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citalopram Celexa Antidepressant; SSRI Tabs 10, 20, 40mg; oral sol 10 mg/5 ml 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 None noted 4 hr 35 hr Steady state 1 wk By mouth Daily
Mechanism of Action:
Inhibits CNS neuron uptake of serotonin but not of norepinephrin; weak inhibitor of CYP450 enzyne system, thus making it more appealing than other products
Elimination:
Metabolized by liver in CYP3A4, CYP2C19; excreted in urine Precautions: Pregnancy (C), breastfeeding, renal/hepatic disease, geriatric patients, seizure disorder, hypersensitivity to escitalopram
cramps, flatulence, taste changes, decreased appetite GU: Dysmenorrhea, decreased libido, urinary frequency, UTI, amenorrhea, cyctitis, impotence, urine retention; INTEG: Sweating, rash, pruritis; acne, alopecia, urticaria; MS: Pain, arthritis, twitching; RESP: Infection, pharyngitis, nasal congestion, sinus headache, sinusitis, cough, dyspnea, bronchitis, asthma, hyperventilation, pneumonia; SYST: Asthenia, viral infection, fever, allergy, chills, hyponatremia (geriatric patients), serotonin syndrome
Interactions: FATAL REACTIONS do not use with MAOIs; Increase: Qtc interval pimoside, quinolones, ziprasidone, do not use together; Increase: effect of tricyclics; use cautiously; Increase: serotonin syndrome serotonin receptor agonists, SSRIs, tramadol, lithium, MAOIs, trazodone, SNRIs (venlaxafine, DULoxetine); Increase: bleeding risk NSAIDs, salicilates, thrombolytics, anticoagulants, antiplatelets; Increase: CNS effects barbiturates, sedative/hypnotics, other CNS depressants; Increase: citalopram levels macrolides, azole antifungals; Increase: plasma levels of -blockers; Decrease: citalopram levels carBAMazepine, cloNIDine Drug/Herb: Increase: serotonin syndrome St. John's Wort, SAM-e; fatal reaction may occur do not use concurrently; Increase: CNS stimulation - yohimbe Nursing Implications: Assess: Mental status: mood, sensorium, affect, suicidal tendencies, increase in psychiatric symptoms, depression, panic; Serotonin syndrome: increased heart rate, sweating, dilated pupils, tremors, twitching, agitation, hyperthermia; B/P lying, standing, pulseq4hr; Weight weekly; ECG for flattening of T-wave, bundle branch, AV block, dysrhythmias in cardia patterns; alcohol consumption; sexual dysfunction; Evaluate: Therapeutic Response: decreased depression; Patient Teaching: That therapeutic effects may take 4-6 wk, that patient may have increased anxiety 1st 5-7 days of therapy; To use caution when driving; To report signs or symptoms of bleeding; To avoid alcohol and other CNS depressants; To notify prescriber if pregnant, planning to become pregnant, or breastfeeding; That suicidal ideas, behavior may occur in children or young adults; about the effects of serotonin syndrome (n/v, tremors) if symptoms occur, to discontinue immediately and notify prescriber