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Citalopram 

Celexa 

Celexa is an FDA-approved antidepressant that belongs to the class of selective serotonin reuptake inhibitors (SSRIs). It primarily treats major depressive disorder by increasing serotonin levels in the brain, which helps improve mood and emotional stability. Available in tablet forms of 10 mg, 20 mg, and 40 mg, as well as a 10 mg/5 mL oral solution, Celexa can be taken with or without food. The typical starting dose is 20 mg daily, with adjustments based on response and tolerability. Common side effects include nausea and headache, while serious side effects may involve mood changes or heart issues. Patients should follow their doctor’s instructions closely to safely manage their condition with Celexa.

Product Overview

Celexa is an antidepressant medication containing citalopram hydrobromide, primarily used to treat major depressive disorder and other mood-related conditions. Approved by the FDA, Celexa belongs to the class of drugs known as selective serotonin reuptake inhibitors (SSRIs). This medication functions by enhancing serotonin levels in the brain, a neurotransmitter linked to mood regulation, which helps alleviate symptoms of depression and improves overall emotional stability.

Celexa is available in tablet form in strengths of 10 mg, 20 mg, and 40 mg, and also as an oral solution at 10 mg/5 mL. The typical starting dose for adults is 20 mg once daily, which may be increased to 40 mg daily depending on the patient’s response to the treatment. Due to its potential for QT prolongation, doses above 40 mg are not recommended. Celexa is suitable for adults and can be taken with or without food. Adolescents and elderly patients may require adjusted dosing schedules based on their health needs and tolerances.

Common side effects of Celexa include nausea, headache, dry mouth, and fatigue. More severe side effects can include changes in mood or behavior, such as developing suicidal thoughts, particularly in young adults and adolescents. Patients are advised to follow their dosing schedule closely and not to discontinue use abruptly to avoid withdrawal symptoms. In case of an overdose, immediate medical attention is necessary. Celexa should be stored at room temperature, away from moisture and heat, and out of reach of children. Given its extensive profile, it’s critical for patients to discuss all potential interactions with other medications with their healthcare provider and to follow all prescribed guidelines to ensure safe usage.

Uses of Celexa 

  • Treats depression
  • Major depressive disorder

How to Use Celexa?

Dosage

Celexa is available in tablet form in the following strengths:

  • 10mg
  • 20mg
  • 40mg

Celexa is available in the form of oral solution:

  • 10mg/5mL

Recommended Dosage for Different Patients

Adults

  • Depression:
    • Initial dose: 20 mg once daily.
    • Maintenance dose: May increase to a maximum of 40 mg per day after at least one week. Doses above 40 mg per day are not recommended due to the risk of QT prolongation.

Elderly Patients

  • Due to potentially greater sensitivity to the drug, the initial dose should be 20 mg per day. Care should be taken when increasing the dose.

Adolescents

  • Depression:
    • Initial dose: Similar to adults, starting at 20 mg per day. Care should be taken when increasing the dose, not exceeding 40 mg daily.

Patients with Liver Impairment

  • Mild to Moderate Liver Impairment:
    • Maximum recommended dose is 20 mg per day due to the slower metabolism of citalopram in this population.

Pregnant Women

  • Celexa should only be used if the potential benefit justifies the potential risk to the fetus. Dose adjustments may be necessary, but specific guidelines are not provided and should be discussed with a healthcare provider.

[Note: Remember these recommendations may vary depending on person to person. Discuss it with your doctor, and they’ll customize your dosage accordingly.]

How to Take It?

  • Take Celexa exactly as your doctor prescribes.
  • Follow all directions on your prescription label and read all medication guides or instruction sheets.
  • Your doctor may occasionally adjust your dose.
  • Be cautious if switching brands, strengths, or forms of Celexa, as your dose needs may change.
  • Avoid medication errors by using only the prescribed medicine.
  • Celexa can be taken with or without food, but ensure consistency in how you take it each time.
  • Use the supplied measuring device for liquid Celexa, not a kitchen spoon.
  • It may take up to 4 weeks before your symptoms improve.
  • Inform your doctor about any changes in sexual function, such as decreased interest in sex or difficulties with sexual performance.
  • Some sexual problems associated with Celexa can be treated.
  • Do not stop using Celexa suddenly to avoid unpleasant withdrawal symptoms like agitation, confusion, and tingling sensations.
  • Follow your doctor’s instructions about carefully tapering your dose.
  • You may need frequent vision exams before starting treatment with Celexa.

