Names and pronunciation
(sigh-tal′oh-pram) CeleXA
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Drug reference
(sigh-tal′oh-pram) CeleXA
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Func. class.: Antidepressant
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Chem. class.: Selective serotonin reuptake inhibitor (SSRI)
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Do not confuse: CeleXA/CeleBREX/Cerebyx/ZyPREXA
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ACTION: Inhibits CNS neuron uptake of serotonin but not of norepinephrine; weak inhibitor of CYP450 enzyme system, thus making it more appealing than other products
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USES: Major depressive disorder
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Unlabeled uses: Obsessive-compulsive disorder in adolescents
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CONTRAINDICATIONS: Hyper- sensitivity Precautions: Pregnancy, breastfeeding, geriatric patients, renal/hepatic disease, seizure disorder, hypersensitivity to esci- talopram, bradycardia, recent MI, abrupt discontinuation, QT prolongation C
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Black Box Warning: Children, suicidal ideation Black Box Warning: Suicide: mood, sen- sorium, affect, suicidal tendencies, increase in psychiatric symptoms, depression, panic; risk for suicide is greater in children and those ≤24 yr; these patients should be eval- uated weekly × 4 wk and then q3wk × 4 wk, give only a small amount of product • Serotonin syndrome: increased heart rate, sweating, dilated pupils, tremors, twitching, hyperthermia, agitation, hyper- reflexia, nausea, vomiting, diarrhea, coma, hallucinations; may be worse in those tak- ing SSRIs, SNRIs, triptans, traZODone, traM- ADol, cyclobenzaprine, linezolid • QT prolongation: Flattening T-wave, bundle branch block, AV block • B/P lying, standing, pulse q4hr; if sys- tolic B/P drops 20 mm Hg, hold product, notify prescriber; take vital signs q4hr in patients with CV disease • Weight weekly; appetite may decrease or increase with product • Torsades de pointes, QT prolonga- tion: is dose-dependent; ECG for flattening of T wave, bundle branch, AV block, dys- rhythmias in cardiac patients • Alcohol consumption; if alcohol is consumed, hold dose until AM • Sexual dysfunction: erectile dysfunc- tion, decreased libido • Beers: avoid in older adults unless safer alternative is unavailable; may cause ataxia, impaired psychomotor function • Pregnancy/breastfeeding: no well- controlled studies; use in pregnancy only if benefits outweigh fetal risk; excreted in breast milk, discontinue breastfeeding or discontinue product Black Box Warning: Suicide: that suicidal ideas, behavior may occur in children or young adults, to watch closely for suicidal thoughts, behaviors, notify prescriber im- mediately • About the effects of serotonin syn- drome: nausea/vomiting, tremors; if symptoms occur, to discontinue immedi- ately, notify prescriber
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SIDE EFFECTS CNS: Headache, insomnia, drowsiness, anxiety, tremor, dizziness, fatigue, sedation, poor concentration, seizures, suicidal attempts, neuroleptic malignant– like syndrome reactions CV: Tachycardia, QT prolongation, ortho- static hypotension, torsades de pointes EENT: Visual changes GI: Nausea, diarrhea, dry mouth, anorexia, dyspepsia, vomiting, flatu- lence, decreased appetite GU: Dysmenorrhea, decreased libido, amenorrhea, impotence INTEG: Sweating, rash, pruritus, photo- sensitivity MS: Arthritis, myalgia RESP: Infection, cough, dyspnea SYST: Hyponatremia (geriatric patients), serotonin syndrome
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INTERACTIONS • Increase fatal reactions: do not use within 14 days of MAOIs Increase: QTc interval—dofetilide, halo- fantrine, probucol, pimozide, quinolones, ziprasidone; do not use together Increase: serotonin syndrome—serotonin receptor agonists, SSRIs, traMADol, lithium, MAOIs, traZODone, SNRIs (venlafaxine, DULoxetine), linezolid, methylene blue, tricyclics, fentaNYL, busPIRone, triptans, cyclobenzaprine Increase: bleeding risk—NSAIDs, salicylates, thrombolytics, anticoagu- lants, antiplatelets Increase: CNS effects—barbiturates, sed- ative/hypnotics, other CNS depressants Increase: citalopram levels—macrolides, azole antifungals Increase: plasma levels of beta-blockers Decrease: citalopram levels—carBAMaz epine, cloNIDine Drug/Herb Increase: serotonin syndrome—St. John’s wort, SAM-e; fatal reaction may occur; do not use concurrently Increase: CNS stimulation—yohimbe Drug/Lab Test Increase: serum bilirubin, blood glucose, alkaline phosphatase Decrease: VMA, 5-HIAA False increase: urinary catecholamines
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DOSAGE AND ROUTES Depression • Adult: PO 20 mg/day AM or PM, may increase if needed to 40 mg/day after 1 wk; maintenance: after 6-8 wk of initial treatment, continue for 24 wk (32 wk total), reevaluate long-term usefulness (max 40 mg/day); poor metabolizers of CYP2C19 or use of CYP2C19 inhibitors max 20 mg/day Hepatic dose/geriatric • Adult: PO 20 mg/day OCD (unlabeled) • Adult: PO 20-60 mg/day
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Available forms: Tablets 10, 20, 40 mg; oral solution 10 mg/5 mL
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Administer: • With food or milk for GI symptoms • Crushed if patient is unable to swallow medication whole • Dosages at bedtime if oversedation occurs during the day; may take entire dose at bedtime • Do not give within 14 days of MAOIs • Store at room temperature; do not freeze
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Assess:
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Evaluate: • Therapeutic response: decreased de- pression
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • That therapeutic effect may take 4-6 wk; that patient may have increased anxiety first 5-7 days of therapy; not to discontinue abruptly • To use caution when driving, performing other activities that require alertness be- cause of drowsiness, dizziness, blurred vi- sion; to report signs, symptoms of bleeding • To use sunscreen, protective clothing to prevent photosensitivity • To avoid alcohol, other CNS depressants
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PHARMACOKINETICS Metabolized in liver by CYP3A4, CYP2C19, some individuals are poor metabolizers; excreted in urine; steady state 1 wk; peak 4 hr; half-life 35 hr
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• Adult: PO 20 mg/day AM or PM, may increase if needed to 40 mg/day after 1 wk; maintenance: after 6-8 wk of initial treatment, continue for 24 wk (32 wk total), reevaluate long-term usefulness (max 40 mg/day); poor metabolizers of CYP2C19 or use of CYP2C19 inhibitors max 20 mg/day Hepatic dose/geriatric
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• Adult: PO 20 mg/day OCD (unlabeled)
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• Adult: PO 20-60 mg/day
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