Citalopram

Selected products treat adult major depressive disorder. Citalopram is not approved for pediatric use; efficacy/safety in pediatric MDD is not established. This reference does not provide off-label anxiety/OCD or pediatric doses.

Tablets and the selected solution allow initiation/titration and lower doses. The 30 mg capsule is unsuitable for starting treatment or doses other than 30 mg once daily. Continue treatment only with response/risk reassessment; the label does not establish a fixed universal course duration.

Take once daily, with or without food. Screen for bipolar disorder before starting.

Wait at least 14 days after stopping an MAOI antidepressant before citalopram, and at least 14 days after stopping citalopram before an MAOI antidepressant. Do not initiate with linezolid/IV methylene blue. Urgent use of these agents requires a clinician-directed interruption/monitoring plan; the selected solution label describes immediate stopping, monitoring for 2 weeks or until 24 hours after the final linezolid/IV methylene-blue dose (whichever first), and possible citalopram resumption 24 hours after that last dose. Gradually reduce citalopram when possible; use a lower-strength tablet/solution to taper a 30 mg capsule regimen.

No adjustment is recommended for mild/moderate renal impairment; severe impairment (CrCl <20 mL/min) lacks PK data and warrants caution. Hepatic impairment has a 20 mg/day maximum, so avoid the 30 mg capsule. Follow the supplied Medication Guide for missed doses and do not double a dose.

MAOI use or within 14 days of stopping an MAOI, including linezolid/IV methylene blue; concomitant pimozide; and citalopram/product hypersensitivity. MAOI antidepressant washout is at least 14 days in either direction. Congenital long QT and other listed cardiac factors are avoidance warnings rather than section-4 contraindications in these labels.

Selected labels carry the antidepressant boxed warning for increased suicidal thoughts/behaviors in pediatric and young adult patients in short-term studies. Closely monitor all treated patients for clinical worsening and emergent suicidality. Citalopram is not approved for pediatric patients.

Reported effects include nausea, dry mouth, sweating, somnolence/insomnia, tremor, diarrhea and sexual dysfunction, especially ejaculatory delay. Serious risks include arrhythmias, serotonin syndrome, bleeding, hyponatremia, seizures and hypersensitivity. Overdose can cause delayed seizures, QRS/QT prolongation and torsades; obtain emergency toxicology care with prolonged cardiac monitoring. Do not interpret older high-dose trial exposures as current prescribed doses.

Available citalopram data have not established increased major-birth-defect or miscarriage risk, but late SSRI exposure can cause poor neonatal adaptation and possible PPHN. Use near delivery is associated with greater postpartum bleeding risk. Consider untreated/relapsing depression before changing treatment; discuss the pregnancy registry. Citalopram enters milk; reported infant effects include sleepiness, irritability, poor feeding and weight loss. Balance maternal need/breastfeeding benefit and monitor infant feeding, weight and alertness.

Not approved for pediatric patients. Monitor suicidality in younger adults. Age >60 limits dosing to 20 mg/day; older adults also have greater hyponatremia susceptibility. Avoid 30 mg capsules in older adults because adjustment is not possible.

Mild/moderate renal impairment needs no adjustment; severe CrCl <20 lacks PK data. Hepatic impairment reduces clearance and doubles half-life, requiring maximum 20 mg/day. CYP2C19 poor metabolizers have increased exposure and the same 20 mg/day ceiling. Do not use the 30 mg capsule where this ceiling applies.

Antidepressant activity is presumed to involve inhibition of CNS serotonin reuptake. Citalopram is the racemate; escitalopram is its S-isomer and has separate labeling. Do not substitute their milligram doses.

Absorption

~80% absolute bioavailability; tablet peak ~4 hours. Food does not meaningfully affect absorption; selected tablet/solution forms are bioequivalent.

Steady state / half-life

~1 week to steady state; mean terminal half-life ~35 hours.

Metabolism / binding

Mainly hepatic CYP2C19/CYP3A4 metabolism; ~80% protein-bound. Parent contributes more serotonin-reuptake inhibition than major metabolites.

Elimination

Mixed clearance; ~20% of systemic clearance is renal. Hepatic impairment/older age/CYP2C19 phenotype increase exposure.

• Assess mood, suicidality, activation/mania, adherence and functional response, especially early or after changes.
• Check dose ceiling, age, liver disease and CYP2C19 interactions; review QT medicines and cardiac symptoms.
• Measure potassium/magnesium in at-risk patients and monitor ECG when indicated; evaluate sodium when risk factors or symptoms warrant.
• Follow bleeding/INR where relevant, sexual adverse effects, weight/appetite and discontinuation symptoms.

• Take once daily as prescribed; benefit may require continued treatment. Do not increase beyond the assigned limit or stop abruptly.
• Report suicidal thoughts/worsening mood, mania, fainting/palpitations, fever/rigidity, unusual bleeding or confusion promptly.
• Verify solution concentration and measuring device; do not confuse citalopram with escitalopram.
• Discuss pregnancy/breastfeeding, other medicines/herbs and driving impairment; follow missed-dose directions without doubling.

Dosage form / strength

Scored film-coated tablet · 20 mg

Distributor

AbbVie Inc.

Appearance / imprint

Pink, oval · F/P around score; 20 mg on reverse

Example NDC

0456-4020-01 · 100 tablets

Celexa tablets: 10, 20 and 40 mg. Selected Chartwell solution: 10 mg/5 mL (2 mg/mL), clear/colorless peppermint flavored, bottle or 10 mL unit-dose cups. Selected Aurobindo capsules: 30 mg only, white/white marked CL / 30. This review does not establish other liquid concentrations; verify any different supplied product before dosing.

Selected tablet, solution and capsule labels specify 20–25°C with excursions 15–30°C. Keep medicine in the supplied labeled container and out of children’s reach. Use accurate solution measurement; do not devise a capsule-division or opening method absent product instructions.