Citalopram Oral Solution Dosage & Rx Info

Citalopram Oral Solution Generic Name & Formulations

Legal Class

General Description

Citalopram (as HBr) 2mg/mL; sugar- and alcohol-free; peppermint flavor; contains parabens.

Pharmacological Class

SSRI.

How Supplied

Tabs—100; Soln—Contact supplier

Manufacturer

Various generic manufacturers

Generic Availability

YES

Mechanism of Action

The mechanism of action of citalopram HBr as an antidepressant is presumed to be linked to potentiation of serotonergic activity in the central nervous system (CNS) resulting from its inhibition of CNS neuronal reuptake of serotonin (5-HT).

Citalopram Oral Solution Indications

Indications

Major depressive disorder (MDD).

Citalopram Oral Solution Dosage and Administration

Adult

Initially 20mg once daily; after ≥1 week may increase to 40mg once daily. Doses >40mg/day: not recommended. Elderly (>60yrs), hepatic impairment, CYP2C19 poor metabolizers, concomitant cimetidine or other CYP2C19 inhibitors: max 20mg/day.

Children

Not established.

Citalopram Oral Solution Contraindications

Contraindications

Concomitant pimozide, linezolid, IV methylene blue. During or within 14 days of MAOIs; do not start an MAOI during or within 14 days of citalopram.

Citalopram Oral Solution Boxed Warnings

Boxed Warning

Suicidal thoughts and behaviors.

Citalopram Oral Solution Warnings/Precautions

Warnings/Precautions

Increased risk of suicidal thinking and behavior in children, adolescents and young adults; monitor for clinical worsening and unusual changes in all patients. Avoid in congenital long QT syndrome, bradycardia, hypokalemia, hypomagnesemia, recent MI, uncompensated heart failure; monitor ECG if therapy is considered. Discontinue therapy if persistent QTc measurements >500ms. Correct hypokalemia, hypomagnesemia before starting and periodically monitor. Monitor for serotonin syndrome; discontinue and treat if occurs. Screen for bipolar disorder, mania, or hypomania prior to initiation. Seizure disorder. Angle-closure glaucoma. Avoid in untreated anatomically narrow angles. Volume-depleted. Hyponatremia (esp. in elderly). Sexual dysfunction. Avoid abrupt cessation. Write ℞ for smallest practical amount. Reevaluate periodically. Hepatic or severe renal impairment (CrCl <20mL/min). Elderly. Pregnancy: effects on neonates exposed in 3^rd trimester (see full labeling). Nursing mothers: monitor infants.

Citalopram Oral Solution Pharmacokinetics

Absorption

Absolute bioavailability: ~80%. Peak blood levels occur at ~4 hours following a single oral dose (40mg tablet).

Distribution

Volume of distribution: ~12 L/kg. Plasma protein bound: ~80%.

Metabolism

Hepatic (CYP3A4, CYP2C19).

Elimination

Renal. Half-life: ~35 hours. Systemic clearance: 330 mL/min.

Citalopram Oral Solution Interactions

Interactions

See Contraindications. Increased risk of serotonin syndrome with other serotonergic drugs (eg, SSRIs, SNRIs, triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, meperidine, methadone, tryptophan, buspirone, amphetamines, St. John's Wort) or with drugs that impair serotonin metabolism (eg, MAOIs, linezolid, IV methylene blue). Avoid drugs that prolong QT interval including Class 1A (eg, quinidine, procainamide) or Class III antiarrhythmics (eg, amiodarone, sotalol), antipsychotics (eg, chlorpromazine, thioridazine), antibiotics (eg, gatifloxacin, moxifloxacin), and others (eg, pentamidine, methadone, levomethadyl acetate). Avoid alcohol. Increased risk of bleeding with NSAIDs, aspirin, warfarin, and others that affect coagulation. May be potentiated by cimetidine, lithium, potent inhibitors of CYP2C19 or CYP3A4 (eg, azole antifungals). May be antagonized by carbamazepine. Increases metoprolol levels.

Citalopram Oral Solution Adverse Reactions

Adverse Reactions

Nausea, diarrhea, dry mouth, somnolence, insomnia, increased sweating, ejaculation disorder, rhinitis, agitation, fatigue, anxiety, anorexia, arthralgia, myalgia; dose-dependent QT prolongation, mania/hypomania, discontinuation syndrome.

Citalopram Oral Solution Clinical Trials

See Literature

Citalopram Oral Solution Note

Notes

Formerly known under the brand name Celexa Oral Solution.

Citalopram Oral Solution Patient Counseling