Makindo Medical Notes

⚠️ Key safety notes: - Never give with an MAOI or within 2 weeks after stopping one. - Avoid abrupt withdrawal (risk of withdrawal syndrome). - Associated with QT prolongation – ECG monitoring may be needed at higher doses.

📖 About

Always check the BNF link here.

• 💊 Selective serotonin reuptake inhibitor (SSRI) antidepressant.
• 📌 Less toxic in overdose compared to tricyclic antidepressants (TCAs) and some other SSRIs.
• ✅ Commonly used in depression and anxiety disorders.

⚡ Mechanism of Action

• Blocks reuptake of serotonin (5-HT) into presynaptic neurons.
• ⬆️ Increases serotonin concentration in the synaptic cleft.
• Clinical effect typically seen after 2–4 weeks of treatment.

🩺 Indications & Dosing (verify with BNF/datasheet)

• 🧠 Depression: 20–40 mg once daily PO (start at 10 mg in elderly).
• ⚡ Panic disorder: 10–40 mg once daily PO.
• 💧 Dose reduction required in hepatic impairment.
• 📉 Maximum recommended dose: 40 mg daily (20 mg in elderly or those with hepatic impairment/QT risk).

🔄 Interactions

• ⬆️ Levels of TCAs, benzodiazepines, clozapine, haloperidol, lithium.
• ⬆️ Risk of serotonin syndrome with other serotonergic drugs (SSRIs, SNRIs, MAOIs, triptans, tramadol).
• ⬆️ Risk of bleeding with anticoagulants, aspirin, NSAIDs.
• Metabolised via CYP enzymes – interactions possible (check BNF for full list).

⚠️ Cautions

• ⚡ QT prolongation – caution with cardiac disease or other QT-prolonging drugs.
• 🧠 Avoid abrupt withdrawal – risk of withdrawal syndrome (dizziness, sensory disturbances, anxiety).
• ⛔ Never use within 2 weeks of an MAOI (risk of serotonin syndrome).
• 📉 Reduce dose in hepatic impairment and elderly patients.
• ⚠️ Risk of suicidal thoughts/behaviours, particularly in young adults at initiation.

🚫 Contraindications

• Concurrent use with MAOIs or within 2 weeks of stopping one.
• Active mania.
• Known QT interval prolongation or congenital long QT syndrome.
• Concomitant use with other QT-prolonging drugs (e.g. certain antiarrhythmics, antipsychotics, macrolides).

💥 Side Effects

• 🤢 GI upset: nausea, dry mouth, diarrhoea, dyspepsia.
• 🧠 Neurological: headache, insomnia, agitation, tremor, seizures (rare).
• 🫀 QT prolongation, arrhythmias (dose-dependent).
• 🧬 Hyponatraemia (SIADH), especially in elderly.
• ⚡ Sexual dysfunction: decreased libido, impotence, anorgasmia.
• 🧠 Psychiatric: anxiety, suicidal ideation (esp. at start of therapy).
• Rare: extrapyramidal symptoms, hepatitis, serotonin syndrome, hypersensitivity reactions.

📑 References

• BNF: Citalopram
• MHRA Safety Guidance: Citalopram & QT prolongation