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standards of non-Merck sources.
ALERT: U.S. Boxed Warning
The FDA-approved labeling includes a boxed warning. See Warnings/Precautions section and/or refer to product labeling for additional detail.
Medication Safety Issues
Sound-alike/look-alike issues:
Celexa® may be confused with Celebrex®, Cerebra®, Cerebyx®, Ranexa™, Zyprexa®
Pronunciation
(sye TAL oh pram)
U.S. Brand Names
Index Terms
Generic Available
Yes
Canadian Brand Names
Pharmacologic Category
Pharmacologic Category Synonyms
Use: Labeled Indications
Treatment of depression
Use: Unlabeled/Investigational
Treatment of mild dementia-associated agitation in nonpsychotic patients; smoking cessation; ethanol abuse; obsessive-compulsive disorder (OCD) in children; diabetic neuropathy
Restrictions
An FDA-approved medication guide concerning the use of antidepressants in children, adolescents, and young adults must be distributed when dispensing an outpatient prescription (new or refill) where this medication is to be used without direct supervision of a healthcare provider. Medication guides are available at http://www.fda.gov/cder/Offices/ODS/medication_guides.htm. Dispense to parents or guardians of children and adolescents receiving this medication.
Pregnancy Risk Factor
C
Pregnancy Considerations
Due to adverse effects observed in animal studies, citalopram is classified as pregnancy category C. Citalopram and its metabolites cross the human placenta. Nonteratogenic effects in the newborn following SSRI exposure late in the third trimester include respiratory distress, cyanosis, apnea, seizures, temperature instability, feeding difficulty, vomiting, hypoglycemia, hypo- or hypertonia, hyper-reflexia, jitteriness, irritability, constant crying, and tremor. An increased risk of low birth weight and lower APGAR scores have also been reported. Exposure to SSRIs after the twentieth week of gestation has been associated with persistent pulmonary hypertension of the newborn (PPHN). Adverse effects may be due to toxic effects of the SSRI or drug withdrawal without a taper. The long term effects of in utero SSRI exposure on infant development and behavior are not known.Due to pregnancy-induced physiologic changes, women who are pregnant may require increased doses of citalopram to achieve euthymia. Women treated for major depression and who are euthymic prior to pregnancy are more likely to experience a relapse when medication is discontinued as compared to pregnant women who continue taking antidepressant medications. The ACOG recommends that therapy with SSRIs or SNRIs during pregnancy be individualized; treatment of depression during pregnancy should incorporate the clinical expertise of the mental health clinician, obstetrician, primary healthcare provider, and pediatrician (ACOG, 2007). If treatment during pregnancy is required, consider tapering therapy during the third trimester in order to prevent withdrawal symptoms in the infant. If this is done and the woman is considered to be at risk from her major depressive disorder, the medication can be restarted following delivery, although the dose should be readjusted to that required before pregnancy.
Lactation
Enters breast milk/consider risk:benefit
Breast-Feeding Considerations
Citalopram and its metabolites are excreted in human milk. According to the manufacturer, the decision to continue or discontinue breast-feeding during therapy should take into account the risk of exposure to the infant and the benefits of treatment to the mother. Excessive somnolence, decreased feeding, colic, irritability, restlessness, and weight loss have been reported in breast-fed infants. The long-term effects on development and behavior have not been studied; therefore, citalopram should be prescribed to a mother who is breast-feeding only when the benefits outweigh the potential risks.
Contraindications
Hypersensitivity to citalopram or any component of the formulation; hypersensitivity or other adverse sequelae during therapy with other SSRIs; concomitant use with MAO inhibitors or within 2 weeks of discontinuing MAO inhibitors
Warnings/Precautions
Boxed warnings:
• Suicidal thinking/behavior: See “Major psychiatric warnings” below.
