CitalopramCitalopram Hydrobromide

About Citalopram

Citalopram is presumed to work by blocking the reuptake of serotonin in the brain; escitalopram is its S-enantiomer, one of its two mirror-image forms. Celexa is labeled for major depressive disorder in adults only. People are screened for bipolar disorder before it starts, at 20 mg once a day, and the dose can rise to a maximum of 40 mg after at least a week. The maximum is 20 mg a day for people over 60, people with liver impairment, people whose bodies break it down slowly through the CYP2C19 enzyme (poor metabolizers), and anyone taking a CYP2C19 inhibitor, such as cimetidine or omeprazole.

The boxed warning says antidepressants increased the risk of suicidal thoughts and behaviors in pediatric and young adult patients in short-term studies, and that Celexa is not approved for use in pediatric patients; everyone taking it is watched for worsening mood, especially early on and after dose changes. Citalopram prolongs the QT interval in a dose-dependent way, and torsade de pointes, ventricular tachycardia and sudden death have been reported. It is avoided in congenital long QT syndrome, a slow heart rate, low potassium or magnesium, a recent heart attack or uncompensated heart failure unless the benefits outweigh the risks, and it is also avoided with other drugs that prolong the QT interval. People at risk have potassium and magnesium checked, some need ECG monitoring, and it is stopped if the QTc stays above 500 ms. It must not be taken with an MAO inhibitor or within 14 days of stopping one, including linezolid or intravenous methylene blue, or with pimozide. Other warnings cover serotonin syndrome, bleeding, mania, discontinuation symptoms, seizures, angle-closure glaucoma, low sodium and sexual dysfunction. Ejaculation disorder, mainly delayed ejaculation, is the most common side effect; nausea, dry mouth, sleepiness, sweating and insomnia are also listed.

Generic oral solution is sold, although the Celexa oral solution is discontinued. Citalopram capsules come only as 30 mg, for adults whose dose is 30 mg once a day: they are not used to start treatment or for any other dose, and their label says to avoid them in people over 60, people with liver impairment, CYP2C19 poor metabolizers and people taking cimetidine or another CYP2C19 inhibitor. The dose is lowered gradually when stopping. Use in the month before delivery may raise the risk of postpartum hemorrhage, and late-pregnancy exposure carries a risk of persistent pulmonary hypertension and other complications in the newborn. Breastfed infants are watched for irritability, restlessness, excessive sleepiness, decreased feeding and weight loss.

Taking Citalopram

How to take it

Once a day, with or without food. Keep taking it as prescribed, and do not stop it without talking to the prescriber.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose and carry on as usual. Do not take a double dose.

Storage

At room temperature in the original, tightly closed container, away from excess heat and moisture (not in a bathroom), and out of reach of children.

Interactions to know about

MAO inhibitors, including linezolid and methylene blue, and pimozide are not combined with it, and other drugs that prolong the QT interval are avoided. CYP2C19 inhibitors such as cimetidine and omeprazole limit the dose to 20 mg. Triptans, tricyclic antidepressants, fentanyl, tramadol, meperidine, methadone, lithium, buspirone, amphetamines, tryptophan and St. John’s wort raise the risk of serotonin syndrome, and aspirin, NSAIDs and warfarin add to bleeding risk. Ask the prescriber about drinking alcohol while taking it.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Citalopram differs from pharmacy to pharmacy

Each pharmacy sets its own cash price for generic citalopram from what it paid its supplier plus its own dispensing fee and markup, so quotes for the same tablets can differ. A prescription that names Celexa and does not allow substitution has to be filled with the brand.

The oral solution and the 30 mg capsules are separate products with their own makers, so each is quoted on its own. A capsule cannot be swapped for tablets at the counter, although the same 30 mg dose can be written as a 10 mg and a 20 mg tablet.

Ways to pay less for Citalopram without insurance

• Ask for generic citalopram tablets, and make sure the prescription does not block substitution.
• Ask whether citalopram is on the pharmacy’s flat-price generic list, and compare more than one pharmacy.
• If 30 mg capsules are prescribed, ask the pharmacy to quote tablets making up the same dose as well, and ask the prescriber which to write.
• Once your dose is stable, ask for a ninety-day supply.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Citalopram

1. 1.What is my maximum dose, given my age and my other medicines?
2. 2.Do any of my medicines, such as omeprazole, cimetidine or heart rhythm drugs, interact with it?
3. 3.Do I need an ECG or potassium and magnesium tests?
4. 4.How should my dose be lowered if I need to stop?

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