Oxidase Inhibitors (MAOI’s):
    See CONTRAINDICATIONS
  • Drugs That Interfere With Hemostasis (NSAIDs, aspirin, warfarin, etc.):
    Serotonin release by platelets plays an important role in hemostasis. Epidemiological studies of the case-control and cohort design that have demonstrated an association between use of psychotropic drugs that interfere with serotonin reuptake and the occurrence of upper gastrointestinal bleeding have also shown that concurrent use of an NSAID or aspirin potentiated the risk of bleeding. Thus, patients should be cautioned about the use of such drugs concurrently with citalopram.

ADVERSE REACTIONS

  • Body as a Whole:
    Increased sweating, serotonin syndrome
  • Central Nervous System:
    Insomnia, somnolence, agitation, tremor
  • Digestive System:
    Nausea, dry mouth, vomiting, dyspepsia

Critical Care Drug Manual

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