[Note: Your doctor will decide the right amount for you based on your condition, following guidelines and studies on the drug. They’ll adjust it as needed over time.]

How Does Celexa Work?

Celexa (Citalopram) is an antidepressant medication that belongs to a class of drugs known as selective serotonin reuptake inhibitors (SSRIs). It works by increasing serotonin levels, a neurotransmitter associated with mood regulation, in the brain. Serotonin is a chemical messenger that transmits signals between nerve cells. Normally, once it has transmitted its signal, it is reabsorbed by the nerve cells (a process known as reuptake). Celexa prevents serotonin reuptake, thereby increasing its availability in the brain. This enhanced presence of serotonin helps to improve mood, relieve anxiety, and increase overall emotional stability, which makes Celexa effective in treating depression and certain anxiety disorders. It is important to note that the full benefits of Celexa may take several weeks to manifest.

Important Safety Information

Side Effects

Common sides effects include:

  • Sweating, including hot flashes
  • Tremors
  • Nausea, vomiting, diarrhea
  • Upset stomach, constipation
  • Fatigue or sleepiness
  • Insomnia (difficulty sleeping)
  • Muscle or joint aches
  • Anxiety or feeling agitated
  • Appetite changes
  • Weight gain or weight loss
  • Dysmenorrhea (painful menstrual periods)
  • Decreased interest in sex, ejaculation disorders, impotence (difficulty achieving or maintaining an erection)
  • Upper respiratory infection (nose or throat)

Serious side effects include:

  • Thoughts of self-harm
  • Increasingly severe depression or anxiety
  • Agitation or irritability
  • Aggressiveness
  • Unusual behaviors or emotions
  • Headaches
  • Mental confusion or ‘brain fog’
  • Weakness or instability
  • Fainting episodes
  • Heightened energy
  • Restlessness
  • Sleep disturbances
  • Rapid thought processes
  • Easy bruising
  • Nosebleeds
  • Blood in urine or stool
  • Palpitations (irregular or extra heartbeats)
  • Episodes of fainting
  • Sweating or fever
  • Tremors
  • Blood pressure fluctuations
  • Accelerated heart rate
  • Dizziness
  • Involuntary arm or leg movements
  • Vision changes
  • Sudden fear or anxiety

[Note: This list may not cover all possible side effects. Always consult with your healthcare provider for medical advice about side effects.]

Warnings

  • Do not discontinue Celexa without consulting your doctor to avoid withdrawal symptoms and ensure safe cessation.
  • Citalopram may cause serious heart issues. Immediately contact your doctor if you experience chest pain, rapid or pounding heartbeats, shortness of breath, or sudden dizziness.
  • Avoid Celexa if you take pimozide, as this combination can lead to serious heart rhythm problems.
  • Do not use Celexa if you have taken MAO inhibitors (like isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, or tranylcypromine) or received methylene blue injections in the past 14 days due to the risk of a fatal reaction.
  • Monitor for increased suicidal thoughts, especially in young people and during the initial treatment phases. Report any sudden changes in mood, behavior, thoughts of suicide, or self-harm to your doctor immediately.
  • Be vigilant for new or worsening symptoms such as mood or behavior changes, anxiety, panic attacks, sleep disturbances, impulsivity, irritability, agitation, hostility, aggression, restlessness, increased activity (mental or physical), or increased depression.

Boxed Warning 

  • Increased Risk of Suicidal Thoughts and Behaviors
      • Celexa may increase the risk of suicidal thoughts and behaviors in children, adolescents, and young adults under the age of 24.
      • The risk is particularly significant during the initial phases of treatment or when doses are adjusted.
      • Adults over 24 may have a lesser risk, while individuals aged 65 and older typically have a reduced risk.
  • QT Interval Prolongation
    • High doses of Celexa can disrupt the heart’s electrical activity, leading to potentially dangerous abnormalities.
    • These cardiac changes can increase the risk of fatal abnormal heart rhythms.
    • Healthcare providers should be cautious when prescribing Celexa to individuals with pre-existing heart conditions.
    • Special caution is also advised for those susceptible to low levels of potassium and magnesium in the blood.
    • Regular monitoring of heart function is recommended.
    • Blood levels of potassium and magnesium should also be regularly checked to prevent complications.

