Citalopram
CELEXA
Pronunciation: sye-TAL-oe-pram (se-LEX-a)
“Shitty Lexus Pram”
Pram is the British word for baby carriage
Blue cloud → serotonin reuptake inhibitor (SRI)
The “impure” form of escitalopram (LEXAPRO)
The pink L is Lexapro; both L’s together resemble a C → Celexa
What it isSerotonin reuptake inhibitor for depression.
Why this oneThe racemate is inexpensive and interaction-light, but offers no clear efficacy advantage over escitalopram.
What limits itQT prolongation is dose-dependent; use lower ceilings in older adults, hepatic impairment or CYP2C19 poor metabolizers. Watch sodium.
FDA-approved for
- depression (1998)
Off-label
- anxiety disorders
- agitation in dementia
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Major depressive disorder | Adult | 20 mg QD | 40 mg QD | 40 mg QD |
| MDD | >60 y, hepatic impairment, CYP2C19 poor metabolizer, or with CYP2C19 inhibitor | 20 mg QD | 20 mg QD | 20 mg QD |
Titration At least 1 week between dose increases.
Renal Undefined
Hepatic Maximum 20 mg once daily
Do not exceed 40 mg/day due to dose-dependent QT prolongation.
Instructions
- Take once daily with or without food
- Taper gradually at discontinuation; do not stop abruptly
- Screen for bipolar disorder before starting
- Allow at least 14 days between an MAOI and citalopram in either direction
Available strengths
- tab 10, 20, 40 mg
- sol 10 mg/5 mL
- cap 30 mg
Contraindications
- MAOIs (concurrently or within 14 days) due to risk of serotonin syndrome
- Concomitant pimozide (QT prolongation)
Cautions
- Dose-dependent QT prolongation and torsade de pointes; avoid in congenital long QT, bradycardia, hypokalemia/hypomagnesemia, recent MI, uncompensated HF, or with QT-prolonging drugs
- Serotonin syndrome
- Increased bleeding risk (with NSAIDs, antiplatelets, anticoagulants)
- Activation of mania/hypomania
- Discontinuation syndrome
- Seizures
- Angle-closure glaucoma
- Hyponatremia/SIADH
- Sexual dysfunction
Adverse reactions
- Ejaculation disorder (mostly delay)
- Nausea
- Dry mouth
- Somnolence
- Insomnia
- Increased sweating
- Tremor
Pregnancy No established increased risk of major birth defects or miscarriage; risk of PPHN and poor neonatal adaptation with late-pregnancy exposure; small (<2-fold) increase in postpartum hemorrhage.
Lactation Present in human milk; monitor infant for irritability, restlessness, excessive somnolence, decreased feeding, and weight loss.
Cost
Generic entry2004
⚠ BOXED WARNING
- Suicidal thoughts and behaviors in patients under 25
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityDose-dependent QT prolongation and serotonin toxicity are the defining serious risks.
Serotonin and MAOI
Provisional washout figures
Elevating mechanismSRI
Non-elevating actionNone recorded
Exposure dependenceTherapeutic exposure; severe toxicity requires meaningful MAO-A inhibition
Washout BEFORE an MAOI14 days
Evidence confidenceHigh
InterpretationClinically significant SRI. A second SRI generally represents therapeutic duplication/additive adverse effects, not the classic life-threatening interaction.
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