Citalopram did not reduce saliva flow in a single dose study in human volunteers and in none of the studies in healthy volunteers did citalopram have significant influence on cardiovascular parameters. Citalopram can be used during pregnancy if clinically needed, taking into account the aspects mentioned below. 0000004822 00000 n
About 12% of the daily dose is excreted in urine as unchanged citalopram. Dizziness, sensory disturbances (including paraesthesia and electric shock sensations), sleep disturbances (including intense dreams), agitation or anxiety, nausea, tremor, confusion, sweating, headache, diarrhoea, palpitations, emotional instability, irritability, and visual disturbances are the most commonly reported reactions. The following symptoms have been seen in reported overdose of citalopram: convulsion, tachycardia, somnolence, QT prolongation, coma, vomiting, tremor, hypotension, cardiac arrest, nausea, serotonin syndrome, agitation, bradycardia, dizziness, bundle branch block, QRS prolongation, hypertension, mydriases, torsade de pointes, stupor, sweating, cyanosis, hyperventilation, hyperpyrexia, and atrial and ventricular arrhythmia. A pharmacokinetic/pharmacodynamic interaction study with concomitantly administered citalopram (20mg daily) and selegiline (10mg daily) (a selective MAO B inhibitor) demonstrated no clinically relevant interactions. For Adult. Citalopram has no effect on the serum levels of prolactin and growth hormone.In a double-blind, placebo-controlled ECG study in healthy subjects, the change from baseline in QTc (Fridericia-correction) was 7.5 (90%CI 5.9-9.1) msec at the 20mg/day dose and 16.7 (90%CI 15.0-18.4) msec at the 60mg/day dose (see sections 4.3, 4.4, 4.5, 4.8 and 4.9).Absorption is almost complete and independent of food intake (TCitalopram is metabolised to the active demethylcitalopram, didemethylcitalopram, citalopram-N-oxide and an inactive deaminated propionic acid derivative. The drops also contain small amounts of ethanol less than 100mg per maximum allowed dose (48mg equivalent to 24 drops daily).Withdrawal symptoms when treatment is discontinued are common, particularly if discontinuation is abrupt (see section 4.8 Undesirable effects). Password. for OCD, PTSD Consider risk/benefit with service user. No information is available in cases of severe renal impairment (creatinine clearance <20ml/min).An initial dose of 8mg (4 drops) daily during the first two weeks of treatment is recommended for patients who are known to be poor metabolisers with respect to CYP2C19. atypical antipsychotics, phenothiazines, tricyclic antidepressants) that can increase the risk of haemorrhage (see section 4.4). Citalopram has minor or moderate influence on the ability to drive and use machines. An ECG should be taken. 31%) and CYP2D6 (approx. Cases of serious and sometimes fatal reactions have been reported in patients receiving an SSRI in combination with a, monoamine oxidase inhibitor (MAOI), including the irreversible MAOI selegiline and the reversible MAOIs linezolid and moclobemide and in patients who have recently discontinued an SSRI and have been started on a MAOI.Some cases presented with features resembling serotonin syndrome. There is no clear relationship between citalopram plasma levels and therapeutic response or side effects.Longer half-lives and decreased clearance values due to a reduced rate of metabolism have been demonstrated in elderly patients.Citalopram is eliminated more slowly in patients with reduced hepatic function. Dosage adjustments should be made carefully on an individual patient basis, to maintain the patient at the lowest effective dose.Patients with depression should be treated for a sufficient period of at least 6 months to ensure that they are free from symptoms.A single oral dose of 8mg (4 drops) is recommended for the first week before increasing the dose to 16mg (8 drops) daily. 0000017015 00000 n
Abrupt discontinuation should be avoided during pregnancy.The following symptoms may occur in the neonates after maternal SSRI/SNRI use in later stages of pregnancy: respiratory distress, cyanosis, apnoea, seizures, temperature instability, feeding difficulty, vomiting, hypoglycaemia, hypertonia, hypotonia, hyperreflexia, tremor, jitteriness, irritability, lethargy, constant crying, somnolence and difficulty sleeping. Caution is warranted for concomitant use of other QT interval prolonging medicines or hypokalaemia/hypomagnesaemia-inducing drugs as they, like citalopram, potentially prolong the QT interval. ECG monitoring may be advisable in case of overdose or conditions of altered metabolism with increased peak levels, e.g. Each drop contains 2mg citalopram (as hydrochloride). 8mg (4 drops) to 16mg (8 drops) daily. 0000003335 00000 n
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Citalopram oral drops have approximately 25% increased bioavailability compared to tablets. Adverse effects observed with citalopram are in general mild and transient. Co-administration with metoprolol resulted in twofold increase in the plasma levels of metoprolol, but did not statistically significant increase the effect of metoprolol on the blood pressure and cardiac rhythm.A pharmacokinetic/pharmacodynamic interaction study with concomitant administration of citalopram and metoprolol (a CYP2D6 substrate) showed a twofold increase in metoprolol concentrations, but no statistically significant increase in the effect of metoprolol on blood pressure and heart rate in healthy volunteers.