Precautions

  • Avoid Celexa if you are allergic to citalopram or escitalopram (Lexapro), or if you are taking pimozide.
  • Do not use Celexa if you have taken an MAO inhibitor in the past 14 days due to the risk of a dangerous drug interaction. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, and tranylcypromine. Ensure a 14-day gap between discontinuing an MAO inhibitor and starting Celexa.
  • Inform your doctor if you use stimulant medications, opioid medications, herbal products, or medications for depression, mental illness, Parkinson’s disease, migraines, serious infections, or prevention of nausea and vomiting, as these can interact with Celexa and potentially cause serotonin syndrome.
  • Disclose any history of heart problems, high blood pressure, long QT syndrome, stroke, bleeding problems, sexual problems, narrow-angle glaucoma, seizures or epilepsy, bipolar disorder, or electrolyte imbalances (such as low levels of potassium, magnesium, or sodium in your blood), and liver or kidney disease to your doctor.
  • Be vigilant for any changes in mood or symptoms, as there is a potential for increased suicidal thoughts, especially in young people starting antidepressants. Family and caregivers should also monitor for sudden behavioral changes.
  • Discuss the risks and benefits of using Celexa during pregnancy with your doctor. Celexa use in the last 3 months of pregnancy may harm the unborn baby.
  • Your name may be included in a pregnancy registry to track the effects of citalopram on the baby.
  • Consult with your doctor about the safety of breastfeeding while on Celexa.

Other Important Precautions 

  • Seizures: While there isn’t a direct link established between Celexa and seizures, if you have a history of seizures, Celexa may increase your risk. Inform your doctor about any past seizures to ensure appropriate treatment options are considered.
  • QT Prolongation and Torsades de Pointes: If you suffer from heart rhythm conditions like QT prolongation or torsades de pointes, Celexa may exacerbate heart-related side effects such as dizziness and fainting. Your doctor will monitor you closely during treatment and may opt for alternative medications if necessary.
  • Bipolar Depression: For those with bipolar depression, taking Celexa may trigger mania or hypomania, characterized by racing thoughts or unusually high energy. Your doctor should screen for bipolar depression before starting Celexa.
  • Angle-Closure Glaucoma: Celexa may cause pupil dilation, which can trigger an attack of angle-closure glaucoma if you are predisposed to this condition. Screening for angle-closure glaucoma is advised before starting treatment.
  • Bleeding Problems: Celexa can increase the risk of bleeding, particularly if you are taking other medications that enhance this risk. Discuss any bleeding disorders with your doctor before beginning Celexa.
  • Low Sodium Levels: If you have hyponatremia (low sodium levels), taking Celexa may further reduce these levels. Regular monitoring of sodium levels will be part of your treatment plan.
  • Pregnancy: The safety of Celexa during pregnancy is not well-established.
  • Breastfeeding: The safety of Celexa during breastfeeding has not been conclusively determined.

Contraindications

Contraindications highlight specific health conditions or circumstances where using a medication is unsafe. If you experience any of the following, you should inform your healthcare provider as Citalopram may not be safe for you:

  • If you are currently taking, or have taken within the last 14 days, an MAOI (Monoamine Oxidase Inhibitor), linezolid (Zyvox), or methylene blue (ProvayBlue).
  • If you take pimozide.

Missed Dose

If you miss a dose, take it as soon as you realize. However, if it’s close to the time for your next dose, skip the missed dose and continue with your regular schedule. Do not take a double dose to make up for the one you missed.

[Note: If you have missed a dose of your medication and are unsure about when to take the next one, immediately consult your doctor or pharmacist.]

Overdose 

Overdosing on Celexa can lead to severe adverse effects, including potentially fatal outcomes. The risk increases significantly if Citalopram is taken in combination with other substances. Celexa should be kept out of reach of children as accidental ingestion can cause severe symptoms such as convulsions and heart issues. It’s crucial to store medications distinctly and clearly labeled to prevent such incidents. While death from Celexa overdose is uncommon, especially when taken alone, it remains a critical risk that underscores the importance of adhering to prescribed dosages.

[Note: If you consumed more than recommended dose, get medical help right away, or call the Poison Help line at 1-800-222-1222.]

Storage

  • Store Celexa at room temperature, ideally between 68°F and 77°F (20°C to 25°C).
  • Keep away from excess heat and moisture.
  • Avoid storing in the bathroom due to humidity.
  • Ensure the medication is in a tightly closed container.
  • Keep out of reach of children and pets.