Major psychiatric warnings:
• [U.S. Boxed Warning]: Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults (18-24 years of age) with major depressive disorder (MDD) and other psychiatric disorders; consider risk prior to prescribing. Short-term studies did not show an increased risk in patients >24 years of age and showed a decreased risk in patients ?65 years. Closely monitor patients for clinical worsening, suicidality, or unusual changes in behavior, particularly during the initial 1-2 months of therapy or during periods of dosage adjustments (increases or decreases); the patient's family or caregiver should be instructed to closely observe the patient and communicate condition with healthcare provider. A medication guide concerning the use of antidepressants should be dispensed with each prescription. Citalopram is not FDA approved for use in children.
• The possibility of a suicide attempt is inherent in major depression and may persist until remission occurs. Patients treated with antidepressants should be observed for clinical worsening and suicidality, especially during the initial few months of a course of drug therapy, or at times of dose changes, either increases or decreases. Worsening depression and severe abrupt suicidality that are not part of the presenting symptoms may require discontinuation or modification of drug therapy. Use caution in high-risk patients during initiation of therapy.
• Prescriptions should be written for the smallest quantity consistent with good patient care. The patient's family or caregiver should be alerted to monitor patients for the emergence of suicidality and associated behaviors such as anxiety, agitation, panic attacks, insomnia, irritability, hostility, impulsivity, akathisia, hypomania, and mania; patients should be instructed to notify their healthcare provider if any of these symptoms or worsening depression or psychosis occur.
• May worsen psychosis in some patients or precipitate a shift to mania or hypomania in patients with bipolar disorder. Monotherapy in patients with bipolar disorder should be avoided. Patients presenting with depressive symptoms should be screened for bipolar disorder. Citalopram is not FDA approved for the treatment of bipolar depression.
Concerns related to adverse effects:
• Anticholinergic effects: Relatively devoid of these side effects.
• Bleeding risk: May impair platelet aggregation resulting in increased risk of bleeding events, particularly if used concomitantly with aspirin, NSAIDs, warfarin or other anticoagulants. Bleeding related to SSRI use has been reported to range from relatively minor bruising and epistaxis to life-threatening hemorrhage.
• CNS depression: Has a low potential to impair cognitive or motor performance; caution operating hazardous machinery or driving.
• Sexual dysfunction: May cause or exacerbate sexual dysfunction.
• SIADH and hyponatremia: SSRIs and SNRIs have been associated with the development of SIADH; hyponatremia has been reported rarely (including severe cases with serum sodium <110 mmol/L), predominately in the elderly. Volume depletion and/or concurrent use of diuretics likely increases risk.
Disease-related concerns:
• Hepatic impairment: Use with caution in patients with hepatic impairment; clearance is decreased and plasma concentrations are increased; a lower dosage may be needed.
• Renal impairment: Use with caution in patients with renal impairment; clearance is decreased and plasma concentrations are increased; a lower dosage may be needed.
Concurrent drug therapy issues:
• Anticoagulants/Antiplatelets: Use caution with concomitant use of NSAIDs, ASA, or other drugs that affect coagulation; the risk of bleeding may be potentiated.
• CNS depressants: Use caution with concomitant therapy.
• MAO inhibitors: Potential for severe reaction when used with MAO inhibitors; autonomic instability, coma, death, delirium, diaphoresis, hyperthermia, mental status changes/agitation, muscular rigidity, myoclonus, neuroleptic malignant syndrome features, and seizures may occur.
• Serotonin syndrome: Symptoms of agitation, confusion, hallucinations, hyper-reflexia, myoclonus, shivering, and tachycardia may occur with concomitant proserotonergic drugs (ie, SSRIs/SNRIs or triptans) or agents which reduce citalopram's metabolism. Concurrent use of serotonin precursors (eg, tryptophan) is not recommended.
Special populations:
• Elderly: Use caution in elderly patients; risk of hyponatremia and other adverse events may be increased.
• Pregnancy: Use caution in pregnant patients; high doses of citalopram have been associated with teratogenicity in animals.
