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Sunday, February 6, 2011

Citalopram hydrobromide

Posted by Sampil 10:02 PM, under | No comments

citalopram hydrobromide
(si tal' oh pram)
Celexa

Pregnancy Category C

Drug classes
Antidepressant
SSRI

Therapeutic actions
Potentiates serotonergic activity in the CNS by inhibiting neuronal reuptake of serotonin, resulting in antidepressant effect, with little effect on norepinephrine or dopamine reuptake.

Indications
·        Treatment of depression, particularly effective in major depressive disorders
·        Unlabeled uses: OCD, panic disorder, PMDD, social phobia, trichotillomania, PTSD

Contraindications and cautions
·        Contraindicated with MAOI use; allergy to drug or any component of the drug or other SSRIs; concomitant use of pimozide.
·        Use cautiously with renal or hepatic impairment, pregnancy, lactation, and in patients who are elderly or suicidal.

Available forms
Tablets—10, 20, 40 mg; oral solution—2 mg/mL

Dosages
ADULTS
Initially, 20 mg/day PO as a single daily dose. May be increased to 40 mg/day if needed.
PEDIATRIC PATIENTS
Safety and efficacy not established.
GERIATRIC PATIENTS OR PATIENTS WITH RENAL OR HEPATIC IMPAIRMENT
20 mg/day PO as a single dose; increase to 40 mg/day only if clearly needed and patient is not responding.

Pharmacokinetics
Route
Onset
Peak
Oral
Slow
2–4 hr

Metabolism: Hepatic; T1/2: 35 hr
Distribution: Crosses placenta; enters breast milk
Excretion: Urine

Adverse effects
·        CNS: Somnolence, dizziness, insomnia, tremor, nervousness, headache, anxiety, paresthesia, blurred vision
·        CV: Palpitations, vasodilation, orthostatic hypotension, hypertension
·        Dermatologic: Sweating, rash, redness
·        GI: Nausea, dry mouth, constipation, diarrhea, anorexia, flatulence, vomiting
·        GU: Ejaculatory disorders
·        Respiratory: Sinusitis, URI, cough, rhinitis

Interactions
·        Increased citalopram levels and toxicity if taken with MAOIs; ensure that patient has been off the MAOI for at least 14 days before administering citalopram
·        Increased citalopram levels with azole antifungals, macrolides
·        Possible severe adverse effects if combined with TCAs, erythromycin; use caution
·        Possible increased effects of beta blockers; monitor patient and reduce beta blocker dose as needed
·        Possible increased bleeding with warfarin, monitor patient carefully
·        Risk of prolonged QT interval and potentially fatal cardiac arrhythmias if combined with pimozide; avoid this combination
·        Increased risk of severe reaction if combined with St. John's wort therapy.

Nursing considerations
CLINICAL ALERT!
Name confusion has occurred between Celexa (citalopram), Celebrex (celecoxib), Xanax (alprazolam), and Cerebyx (fosphenytoin); use caution.

Assessment
·        History: MAOI use; allergy to drug or any component of the drug; renal or hepatic impairment, the elderly, pregnancy, lactation, suicidal tendencies
·        Physical: Orientation, reflexes; P, BP, perfusion; bowel sounds, normal output; urinary output; liver evaluation; LFTs, renal function tests

Interventions
·        Administer once a day, in the morning; may be taken with food if desired.
·        Encourage patient to continue use for 4–6 wk, as directed, to ensure adequate levels to affect depression.
·        Limit amount of drug given in prescription to potentially suicidal patients.
·        Establish appropriate safety precautions if patient experiences adverse CNS effects.
·        Institute appropriate therapy for patient suffering from depression.

Teaching points
·        Take this drug exactly as directed, and as long as directed; it may take a few weeks to realize the benefits of the drug. The drug may be taken with food if desired.
·        This drug should not be taken during pregnancy or when nursing a baby; using barrier contraceptives is suggested.
·        You may experience these side effects: Drowsiness, dizziness, tremor (use caution and avoid driving a car or performing other tasks that require alertness if you experience daytime drowsiness); GI upset (eat frequent small meals; perform frequent mouth care); alterations in sexual function (it may help to know that this is a drug effect, and will pass when drug therapy is ended).
·        Report severe nausea, vomiting; palpitations; blurred vision; excessive sweating.

Adverse effects in Italic are most common; those in Bold are life-threatening.

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