Citalopram 💊
⚠️ 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
