Citalopram: clinical use

Prescribing considerations

• Assess suicide and self-harm risk, particularly early in treatment, after changes and in younger adults.
• Review cardiac history, bradycardia, recent myocardial infarction, heart failure and medicines affecting QT interval or electrolytes.
• Use caution with epilepsy, bipolar disorder or mania, diabetes, bleeding disorders, glaucoma, hepatic or renal impairment and older age.
• Counsel about delayed onset, possible initial anxiety in panic disorder, sexual dysfunction and withdrawal after abrupt cessation.
• This product is not licensed for patients under 18 years.

Contraindications and cautions

• Hypersensitivity to citalopram or the product excipients.
• Known QT-interval prolongation or congenital long-QT syndrome.
• Concurrent medicines known to prolong the QT interval.
• Contraindicated MAOI combinations and restricted use with linezolid as specified in the product SmPC.

Monitoring

• Monitor clinical response, adverse effects, behavioural change and suicidal thinking.
• Consider an ECG before treatment in stable cardiac disease and investigate palpitations, vertigo, syncope or seizures with cardiac assessment.
• Correct hypokalaemia or hypomagnesaemia before treatment; consider electrolyte monitoring where risk factors are present.
• Monitor controlled epilepsy for increased seizure frequency and diabetes for altered glycaemic control.
• Consider hyponatraemia when compatible symptoms occur, especially in older adults.

Clinical pharmacology

Citalopram is a racemic, highly selective serotonin-reuptake inhibitor with minimal direct effect on noradrenaline, dopamine or GABA uptake. It is metabolised particularly through CYP2C19, CYP3A4 and CYP2D6 and has a terminal half-life of about one and a half days.

Formulation and product differences

• The selected product is a film-coated tablet containing citalopram as citalopram hydrobromide.
• The selected tablet contains lactose monohydrate and is described as essentially sodium-free.
• Tablet appearance, excipients and whether a score line permits equal division differ between UK products; check the specific SmPC and packaging.
• Oral-drop formulations also exist, but their administration and exposure are formulation-specific and should not be assumed equivalent from tablet instructions.

Tablet

Route: Oral

Strengths: 10 mg, 20 mg, 30 mg, 40 mg