Other warnings/precautions:
• Electroconvulsive therapy: May increase the risks associated with electroconvulsive therapy; consider discontinuing, when possible, prior to ECT treatment.
• Withdrawal syndrome: May cause dysphoric mood, irritability, agitation, dizziness, sensory disturbances, anxiety, confusion, headache, lethargy, emotional lability, insomnia, hypomania, tinnitus, and seizures. Upon discontinuation of citalopram therapy, gradually taper dose. If intolerable symptoms occur following a decrease in dosage or upon discontinuation of therapy, then resuming the previous dose with a more gradual taper should be considered.
Adverse Reactions
>10%:
Central nervous system: Somnolence, insomnia
Gastrointestinal: Nausea, xerostomia
Miscellaneous: Diaphoresis
<10%:
Central nervous system: Anxiety, anorexia, agitation, yawning
Dermatologic: Rash, pruritus
Endocrine & metabolic: Sexual dysfunction
Gastrointestinal: Diarrhea, dyspepsia, vomiting, abdominal pain, weight gain
Neuromuscular & skeletal: Tremor, arthralgia, myalgia
Respiratory: Cough, rhinitis, sinusitis
<1%, postmarketing, and/or case reports: Acute renal failure, akathisia, allergic reaction, anaphylaxis, angioedema, choreoathetosis, chest pain, delirium, dyskinesia, ecchymosis, epidermal necrolysis, erythema multiforme, gastrointestinal hemorrhage, grand mal seizure, hemolytic anemia, hepatic necrosis, myoclonus, neuroleptic malignant syndrome, nystagmus, pancreatitis, priapism, prolactinemia, prothrombin decreased, QT prolonged, rhabdomyolysis, serotonin syndrome, SIADH, spontaneous abortion, thrombocytopenia, thrombosis, ventricular arrhythmia, torsade de pointes, withdrawal syndrome
Metabolism/Transport Effects
Substrate of CYP2C19 (major), 2D6 (minor), 3A4 (major); Inhibits CYP1A2 (weak), 2B6 (weak), 2C19 (weak), 2D6 (weak)
Drug Interactions
Alcohol (Ethyl): CNS Depressants may enhance the CNS depressant effect of Alcohol (Ethyl). Risk C: Monitor therapy
Alpha-/Beta-Blockers: Selective Serotonin Reuptake Inhibitors may decrease the metabolism of Alpha-/Beta-Blockers. Risk C: Monitor therapy
Analgesics (Opioid): May enhance the serotonergic effect of Selective Serotonin Reuptake Inhibitors. This may cause serotonin syndrome. Risk C: Monitor therapy
Anticoagulants: Antiplatelet Agents may enhance the anticoagulant effect of Anticoagulants. Risk C: Monitor therapy
Antidepressants (Serotonin Reuptake Inhibitor/Antagonist): Selective Serotonin Reuptake Inhibitors may enhance the serotonergic effect of Antidepressants (Serotonin Reuptake Inhibitor/Antagonist). This may cause serotonin syndrome. Risk C: Monitor therapy
Antiplatelet Agents: May enhance the anticoagulant effect of other Antiplatelet Agents. Risk C: Monitor therapy
Aspirin: Selective Serotonin Reuptake Inhibitors may enhance the antiplatelet effect of Aspirin. Risk C: Monitor therapy
Beta-Blockers: Selective Serotonin Reuptake Inhibitors may enhance the bradycardic effect of Beta-Blockers. Exceptions: Acebutolol; Atenolol; Carteolol; Esmolol; Levobunolol; Metipranolol; Nadolol; Penbutolol. Risk C: Monitor therapy
BusPIRone: May enhance the serotonergic effect of Selective Serotonin Reuptake Inhibitors. This may cause serotonin syndrome. Selective Serotonin Reuptake Inhibitors may decrease the metabolism of BusPIRone. Risk C: Monitor therapy
Carbamazepine: Selective Serotonin Reuptake Inhibitors may decrease the metabolism of Carbamazepine. Specifically those SSRIs that inhibit CYP3A4 isoenzymes. Carbamazepine may increase the metabolism of Selective Serotonin Reuptake Inhibitors. Specifically those agents metabolized via CYP1A2, 2C, and/or 3A4 isoenzymes. Risk D: Consider therapy modification
