Home Drug Guide Citalopram Hydrobromide

Drug Guide

Generic Name

Citalopram Hydrobromide

Brand Names Celexa

Classification

Therapeutic: Antidepressant

Pharmacological: Selective Serotonin Reuptake Inhibitor (SSRI)

FDA Approved Indications

  • Major depressive disorder

Mechanism of Action

Citalopram selectively inhibits the reuptake of serotonin in the central nervous system, increasing serotonergic activity in the synaptic cleft.

Dosage and Administration

Adult: Starting dose typically 20 mg once daily; can be increased up to 40 mg/day based on response and tolerability.

Pediatric: Not FDA-approved for pediatric use; data limited.

Geriatric: Start at a lower dose, e.g., 10 mg/day, and titrate as needed, considering increased sensitivity and risk of side effects.

Renal Impairment: Use with caution; consider dose adjustments, especially in severe impairment.

Hepatic Impairment: Use with caution; start at lower doses with careful monitoring.

Pharmacokinetics

Absorption: Well-absorbed orally, with peak plasma levels in approximately 2-4 hours.

Distribution: Widely distributed; volume of distribution approximately 12 L/kg.

Metabolism: Primarily hepatic via CYP2C19, CYP3A4, and CYP2D6 enzymes.

Excretion: Primarily excreted in urine (cholesterols and conjugates), with a smaller amount in feces.

Half Life: Approximately 35 hours, allowing once-daily dosing.

Contraindications

  • Concurrent use of Monoamine Oxidase Inhibitors (MAOIs)
  • History of hypersensitivity to citalopram

Precautions

  • Use cautiously in patients with a history of seizure disorders
  • Monitor for increased risk of suicidal thoughts in children, adolescents, and young adults
  • Monitor QT interval, especially at higher doses

Adverse Reactions - Common

  • Nausea (Common)
  • Insomnia (Common)
  • Dry mouth (Common)
  • Somnolence (Common)
  • Increased sweating (Common)

Adverse Reactions - Serious

  • QT prolongation (Rare)
  • Serotonin syndrome (Rare)
  • Suicidal thoughts or behavior (Potentially increased in young populations)

Drug-Drug Interactions

  • MAOIs
  • Other serotonergic agents (e.g., triptans, SNRI antidepressants)
  • CYP450 inhibitors and inducers

Drug-Food Interactions

  • Alcohol (may increase CNS depression and interfere with medication)
  • Foods affecting CYP enzymes

Drug-Herb Interactions

  • St. John's Wort (risk of serotonin syndrome)

Nursing Implications

Assessment: Monitor mood, suicidal thoughts, and side effects; baseline ECG if at risk for QT prolongation.

Diagnoses:

  • Risk for decreased cardiac output related to QT prolongation
  • Risk for injury related to somnolence or dizziness

Implementation: Administer with food if GI upset occurs; monitor for therapeutic response and adverse effects.

Evaluation: Assess improvement in depressive symptoms; monitor for adverse effects, including cardiac issues.

Patient/Family Teaching

  • Take medication exactly as prescribed; do not double doses.
  • Report any signs of unusual bleeding, agitation, or suicidal thoughts.
  • Avoid alcohol and other central nervous system depressants.
  • Be aware of potential side effects like nausea, sleep disturbances, or dry mouth.
  • Schedule regular follow-ups for efficacy and safety monitoring.

Special Considerations

Black Box Warnings:

  • Increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults

Genetic Factors: Variations in CYP2C19 genotype can affect metabolism and plasma levels.

Lab Test Interference: May slightly elevate liver enzymes; routine monitoring recommended in long-term therapy.

Overdose Management

Signs/Symptoms: Nausea, vomiting, dizziness, tremor, arrhythmias, seizures.

Treatment: Supportive care, activated charcoal if within a few hours of ingestion, cardiac monitoring, and symptomatic treatment.

Storage and Handling

Storage: Store at room temperature away from light and moisture.

Stability: Stable for at least 2 years if stored properly.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.