Celexa for treatment of major depressive disorder in adults

Celexa (citalopram) is an oral antidepressant medication approved for treating major depressive disorder (MDD) in adults. It belongs to the class of selective serotonin reuptake inhibitors (SSRIs), which work by increasing serotonin levels in the brain to help improve mood.

Celexa is indicated for the treatment of major depressive disorder (MDD) in adults. It is not approved for use in pediatric patients.

citalopram hydrobromide

Celexa works by selectively inhibiting the reuptake of serotonin, a neurotransmitter, in the brain. This increases serotonin availability in nerve synapses, which helps regulate mood and emotional state.

Adults: Start with 20 mg orally once daily, with or without food. After at least one week, the dose may be increased to a maximum of 40 mg once daily.

Special populations: For patients older than 60 years, those with hepatic impairment, or CYP2C19 poor metabolizers, the maximum recommended dose is 20 mg once daily.

Drug interactions: When taken with CYP2C19 inhibitors, the dose should not exceed 20 mg daily.

Discontinuation: Gradually taper the dose rather than stopping abruptly to reduce the risk of adverse effects.

Dose limits: Doses above 40 mg daily are not recommended due to risk of QT interval prolongation.

Switching: Allow at least 14 days between stopping a monoamine oxidase inhibitor (MAOI) and starting Celexa, and vice versa.

Do not use Celexa in patients currently taking or within 14 days of stopping monoamine oxidase inhibitors (MAOIs), including linezolid or intravenous methylene blue, due to increased risk of serotonin syndrome. Avoid use with pimozide because of QT prolongation risk. Contraindicated in patients with known hypersensitivity to citalopram or any inactive ingredient.

Suicidal thoughts and behaviors: Antidepressants including Celexa increase the risk of suicidal ideation and behavior in pediatric and young adult patients. Monitor all patients closely during early treatment and dosage changes. Celexa is not approved for pediatric use.

QT prolongation and cardiac risk: Celexa causes dose-dependent QT prolongation, which can lead to serious arrhythmias such as Torsade de Pointes and sudden death. Avoid in patients with congenital long QT syndrome, bradycardia, electrolyte abnormalities, recent myocardial infarction, uncompensated heart failure, or those taking other drugs that prolong QT interval. Discontinue if QTc > 500 ms persists.

Serotonin syndrome: Increased risk when used with other serotonergic agents or MAOIs. Discontinue Celexa and serotonergic drugs if serotonin syndrome develops.

Bleeding risk: Use caution with concomitant aspirin, NSAIDs, anticoagulants, or antiplatelets, which may increase bleeding risk.

Mania/hypomania: Screen for bipolar disorder before starting treatment.

Other cautions: Use caution in patients with seizure disorders, angle-closure glaucoma, and risk of hyponatremia.

Common side effects: Sexual dysfunction symptoms have been reported.

Serious side effects: Angioedema and anaphylaxis in case of hypersensitivity. Cardiac arrhythmias due to QT prolongation have been observed post-marketing.

CYP2C19 inhibitors (e.g., cimetidine) require dose adjustment to a maximum of 20 mg daily Celexa. Concomitant use with MAOIs or pimozide is contraindicated due to risk of serotonin syndrome and QT prolongation, respectively. Other serotonergic drugs (e.g., triptans, lithium, tramadol) increase risk of serotonin syndrome. Drugs that prolong QT interval (e.g., class 1A and III antiarrhythmics, some antipsychotics, certain antibiotics) increase risk of arrhythmias.