Citalopram

Aka: Citalopram, Celexa, Escitalopram, Lexapro

1. Mechanism
   1. Selective Serotonin Reuptake Inhibitor (SSRI)
   2. Minimal effects on other neurotransmitters
2. Pharmacokinetics
   1. Half-life: 20 hours
3. Indications
   1. Major Depression
4. Preparations
   1. Citalopram (Celexa)
      1. Tablets: 10, 20 (scored), 40 (scored)
      2. Oral Solution: 10 mg/5 ml
   2. Escitalopram (Lexapro)
      1. Active isomer of racemic Citalopram
      2. Tablets: 5, 10 (scored), 20 mg (scored)
5. Dosing
   1. Citalopram (Celexa)
      1. Starting dose: 20 mg PO qd
      2. Most effective dose: 40 mg PO qd
      3. Maximum Dose: 40 mg
   2. Escitalopram (Lexapro)
      1. Starting Dose: 10 mg qd (equivalent to 40 mg Celexa)
      2. Higher dose at 20 mg is not more effective than 10 mg
6. Adverse Effects
   1. No increased weight gain
   2. Midway on spectrum between Anxiolytic and anxiogenic
      1. Similar to Zoloft on this spectrum
      2. Well tolerated
   3. Nausea
      1. May occur initially but is transient
      2. Consider decreasing dose to 10 mg initially
   4. Less Sexual Dysfunction than Prozac, Zoloft, Paxil
      1. Sexual dysfunction in 10-15% of cases
      2. Similar to Luvox and Effexor in terms of this effect
      3. See Antidepressant Induced Sexual Dysfunction
7. Drug Interactions
   1. Minimal Cytochrome P450 inhibition
   2. No Clinically Significant drug interactions
      1. May be best SSRI for patients on multiple medications
8. Resources
   1. Celexa Website (Forest Pharmaceuticals)
      1. http://www.celexa.com