Cimetidine: May decrease the metabolism of Selective Serotonin Reuptake Inhibitors. Risk D: Consider therapy modification
Clozapine: Selective Serotonin Reuptake Inhibitors may decrease the metabolism of Clozapine. Risk D: Consider therapy modification
CNS Depressants: May enhance the adverse/toxic effect of other CNS Depressants. Risk C: Monitor therapy
Coumarin Derivatives: Selective Serotonin Reuptake Inhibitors may enhance the anticoagulant effect of Coumarin Derivatives. Risk C: Monitor therapy
CYP2C19 Inducers (Strong): May increase the metabolism of CYP2C19 Substrates. Risk C: Monitor therapy
CYP2C19 Inhibitors (Moderate): May decrease the metabolism of CYP2C19 Substrates. Risk C: Monitor therapy
CYP2C19 Inhibitors (Strong): May decrease the metabolism of CYP2C19 Substrates. Risk D: Consider therapy modification
CYP3A4 Inducers (Strong): May increase the metabolism of CYP3A4 Substrates. Risk C: Monitor therapy
CYP3A4 Inhibitors (Moderate): May decrease the metabolism of CYP3A4 Substrates. Risk C: Monitor therapy
CYP3A4 Inhibitors (Strong): May decrease the metabolism of CYP3A4 Substrates. Risk D: Consider therapy modification
Cyproheptadine: May diminish the therapeutic effect of Selective Serotonin Reuptake Inhibitors. Risk C: Monitor therapy
Dasatinib: May enhance the anticoagulant effect of Antiplatelet Agents. Risk C: Monitor therapy
Dextromethorphan: Selective Serotonin Reuptake Inhibitors may enhance the adverse/toxic effect of Dextromethorphan. Risk D: Consider therapy modification
Drotrecogin Alfa: Antiplatelet Agents may enhance the adverse/toxic effect of Drotrecogin Alfa. Bleeding may occur. Risk D: Consider therapy modification
Haloperidol: Selective Serotonin Reuptake Inhibitors may decrease the metabolism of Haloperidol. Risk C: Monitor therapy
Herbs (Anticoagulant/Antiplatelet Properties) (eg, Alfalfa, Anise, Bilberry): May enhance the adverse/toxic effect of Antiplatelet Agents. Bleeding may occur. Risk D: Consider therapy modification
Herbs (CYP3A4 Inducers): May increase the metabolism of CYP3A4 Substrates. Risk C: Monitor therapy
Ibritumomab: Antiplatelet Agents may enhance the adverse/toxic effect of Ibritumomab. Both agents may contribute to impaired platelet function and an increased risk of bleeding. Risk C: Monitor therapy
Lithium: Selective Serotonin Reuptake Inhibitors may enhance the adverse/toxic effect of Lithium. Risk C: Monitor therapy
Macrolide Antibiotics: May decrease the metabolism of Selective Serotonin Reuptake Inhibitors. Exceptions: Azithromycin; Dirithromycin [Off Market]; Spiramycin. Risk C: Monitor therapy
MAO Inhibitors: May enhance the serotonergic effect of Selective Serotonin Reuptake Inhibitors. This may cause serotonin syndrome. Risk X: Avoid combination
Methadone: Selective Serotonin Reuptake Inhibitors may decrease the metabolism of Methadone. Fluvoxamine appears to be the only interacting SSRI. Risk D: Consider therapy modification
Mexiletine: Selective Serotonin Reuptake Inhibitors may decrease the metabolism of Mexiletine. Risk D: Consider therapy modification
NSAID (COX-2 Inhibitor): Selective Serotonin Reuptake Inhibitors may enhance the antiplatelet effect of NSAID (COX-2 Inhibitor). Risk D: Consider therapy modification
NSAID (Nonselective): Selective Serotonin Reuptake Inhibitors may enhance the antiplatelet effect of NSAID (Nonselective). Risk D: Consider therapy modification
Omega-3-Acid Ethyl Esters: May enhance the antiplatelet effect of Antiplatelet Agents. Risk C: Monitor therapy
