Selective serotonin reuptake inhibitors include-

Fluoxetine, Fluvoxamine, Paroxetine, Sertraline, Citalopram, Escitalopram

Refer- Fluoxetine

Reports of enhanced serotonergic effects when other SSRI's have been given with lithium and tryptophan and therfore the concomittant use of citalopram with these drugs should be undertaken with caution.

Cimetidine causes a moderate increase in the average steady state levels of citalopram.

Experience with citalopram has not revealed any clinically relevant interactions with neuroleptics

However, as with other SSRIs the possibility of a pharmacodynamic interaction cannot be excluded.

Increased sweating, headache, tremor, dizziness, abnormal accomodation, somnolence,

insomnia, agitation, nervousness, nausea, dry mouth, constipation, diarrhoea, palpitation,

asthenia, rash, pruritus, migraine amnesia, anxiety, increased appetite, anorexia, suicide attempt.

Hypersensitivity

Special precautions:

Should not be given to patients receiving monoamine oxidase inhibitors, or for 14 days after their discontinuation.

Until further evidence is available it is advised not to use citalopram simultaneously with 5-HT agonists eg., sumatriptan.

Should be discontinued if the patient enters a manic phase.

Due to limited human data, it should only be used in pregnancy if considered necessary and under the close supervision of a physician

Citalopram appears in breast milk in very low concentrations.

Date of Approval     2001

Indication-

Depression

Dosage-

Adults -20mg should be administered as a single oral dose.

Dose may be increased to a maximum of 60mg daily.

Refer- Fluoxetine

Pharmacology:

Citalopram is a potent inhibitor of the serotin 5-hydroxytryptamine (5-HT) uptake. Tolerance to the inhibition of 5-HT uptake is not induced by long term treatment with citalopram.

Pharmacokinetics:

Absorption is almost complete and independent of food intake. The oral bioavailability is about 80%. Steady state plasma levels are reached in 1-2 weeks. it is metabolised into active metabolites which are also SSRIs, although weaker than the parent compound.

The elimination half-life is about 1and 1/2 days.

Citalopram is excreted mainly via the liver (85%) and the remainder (15%) via the kidneys. 12-23% of the daily dose is excreted in urine as unchanged citalopram.

Absorption is almost complete and independent of food intake.

Should only be used in pregnancy if considered necessary and under the close supervision of a physician

Citalopram appears in breast milk in very low concentrations.