Citalopram

Citalopram is an antidepressant belonging to the class of selective serotonin reuptake inhibitors (SSRIs). Citalopram , along with other SSRIs like fluoxetine, is often considered a first-line treatment for depression.

Molecule names:
Citalopram, Citalopramum (Latin name)
Sold as salts: Citalopram hydrobromide or Citalopram hydrobromide (Latin name: Citaloprami hydrobromidum) in tablets and as an injection of Citalopram hydrochloridum (Latin name: Citaloprami hydrochloridum).

Molecule formula:
20 H 21 FN 2 O

Metabolism:
Citalopram has a long half-life of 30 to 50 hours. There are active metabolites of citalopram, but these are likely to be of little significance for clinical effect. Elimination of citalopram is mainly done by the liver.

Effects:
Citalopram’s effects are based on the inhibition of serotonin reuptake in presynaptic nerve cells. Serotonin is a neurotransmitter. Other neurotransmitters are thought to be little or not affected by citalopram.

Indications:
– Depression from various causes, including severe depression (note: for depression can be combined with other antidepressant medications)
– Depression from or following an illness (e.g. stroke)
– Anxiety disorders, panic disorders
– Obsessive disorder compulsive disorder (OCD)
– Premenstrual syndrome
– Possible effect on fibromyalgia

Side effects:
The main side effects are: dry mouth, increased sweating, diarrhea, nausea, headache, fatigue, weakness, insomnia (restlessness), sexual (erectile) dysfunction, decreased libido, ejaculation disorders and anorgasms in women .
Weight gain is possible with citalopram, as weight loss is less frequent.
Citalopram also has possible side effects on blood platelets (inhibitory effect), which may result in gastrointestinal bleeding. An increased risk of fractures is also possible.
A serious side effect can occur, particularly during the first few weeks of use: thoughts of self-harm or suicide. In that case, please inform your doctor immediately or go to the nearest hospital if, during the treatment, you have dark thoughts or moments of deep torment, especially if you are tired of life or feel like hurting yourself. The risk of suicide is more significant in younger people taking citalopram.
For a complete list of side effects, please read the package leaflet.

Contraindications:
Hypersensitivity, combination with MAO inhibitors, patients with prolonged QT interval, cardiac arrhythmia.
This drug is contraindicated during pregnancy unless otherwise stated.
For a complete list of contraindications, please read the package leaflet.

Interactions:
Citalopram is metabolised by CYP2C19, CYP3A4 and CYP2D6 and is a CYP inhibitor. This creates a high risk of interactions with other drugs. Do not take citalopram with other drugs that prolong the QT interval.
For a complete list of interactions, please read the package insert.

In what form (dosage form)?
Citalopram (citalopram bromide) is available in Brazil in the form of 20 mg and 40 mg tablets and 20 mg film-coated tablets.
In hospitals, citalopram (citalopram hydrochloride) is also available as an infusion concentrate.

Dosage:
The starting dose for an adult is 10 to 20 mg per 24 hours for an adult. The maintenance or standard dose is then 10 mg to 40 mg over 24 hours.
Note: In people over 65 years of age the daily dose should not exceed 20 mg.
Citalopram is usually taken once a day and without regard to meals. The time of day is not important, but it is advisable to take it every day at about the same time (e.g. every night, every morning, etc.).
The maximum dose was fixed at 40 mg per day in 2011, due to the risk of QT interval prolongation, as noted by pharmawiki.ch.

Medicines in Brazil (non-exhaustive list, from Anvisa ):
Reference medicine:
– Cipramil ®, from Lundbeck Brazil ( citalopram hydrobromide ) 
Generics:

– Citalopram hydrobromide Eurofarma
– Citalopram Aché
– Citalopram Zydus Nikkho
– Citalopram hydrobromide Novartis
– Citalopram hydrobromide citalopram Prati Donaduzzi & Cia
– Citalopram hydrobromide Ranbaxy Farmacêutica
– Citalopram hydrobromide Sandoz
– Citalopram Sanofi Medley
Similar (Anvisa list and Anvisa website):
 Alcytam®, from Torrent do Brasil ( citalopram hydrobromide )
 Citafortin®, from Legrand Pharma Indústria Farmacêutica ( citalopram hydrobromide )
 Citagran®, from Germed Farmacêutica ( citalopram hydrobromide )
 Città®, from Momenta Farmacêutica ( hydrobromide citalopram )
 Denyl®, by Cristália Chemical Products ( citalopram hydrobromide )
 Maxapran®, by Biosintética Farmacêutica ( citalopram )
 Nypram®, by Prati Donaduzzi & Ciacitalopram hydrobromide )
– Procimax®, by Libbs Pharmaceuticals ( citalopram hydrobromide )
– Zycitapram®, by Zydus Nikkho ( citalopram hydrobromide )

Notes:
– The FDA approved citalopram in the US in 1990. The pure S-enantiomer of citalopram, escitalopram , is also available in some markets (eg Brazil). But there are no significant advantages in using escitalopram over citalopram (racemate), as pointed out by the German book “100 wichtige Medikamente” in its 2020 edition, published by Infomed.
– Most antidepressant drugs like citalopram take at least one to four weeks to work and are not effective enough in about 30% to 40% of patients with severe depression. Therefore, in some special cases, ketamine (and esketamine) can be an interesting alternative. If citalopram doesn’t work after four weeks, it probably won’t be effective against depression.
Alternatives
– Citalopram is one of the most prescribed SSRIs. The first SSRI to be marketed was fluoxetine. It is unclear whether there are significant differences between different SSRIs (eg, citalopram, fluoxetine, fluvoxamine, sertraline, or paroxetine). Citalopram is thought to have a lower risk of interactions than other SSRIs, but a higher risk of cardiac arrhythmia.
– Tricyclic antidepressants such as amitriptyline can be an effective alternative for depression. SSRIs such as citalopram are thought to have the same antidepressant potency or slightly lower antidepressant potency than tricyclic antidepressants1 .
Critical opinion (French magazine Prescrire):
In early 2017, the French magazinePrescrireadvised against the use of citalopram for depression, due to the risk of cardiovascular side effects. Duloxetine and venlafaxine were other antidepressants that were not recommended on the 2017 list (and the 2021 and 2022 list as well). For French scientists, there are other antidepressants that are equally effective, but that have fewer side effects. In late 2020,Prescrirealso wrote that in their 2021 list: “citalopram and escitalopram are associated with increased electrocardiogram QT prolongation and torsades de pointes compared to other SSRI antidepressants, as well as overdoses with more serious consequences”2.

Jeanne Kenney
 | Website

I’m a stylist trainer, a content creator, and an entrepreneur passion. Virgo sign and Pisces ascendant, I move easily between my dreams, the crazy world I want, and my feet on the ground to carry out my projects.

Leave a Reply

Your email address will not be published. Required fields are marked *