Citalopram: Difference between revisions
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{{MedTemplate | {{MedTemplate | ||
| generic | | generic = Citalopram | ||
| brand | | brand = Celexa | ||
| structure | | structure = | ||
| classes | | classes = [[:Category:SSRIs|Selective serotonin reuptake inhibitor (SSRI)]], [[:Category:Antidepressants|Antidepressant]] | ||
| | | uses = <vote slug="major-depressive-disorder-use">Major depressive disorder (FDA)</vote>, <vote slug="generalized-anxiety-disorder-use">Generalized anxiety disorder (off-label)</vote>, <vote slug="panic-disorder-use">Panic disorder (off-label)</vote>, <vote slug="ocd-use">Obsessive-compulsive disorder (off-label)</vote>, <vote slug="ptsd-use">Posttraumatic stress disorder (off-label)</vote>, <vote slug="premenstrual-dysphoric-disorder-use">Premenstrual dysphoric disorder (off-label)</vote>, <vote slug="menopausal-vasomotor-use">Menopausal vasomotor symptoms (off-label)</vote> | ||
| uses | | starting_dose = 20 mg PO once daily; titrate to 40 mg/day after 1 week if tolerated. Elderly (>60) and hepatic impairment: 20 mg/day ceiling | ||
| starting_dose | | preparations = Tablets 10, 20, 40 mg; oral solution 10 mg/5 mL | ||
| preparations | | fda_max = '''20 mg/day in adults >60 years''' per FDA's 2011-2012 QT-prolongation warning; 40 mg/day in adults ≤60 | ||
| fda_max = | | pill_id = | ||
| routes | | routes = Oral | ||
| onset | | onset = Antidepressant effect over 1-2 weeks; full clinical effect 4-6 weeks | ||
| duration | | duration = 24 hours (once-daily dosing) | ||
| halflife | | halflife = ~35 hours<ref name="celexa-label">FDA Prescribing Information, Celexa (citalopram hydrobromide), Allergan/AbbVie, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/020822s045lbl.pdf</ref> | ||
| bioavailability = ~80% (oral)<ref name="celexa-label" /> | |||
| pregnancy = Observational signal for persistent pulmonary hypertension of the newborn (small absolute risk) and neonatal adaptation syndrome with third-trimester exposure.{{citation needed}} | |||
| legal = [[USLegal:Prescription only|Rx-only]] in US. Carries the antidepressant '''Boxed Warning''' for suicidality in children, adolescents, and young adults<ref name="celexa-label" /> | |||
| | | mechanism = <vote slug="citalopram-mech-claim">Racemic mixture of R- and S-citalopram (the S-enantiomer is escitalopram, separately marketed as Lexapro). The S-enantiomer carries essentially all of the serotonin transporter (SERT) binding activity, while the R-enantiomer contributes the QT-prolonging liability that prompted the FDA's 2011 dose ceiling for adults over 60.</vote> CYP2C19 + CYP3A4 metabolism, with CPIC PGx guidance: poor CYP2C19 metabolizers have ~3-fold higher exposure and benefit from a lower starting dose; ultrarapid metabolizers may have inadequate response<ref name="cpic-ssri">CPIC Guideline for CYP2D6 and CYP2C19 Genotypes and Dosing of Selective Serotonin Reuptake Inhibitors, 2023. https://cpicpgx.org/guidelines/guideline-for-selective-serotonin-reuptake-inhibitors-and-cyp2d6-and-cyp2c19/</ref>. | ||
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}} | }} | ||
== References == | |||
<references /> | |||
[[Category:SSRIs]] | |||
[[Category:Antidepressants]] | [[Category:Antidepressants]] | ||
Latest revision as of 06:34, 23 May 2026
Citalopram
Celexa
Experience
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1 provider report · avg efficacy 40.0/100 · avg side-effect burden 40.0/100 · 10 patients managed total
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Problems
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Effects
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Relevant Literature
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Summary
Common uses
Major depressive disorder (FDA)0, Generalized anxiety disorder (off-label)0, Panic disorder (off-label)0, Obsessive-compulsive disorder (off-label)0, Posttraumatic stress disorder (off-label)0, Premenstrual dysphoric disorder (off-label)0, Menopausal vasomotor symptoms (off-label)0
Pharmacy
Starting dose
20 mg PO once daily; titrate to 40 mg/day after 1 week if tolerated. Elderly (>60) and hepatic impairment: 20 mg/day ceiling
Preparations
Tablets 10, 20, 40 mg; oral solution 10 mg/5 mL
US FDA Max
20 mg/day in adults >60 years per FDA's 2011-2012 QT-prolongation warning; 40 mg/day in adults ≤60
Pharmacology
Routes
Oral
Onset
Antidepressant effect over 1-2 weeks; full clinical effect 4-6 weeks
Duration
24 hours (once-daily dosing)
Half-life
~35 hours[2]
Bioavailability
~80% (oral)[2]
Pregnancy
Observational signal for persistent pulmonary hypertension of the newborn (small absolute risk) and neonatal adaptation syndrome with third-trimester exposure.[citation needed]
Legal status
Purported mechanism
Racemic mixture of R- and S-citalopram (the S-enantiomer is escitalopram, separately marketed as Lexapro). The S-enantiomer carries essentially all of the serotonin transporter (SERT) binding activity, while the R-enantiomer contributes the QT-prolonging liability that prompted the FDA's 2011 dose ceiling for adults over 60.0 CYP2C19 + CYP3A4 metabolism, with CPIC PGx guidance: poor CYP2C19 metabolizers have ~3-fold higher exposure and benefit from a lower starting dose; ultrarapid metabolizers may have inadequate response[1].
References
- ↑ CPIC Guideline for CYP2D6 and CYP2C19 Genotypes and Dosing of Selective Serotonin Reuptake Inhibitors, 2023. https://cpicpgx.org/guidelines/guideline-for-selective-serotonin-reuptake-inhibitors-and-cyp2d6-and-cyp2c19/
- ↑ 2.0 2.1 2.2 FDA Prescribing Information, Celexa (citalopram hydrobromide), Allergan/AbbVie, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/020822s045lbl.pdf