Legal classification of medication
POM
Citalopram can only be obtained in accordance with a prescription given by an appropriate prescriber and therefore the legal status of the medication is prescription only medicine (POM)
Formulations
Citalopram comes in two formulations with the following strengths:
Class of drug
Citalorpam is a selective serotonin reuptake inhibitor type antidepressant.
Indications
How does it work?
Citalopram is thought to increase the levels of serotonin in the brain. Serotonin is a neurotransmitter which is thought to play a crucial role in how we feel. It is thought that increasing serotonin levels may make us happier.
How is it taken?
Citalopram can be taken at anytime of day and can be taken with or without food. The oral drops can be mixed with water, orange juice, or apple juice before taking.
In depression, the normal recommended starting dose in 20mg, however improvements may not be felt for at least 2 weeks. The dose may need to be reviewed and most doctors will ask patients to return in 3 to 4 weeks to see how the patient is doing. The maximum dose is no greater than 60mg once a day.
In panic disorder, the normal recommended starting dose is 10mg and this may be increased in 10mg increments to achieve symptomatic control. The normal treatment dose is 20 to 30mg once a day.
Initially in the first 2 weeks symptoms of anxiety may worsen, if this continues you should seek advice from your doctor. It is important not to stop treatment suddenly, as doing so may precipitate sudden onset of previous symptoms or other withdrawal symptoms. It is advised that treatment should be tapered off over 2 weeks.
Regular monitoring is essential in elderly patients, and patients who have reduced liver and renal functions taking citalopram. The medication takes longer to be eliminated from these patient groups as the concentration of the drug can be twice as high in blood leading to a greater degree of side-effects.
Pregnancy and Breast feeing
Despite animal studies not showing any obvious harm to the unborn child, this has not been reliably established for human pregnancies. Therefore treatment should only be continued if the benefits of treatment to the mother outweigh the potential risks to the unborn child. Citalopram is thought to cross the placenta, and as such newborns should be observed for withdrawal symptoms if the mother was on citalopram.
Citalopram is excreted in breast milk and if long term treatment is required, consideration should be given to discontinue breast feeding.
Contraindications
Citalopram should be not taken together with drugs belonging to the class: Monoamine Oxidase Inhibitors (a different class of antidepressant). If a patient experiences severe mental and physical hyperactivity (manic phase) treatment with citalopram should be discontinued.
Side-effects
In adults, the most commonly (ranging from an occurrence of 1 in 100 to 1 in 10) reported side-effects were:
Rare side effects (ranging from an occurrence of 1 in 10,000 but no more than 1 in 1000) included:
The use of citalopram with anti-inflammatory medications (such as Aspirin and Ibuprofen) may cause an increase risk of gastric bleeding (bleeding from the stomach), this is thought to be more likely in older people.