Pentosan Polysulfate Sodium: May enhance the adverse/toxic effect of Antiplatelet Agents. Specifically, the risk of bleeding may be increased by concurrent use of these agents. Risk C: Monitor therapy
Phenytoin: Selective Serotonin Reuptake Inhibitors may decrease the metabolism of Phenytoin. Risk D: Consider therapy modification
Pimozide: Selective Serotonin Reuptake Inhibitors may enhance the adverse/toxic effect of Pimozide. Management: Use of pimozide with fluvoxamine, paroxetine, and sertraline is contraindicated. Risk D: Consider therapy modification
Propafenone: Selective Serotonin Reuptake Inhibitors may decrease the metabolism of Propafenone. Risk D: Consider therapy modification
Prostacyclin Analogues: May enhance the antiplatelet effect of Antiplatelet Agents. Risk C: Monitor therapy
Risperidone: Selective Serotonin Reuptake Inhibitors may decrease the metabolism of Risperidone. Risk C: Monitor therapy
Salicylates: Antiplatelet Agents may enhance the adverse/toxic effect of Salicylates. Increased risk of bleeding may result. Risk C: Monitor therapy
Serotonin Modulators: May enhance the adverse/toxic effect of other Serotonin Modulators. The development of serotonin syndrome may occur. Risk D: Consider therapy modification
Sibutramine: May enhance the serotonergic effect of Serotonin Modulators. This may cause serotonin syndrome. Risk X: Avoid combination
Tositumomab and Iodine I 131 Tositumomab: Antiplatelet Agents may enhance the adverse/toxic effect of Tositumomab and Iodine I 131 Tositumomab. Specifically, the risk of bleeding-related adverse events may be increased. Risk C: Monitor therapy
Tramadol: Selective Serotonin Reuptake Inhibitors may enhance the neuroexcitatory and/or seizure-potentiating effect of Tramadol. Tramadol may enhance the serotonergic effect of Selective Serotonin Reuptake Inhibitors. This may cause serotonin syndrome. Risk D: Consider therapy modification
Tricyclic Antidepressants: Selective Serotonin Reuptake Inhibitors may decrease the metabolism of Tricyclic Antidepressants. Risk D: Consider therapy modification
Tryptophan: May enhance the serotonergic effect of Selective Serotonin Reuptake Inhibitors. This may cause serotonin syndrome. Risk D: Consider therapy modification
Ethanol/Nutrition/Herb Interactions
Ethanol: Avoid ethanol (may increase CNS depression).
Herb/Nutraceutical: Avoid valerian, St John's wort, SAMe, kava kava, and gotu kola (may increase CNS depression).
Storage
Store below 25°C.
Mechanism of Action
A bicyclic phthalane derivative, citalopram selectively inhibits serotonin reuptake in the presynaptic neurons
Pharmacodynamics/Kinetics
Onset of action: Depression: The onset of action is within a week, however, individual response varies greatly and full response may not be seen until 8-12 weeks after initiation of treatment.
Distribution: Vd: 12 L/kg
Protein binding, plasma: ~80%
Metabolism: Extensively hepatic, via CYP3A4 and 2C19 (major pathways), and 2D6 (minor pathway); forms metabolites, N-demethylcitalopram (DCT) and didemethylcitalopram (DDCT) which are at least eight times less potent than citalopram
Bioavailability: 80%
Half-life elimination: 24-48 hours (average: 35 hours); doubled with hepatic impairment
Time to peak, serum: 1-6 hours, average within 4 hours
Excretion: Urine (Citalopram 10% and DCT 5%)
Note: Clearance was decreased, while AUC and half-life were significantly increased in elderly patients and in patients with hepatic impairment. Mild-to-moderate renal impairment may reduce clearance (17%) and prolong half-life of citalopram. No pharmacokinetic information is available concerning patients with severe renal impairment.
