Firma Welfare Instrument
SB Pharma
Concise Prescribing Info
Citalopram HBr
Treatment of depressive illness in the initial phase & as maintenance against potential relapse/recurrence. Treatment of panic disorder w/ or w/o agoraphobia.
Dosage/Direction for Use
Major depressive episodes Adult 20 mg daily as single oral dose, may be increased to a max of 40 mg daily. Panic disorder Adult 10 mg single oral dose for the 1st wk before increasing to 20 mg daily. Max: 40 mg daily. Elderly >65 yr Decrease dose to ½ of the recommended dose. Max: 20 mg daily. Mild or moderate hepatic impairment Initially 10 mg daily for the 1st 2 wk of treatment, may be increased to a max of 20 mg daily. CYP2C19 poor metabolisers Initially 10 mg daily for the 1st 2 wk of treatment, may be increased to a max of 20 mg daily.
May be taken with or without food.
Hypersensitivity. Concomitant use w/ MAOIs, including selegiline, in daily doses >10 mg/day. Should not be given for 14 days after discontinuation of an irreversible MAOI or for the time specified after discontinuation of a reversible MAOI. MAOIs should not be introduced for 7 days after discontinuation of citalopram. Concomitant use w/ linezolid. Patients w/ known QT-interval prolongation or congenital long QT syndrome; concomitant use w/ medicinal products known to prolong QT-interval.
Special Precautions
Increased risk of suicidal thoughts, self-harm & suicide (suicide-related events). Patients w/ panic disorder may experience intensified anxiety symptoms at the start of treatment. Risk of hyponatraemia; akathisia/psychomotor restlessness; seizures; serotonin syndrome; dose-dependent QT interval prolongation. Change towards manic phase may occur in patients w/ manic-depressive illness. May alter glycaemic control in patients w/ diabetes. May have an effect on pupil size resulting in mydriasis. Reports of prolonged bleeding time &/or bleeding abnormalities. Withdrawal symptoms on discontinuation. Treatment of psychotic patients w/ depressive episodes may increase psychotic symptoms. Use w/ caution when co-administered w/ electroconvulsive therapy. Do not use concomitantly w/ serotonergic medicinal products eg, sumatriptan or other triptans, tramadol, oxitriptan & tryptophan; St. John's wort prep. Patients w/ reduced kidney & liver function. Should not be used in the treatment of childn & adolescents <18 yr. Elderly.
Adverse Reactions
Sleep disorder; somnolence, insomnia, headache; dry mouth, nausea; sweating increased; asthenia. Appetite decreased, wt decreased; agitation, libido decreased, anxiety, nervousness, confusional state, abnormal orgasm (female), abnormal dreams, apathy; tremor, paraesthesia, dizziness, disturbance in attention, migraine, amnesia; tinnitus; palpitations; yawning, rhinitis; diarrhoea, vomiting, constipation, dyspepsia, abdominal pain, flatulence, salivary hypersecretion; pruritus; myalgia, arthralgia; impotence, ejaculation disorder, ejaculation failure; fatigue.
Drug Interactions
Severe undesirable effects including serotonin syndrome w/ MAOIs. Additive effect on QT interval w/ medicinal products that prolong QT interval eg, Class IA & III antiarrhythmics, antipsychotics (eg, phenothiazine derivatives, pimozide, haloperidol), TCAs, certain antimicrobial agents (eg, sparfloxacin, moxifloxacin, erythromycin IV, pentamidine, antimalarial treatment particularly halofantrine), certain antihistamines (astemizole, mizolastine). Enhanced effects w/ lithium or tryptophan; serotonergic medicinal products (eg, tramadol, sumatriptan). Increased undesirable effects w/ St. John’s wort. Increased risk of haemorrhage w/ anticoagulants, medicinal products that affect platelet function eg, NSAIDs, acetylsalicylic acid, dipyridamole, & ticlopidine or other medicines (eg, atypical antipsychotics). Combination w/ alcohol is not advisable. Increased risk of malignant arrhythmias w/ hypokalaemia-/hypomagnesaemia-inducing medicinal products. Additive effect w/ medicinal products capable of lowering seizure threshold (eg, antidepressants [SSRIs], neuroleptics [thioxanthenes & butyrophenones]), mefloquine, bupropion & tramadol). Moderate increase in the average steady state levels w/ cimetidine (potent CYP2D6, 3A4 & 1A2 inhibitor). Increased plasma conc of escitalopram (active enantiomer of citalopram) w/ omeprazole & other CYP2C19 inhibitor (eg, esomeprazole, fluvoxamine, lansoprazole, ticlopidine). Increased plasma levels of CYP2D6 substrate (eg, metoprolol). Increased plasma conc of desipramine (primary metabolite of imipramine).
MIMS Class
ATC Classification
N06AB04 - citalopram ; Belongs to the class of selective serotonin reuptake inhibitors. Used in the management of depression.
Selon tab 20 mg
2 × 14's
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