Citalopram

ADMINISTRATION ROUTES:

PO

ALTERNATIVE NAMES:

Celapram, Cipramil

ICU INDICATIONS:

1. Treatment of depression

Note: citalopram is usually only given to 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 20 mg tablets (white), Cipramil 20 mg tablets (white), Citalopram 20 mg tablets (white)

DOSAGE:

PO:

Initially 20 mg once daily (10 mg in the elderly) Increase to maximum of 60 mg once daily Maximum 40 mg daily in the elderly, 30 mg in hepatic impairment

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

Dose in renal impairment

Dose in renal replacement therapy

DOSAGE IN PAEDIATRICS:

PO:

0.4 mg/kg once 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 (MAOIs)
2. Hypersensitivity to citalopram

WARNINGS:

Use in Patients With Concomitant Illness:

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 haemodynamic 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 behaviour (suicidality) or unusual changes in behaviour, 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.

Hyponatraemia:

Cases of hyponatraemia 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 IN ICU:

Central Nervous System 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 (MAOIs):

See CONTRAINDICATIONS

Drugs That Interfere With Haemostasis (NSAIDs, aspirin, warfarin, etc):

Serotonin release by platelets plays an important role in haemostasis. 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