Dosage
Oral:
Children and Adolescents: Obsessive-compulsive disorder (unlabeled use): 10-40 mg/day
Adults: Depression: Initial: 20 mg/day, generally with an increase to 40 mg/day; doses of more than 40 mg are not usually necessary. Should a dose increase be necessary, it should occur in 20 mg increments at intervals of no less than 1 week. Maximum dose: 60 mg/day; reduce dosage in elderly or those with hepatic impairment.
Elderly: Alzheimer's dementia-related depression: Initial: 5-10 mg/day; may increase at multi-week intervals to maximum of 40 mg/day
Monitoring Parameters
Monitor patient periodically for symptom resolution; mental status for depression, suicidal ideation (especially at the beginning of therapy or when doses are increased or decreased), anxiety, social functioning, mania, panic attacks; akathisia
Dietary Considerations
May be taken without regard to food.
Patient Education
It may take up to 3 weeks to see therapeutic effects from this medication. Take as directed; do not alter dose or frequency without consulting prescriber. May be taken with or without food. Avoid alcohol, caffeine, and CNS stimulants. Avoid use of aspirin or other NSAIDs unless approved by prescriber (may increase risk of bleeding). You may experience sexual dysfunction (reversible). May cause dizziness, anxiety, or blurred vision (rise slowly from sitting or lying position and use caution when driving or engaging in tasks requiring alertness until response to drug is known); or nausea or dry mouth (small frequent meals, frequent mouth care, chewing gum, or sucking lozenges may help). Report confusion or impaired concentration, thoughts of suicide, severe headache, palpitations, rash, insomnia or nightmares, changes in personality, muscle weakness or tremors, altered gait pattern, signs and symptoms of respiratory infection, or excessive perspiration. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to become pregnant. Do not breast-feed.
Geriatric Considerations
In open-label and placebo-controlled studies, elderly patients with or without dementia have shown significant improvement in depressive symptoms, irritability, anxiety, behavior, and restlessness. Effects on intellectual function have not been consistent. Thus, it appears that citalopram has additional effects in stabilizing emotion. A seven- to eightfold variation in citalopram S(+) (active) and R(-) enantiomer concentrations have been reported in the elderly. The racemic citalopram concentration-to-dose ratio was 1.8 times greater in elderly patients compared to younger patients.
Clearance was decreased, while AUC and half-life were significantly increased in elderly patients and in patients with hepatic impairment. Mild to moderate renal impairment may reduce clearance of citalopram (17% reduction noted in trials). No pharmacokinetic information is available concerning patients with severe renal impairment.
Dental Health: Effects on Dental Treatment
Key adverse event(s) related to dental treatment: Xerostomia (normal salivary flow resumes upon discontinuation). Premarketing trials reported abnormal taste. See Dental Comment.
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
Although caution should be used in patients taking tricyclic antidepressants, no interactions have been reported with vasoconstrictors and citalopram, a nontricyclic antidepressant which acts to increase serotonin; no precautions appear to be needed
Dental Comment
Problems with SSRI-induced bruxism have been reported and may preclude their use; clinicians attempting to evaluate any patient with bruxism or involuntary muscle movement, who is simultaneously being treated with an SSRI drug, should be aware of the potential association.
Mental Health: Child/Adolescent Considerations
Twenty-three patients with OCD (9-18 years of age) received 10-40 mg/day (40 mg modal) (Thomsen, 1997).
