#51: citalopram (Celexa) | Treats Major Depressive & Obsessive Compulsive Disorder
citalopram (sye TAL oh pram)
Below will be links for the full Podcast and the Drug Card for citalopram along with a brief summary of various points on citalopram.
QUESTIONS:
- True or False. Due to citalopram’s extensive side effect profile and black box warning for suicidality, it should be stopped immediately especially if the patient is feeling well.
- A patient started taking Celexa about 2 week ago and has missed their dose >50% of the time since it “made them feel weird and they hate taking medications”. They state to the prescriber they do feel like it has been helping “A little bit but not enough” so they only took it when they thought they needed to. What is/are the most appropriate course(s) of action? Select all that apply.
- A). Have the patient stop immediately and try a different medication.
- B). Increase the dose to the max of 40 mg/day immediately and have the patient continue taking it PRN.
- C). Leave at the current dose and consult the patient on why it is important for them to not miss any dose for the first 2 weeks and set a follow up in 2-4 weeks.
- D). Increase the dose and consult the patient on why it is important for them to not miss any dose for the first 2 weeks and set a follow up in 2-4 weeks.
- E). All of the above are appropriate based on the patient follow up.
- A patient has been identified as a poor CYP2C19 metabolizer. Which of the following is the most correct when treating a patient for the only approved indication? Select all that apply.
- A). A patient does not appear to be responding enough at 10 mg PO QD. Increase to the approved max of 40 mg/day.
- B). A patient does not appear to be responding enough at 10 mg PO QD. Increase to the approved max of 20 mg/day.
- C). Discontinue the medication immediately due to risk of toxicity.
- D). Run ECG due to increased risk of QT prolongation.
- E). None of the above.
SUMMARY:
Citalopram is also known by the brand name Celexa. It is an antidepressant and a selective serotonin reuptake inhibitor (SSRI). The tablet come in a 10 mg, 20 mg, and 40 mg strength and is also available as a 10 mg/5 ml solution. In adults and pediatrics it can be used to treat both major depressive and obsessive compulsive disorder. There are other off-labe indications in children but the only approved use is in adults for major depressive disorder. The treatment range for treating major depressive disorder in adults is 20-40 mg PO qd with a max of 40 mg/day. There is literature with a max of 60 mg/day for OCD but 40 mg/day is the most commonly accepted max dose. The onset of action and benefits for patients are typically seen within the first 1-2 weeks with continued improvements through weeks 4-6. The medication half-life is around 24-48 hours with a duration of action being the same. There is a black box warning for suicidality with the greatest concern for children, adolescents and young adults. The risk does appear to decrease in adults >24 years of age and in the elderly >65 years of age. The medication should never be stopped without approval from the prescriber even when feeling well.
ANSWERS:
- False. Citalopram should be taken continuously as prescribed even if feeling well.
- C and D are the most correct. Although A could be done, the patient had poor adherence and the peak of the benefits can be seen in weeks 4-6. If the patient is not experiencing any intolerable side effects, they should try to continue. B is incorrect because the medication is not taken PRN (as needed).
- B is correct. A is incorrect due to the max dose of 40 mg/day no longer being appropriate. C is incorrect due to there being no concern of toxicity. D is incorrect due to no risk of QT prolongation exhibited.
