Citalopram

FDA label

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Titration At least 1 week between dose increases.

Renal Undefined

Hepatic Maximum 20 mg once daily

Do not exceed 40 mg/day due to dose-dependent QT prolongation.

Instructions

• Take once daily with or without food
• Taper gradually at discontinuation; do not stop abruptly
• Screen for bipolar disorder before starting
• Allow at least 14 days between an MAOI and citalopram in either direction

Contraindications

• MAOIs (concurrently or within 14 days) due to risk of serotonin syndrome
• Concomitant pimozide (QT prolongation)

Cautions

• Dose-dependent QT prolongation and torsade de pointes; avoid in congenital long QT, bradycardia, hypokalemia/hypomagnesemia, recent MI, uncompensated HF, or with QT-prolonging drugs
• Serotonin syndrome
• Increased bleeding risk (with NSAIDs, antiplatelets, anticoagulants)
• Activation of mania/hypomania
• Discontinuation syndrome
• Seizures
• Angle-closure glaucoma
• Hyponatremia/SIADH
• Sexual dysfunction

Adverse reactions

• Ejaculation disorder (mostly delay)
• Nausea
• Dry mouth
• Somnolence
• Insomnia
• Increased sweating
• Tremor

Pregnancy No established increased risk of major birth defects or miscarriage; risk of PPHN and poor neonatal adaptation with late-pregnancy exposure; small (<2-fold) increase in postpartum hemorrhage.

Lactation Present in human milk; monitor infant for irritability, restlessness, excessive somnolence, decreased feeding, and weight loss.