Thomsen PH, “Child and Adolescent Obsessive-Compulsive Disorder Treated With Citalopram: Findings From an Open Trial of 23 Cases,” J Child Adolesc Psychopharmacol, 1997, 7(3):157-66.
Mental Health: Comment
The SSRIs as a class are generally considered to be safe and equally effective. For the management of depression, these drugs display a flat dose-response curve. Allow sufficient dose-response time (6-12 weeks). Differences lie in approved indications, receptor profiles, pharmacokinetics, and cytochrome P450 activity profile. Subtle differences exist in adverse effect profiles. All SSRIs have the potential to cause sexual dysfunction. Among the SSRIs, citalopram possesses a mild effect on CYP isoenzymes.
Nursing: Physical Assessment/Monitoring
Assess other medications patient may be taking for possible interaction (especially MAO inhibitors, P450 inhibitors, and other CNS active agents). Monitor for effectiveness of therapy and adverse reactions. Assess mental status for depression, suicidal ideation, anxiety, social functioning, mania, or panic attack. Assess knowledge/teach patient appropriate use, interventions to reduce side effects (eg, hypotensive precautions), and adverse symptoms to report.
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, oral: 10 mg/5 mL (240 mL)
Celexa®: 10 mg/5 mL (240 mL) [alcohol free, sugar free; contains propylene glycol; peppermint flavor]
Tablet: 10 mg, 20 mg, 40 mg
Celexa®: 10 mg, 20 mg, 40 mg
Pricing: U.S. (www.drugstore.com)
Solution (Citalopram Hydrobromide)
10 mg/5 mL (240): $114.00
Tablets (Celexa)
10 mg (30): $95.21
20 mg (30): $96.99
40 mg (30): $103.67
Tablets (Citalopram Hydrobromide)
10 mg (30): $39.99
20 mg (30): $39.99
40 mg (30): $26.99
References
American College of Obstetricians and Gynecologists, "ACOG Practice Bulletin No. 87 November 2007: Use of Psychiatric Medications During Pregnancy and Lactation," Obstet Gynecol, 2007, 110(5):1179-98.
Bernard L, Stern R, Lew D, et al, “Serotonin Syndrome After Concomitant Treatment With Linezolid and Citalopram,” Clin Infect Dis, 2003, 36(9):1197.
Boyer EW and Shannon M, “The Serotonin Syndrome,” N Engl J Med, 2005, 352:1112-20.
Chambers CD, Hernandez-Diaz S, Van Marter LJ, et al, “Selective Serotonin-Reuptake Inhibitors and Risk of Persistent Pulmonary Hypertension of the Newborn,” N Engl J Med, 2006, 354(6):579-87.
Mahlberg R, Kunz D, Sasse J, et al, “Serotonin Syndrome With Tramadol and Citalopram,” Am J Psychiatry, 2004, 161(6):1129.
Mokhlesi B, Leikin JB, Murray P, et al, “Adult Toxicology in Critical Care: Part II: Specific Poisonings,” Chest, 2003, 123(3):897-922.
Pass SE and Simpson RW, “Discontinuation and Reinstitution of Medications During the Perioperative Period,” Am J Health Syst Pharm, 2004, 61(9):899-912.
Rabins PV, Blacker D, Rovner BW, et al, “Practice Guidelines for the Treatment of Patients With Alzheimer's Disease and Other Dementias,” October, 2007. Available at http://www.psych.org/psych_pract/treatg/pg/prac_guide.cfm.
Tahir N, “Serotonin Syndrome as a Consequence of Drug-Resistant Infections: An Interaction Between Linezolid and Citalopram, J Am Med Dir Assoc, 2004, 5(2):111-3.
Thomsen PH, “Child and Adolescent Obsessive-Compulsive Disorder Treated With Citalopram: Findings From an Open Trial of 23 Cases,” J Child Adolesc Psychopharmacol, 1997, 7(3):157-66.
International Brand Names
Lexi-Comp.com
Last full review/revision August 2008
Content last modified August 2008
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