Citalopram
Regulatory sources consulted
- openfda-label-3401590f-c858-2164-e063-6294a90a7ea1
- aemps-ft-66483
- ansm-rcp-69771920
- PubMed PMID:36749328 ↗
- PubMed PMID:37032427 ↗
- PubMed PMID:35707298 ↗
- PubMed PMID:36253442 ↗
- PubMed PMID:37955823 ↗
- CredibleMeds.org
- OpenFDA · N06AB04
- RxNorm rxcui 2556 ↗
Approved indications
- Treatment of major depressive disorder (MDD) in adults.
- Treatment of vasomotor symptoms (hot flashes) associated with menopause. · off-label
Contraindications
Absolute
- Concomitant use with monoamine oxidase inhibitors (MAOIs) or within 14 days of stopping an MAOI.
- Concomitant use of pimozide.
- Patients with known congenital or acquired QT interval prolongation.
- Known hypersensitivity to citalopram or any of its excipients.
Clinical warnings
- Boxed warning · Increased risk of suicidal thoughts and behaviors in pediatric and young adult patients. Closely monitor for clinical worsening and emergence of suicidal thoughts and behaviors. Not approved for use in pediatric patients. — FDA
- Major warning · QT-Prolongation and Torsade de Pointes: Causes a dose-dependent QT interval prolongation. Doses above 40 mg/day are not recommended. Maximum dose is 20 mg/day in patients >60 years, with hepatic impairment, CYP2C19 poor metabolizers, or on CYP2C19 inhibitors. — FDA
- Major warning · Serotonin Syndrome: Potentially life-threatening. The risk is increased with concomitant use of other serotonergic drugs (triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, St. John's Wort, etc.) and with drugs that impair metabolism of serotonin (MAOIs). — FDA
Drug interactions
- HighMonoamine Oxidase Inhibitors (MAOIs)N06AF
Mechanism: Increased serotonin levels leading to a high risk of serotonin syndrome.
Recommendation: Contraindicated. A washout period of at least 14 days is required between stopping the MAOI and starting citalopram, and 7 days when switching from citalopram to an MAOI.
FDA labelANSM RCP
- HighPimozideN05AG02
Mechanism: Increased pimozide concentrations and additive risk of QT interval prolongation, which can lead to serious ventricular arrhythmias.
Recommendation: Concomitant use is contraindicated.
FDA labelANSM RCP
- ModerateCYP2C19 Inhibitors (e.g., omeprazole)A02BC01
Mechanism: Inhibition of citalopram metabolism, leading to increased plasma concentrations and risk of QT interval prolongation.
Recommendation: Limit the citalopram dose to a maximum of 20 mg/day when co-administered with a CYP2C19 inhibitor.
FDA labelPMID:37032427
Adverse events
Common (≥1%)
nausea · dry mouth · somnolence · increased sweating · ejaculation disorder · insomnia · headache · agitation
Rare but serious
QT prolongation · Torsade de Pointes · serotonin syndrome · hyponatremia · seizures · angle-closure glaucoma · bleeding · activation of mania/hypomania
Pregnancy and lactation
FDA category: Not Assigned
SSRI use late in pregnancy may increase the risk for persistent pulmonary hypertension of the newborn (PPHN) and a neonatal poor adaptation syndrome. Observational data indicate an increased risk of postpartum hemorrhage.
Recent literature (PubMed)
Guía de práctica clínica que actualiza las recomendaciones de dosificación de ISRS, incluido citalopram, basadas en genotipos de CYP2D6 y CYP2C19. Recomienda reducir la dosis de citalopram en metabolizadores lentos de CYP2C19 para evitar efectos adversos, especialmente la prolongación del QT.
Metaanálisis en red que demuestra que citalopram, entre otros antidepresivos, es significativamente más eficaz que el placebo para prevenir la recaída en pacientes con trastorno depresivo mayor durante la fase de mantenimiento del tratamiento.
Revisión exhaustiva sobre el manejo de los síntomas menopáusicos. Cita al citalopram como una opción no hormonal eficaz para reducir los síntomas vasomotores (sofocos y sudores nocturnos), con una reducción de la frecuencia de aproximadamente 40% a 65%.
Revisión sobre los trastornos del sueño en la menopausia que menciona al citalopram como una de las opciones farmacológicas útiles para su manejo, especialmente cuando se asocian con ansiedad o depresión.
Revisión sobre los mecanismos de acción de los ISRS, que se aleja de la simple idea de aumentar la serotonina sináptica hacia modelos más complejos de neuroplasticidad. También aborda la falta de investigación sobre el síndrome de discontinuación.