[Note: Discuss with your healthcare professional about the proper disposal of any unused medicine and any questions you may have regarding its storage.]

Celexa Interactions

  • MAO Inhibitors: There is a risk of a severe, potentially fatal reaction if Celexa is taken with, or within two weeks of taking, monoamine oxidase inhibitors (MAOIs) like phenelzine, tranylcypromine or isocarboxazid. A similar risk exists when switching from Celexa to an MAOI.
  • Serotonergic Drugs: Combining Celexa with other drugs that modulate serotonin levels, such as SSRIs, SNRIs, tricyclic antidepressants, triptans, tramadol, fentanyl, and tryptophan, can increase the risk of serotonin syndrome, a potentially life-threatening condition.
  • NSAIDs and Aspirin: Taking nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, or other drugs that affect blood clotting may increase the risk of bleeding when taken together with Celexa.
  • Antipsychotics and Other QT Prolonging Drugs: Celexa can prolong the QT interval on an EKG, and using it in conjunction with other drugs that have the same effect, such as certain antipsychotics and antibiotics, can increase the risk of developing arrhythmia.
  • Blood Thinners: Warfarin and similar blood thinners may interact with Celexa, increasing the risk of bleeding. Close monitoring of blood clotting times is recommended when these are used together.
  • CYP2C19 Inhibitors: Drugs that inhibit the enzyme CYP2C19, such as omeprazole, can increase the blood levels of citalopram, potentially leading to increased side effects.
  • Alcohol: Although not a medication, it’s important to note that alcohol can exacerbate the side effects of Celexa, particularly its impact on coordination, judgment, and reaction times.

[Note: This isn’t a complete list, and there could be other drugs that interact with Celexa. Make sure to tell your doctor any prescription, over-the-counter medicines, and herbal products you’re taking.]

Celexa Alternatives

[Note: Your doctor will choose what’s best for you. Don’t use any of these alternative medications without consulting your healthcare provider. Taking them by yourself may cause serious side effects.] 

Frequently Asked Questions

How long does it typically take for Celexa to start working?

Celexa may begin to alleviate symptoms within the first two weeks for some individuals. Still, generally, it takes about one to two months to experience the full therapeutic effects when treating depression. It’s common to encounter side effects such as nausea and sleep disturbances before noticing an improvement in mood. It’s important not to get discouraged and to continue taking the medication as directed by your healthcare provider. Since responses to Citalopram can vary from person to person, consult your prescriber if you have concerns about whether the medication is effective for you.

Can Celexa lead to weight gain?

While taking Celexa, some individuals might notice changes in their weight, including potential weight gain. However, compared to other SSRIs, such as paroxetine (Paxil), the risk of gaining weight with citalopram is relatively low. In fact, clinical studies have shown that some people might experience a slight weight loss (approximately 1 pound) after starting the medication. If you encounter unexpected weight changes after beginning treatment with citalopram, it’s important to discuss this with your psychiatrist or primary care provider.

Can Celexa affect your sleep?

Celexa can indeed impact your sleep by causing tiredness or, conversely, making it difficult to fall asleep. It’s important to monitor how the medication affects your sleep patterns, particularly when you first start taking it or when your dosage is adjusted. If you find that citalopram is making you excessively sleepy or disrupting your sleep, consult your psychiatrist or primary care provider. They may suggest altering the time of day you take the medication or adjusting your dosage to better suit your needs.

What activities and substances should I avoid while taking Celexa?

  • While taking Citalopram, there are several precautions to consider:
  • Consult your doctor before using any nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, naproxen, Advil, Aleve, or Motrin. Combining NSAIDs with Celexa can increase your risk of bruising and bleeding.
  • Avoid consuming alcohol, as it can exacerbate the side effects of Celexa.
  • Be cautious when driving or engaging in hazardous activities until you understand how Celexa affects you, as it can impair your reactions.

Is it safe to use Celexa if I have heart conditions?

If you have heart problems, you may still be able to use Celexa, but with caution. Due to the potential risks of heart palpitations, abnormal heart rhythms, and increased bleeding associated with Celexa, your doctor might monitor your condition more closely or consider alternative treatments for your depression. Additionally, if you’re taking other medications that could exacerbate heart-related side effects, your doctor might recommend a different antidepressant. It’s important to provide your doctor with a complete list of all your medications and supplements before starting treatment with Celexa.

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