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Celexa, an antidepressant class drug, contains the active ingredient citalopram HBr and is used in the treatment of depression and anxiety-related disorders. Citalopram repairs the neurotransmitter balance in the brain via selective serotonin reuptake inhibition.
When an individual has received a diagnosis of depression or clinical depression, their physician may prescribe Celexa. In addition to treating depressive symptoms, this medication can also be used to treat panic disorders and obsessive-compulsive disorders.
In a similar manner to other selective serotonin reuptake inhibitors, or SSRIs, Celexa treats depression by affecting the levels of chemical messengers within the brain. When an individual is suffering from depression, it is thought that neurotransmitters, specifically serotonin, are out of balance. By allowing more serotonin to be present in the brain, Celexa helps to relieve depressive symptoms.
Indication/Usage: Celexa, indicated for the treatment of major depressive disorder (MDD)
Dose, Administration and Dosage forms: Celexa is available in two dosage forms - tablets and oral solution. Tablets are available in 10 mg, 20 mg, and 40 mg strengths, while Celexa oral solution is available in 2 mg/mL strength. The starting dose of Celexa should be 20 mg once daily which can be further titrated based upon the results in individual patients. The maximum dose of Celexa should not exceed 40 mg per day in order to avoid the risk of QT prolongation. For special populations, like poor metabolizers or those taking cimetidine and related drugs, Celexa should not be prescribed in dosages over 20 mg per day.
Mechanism of action: The mechanism of action of Celexa is similar to other serotonin reuptake inhibitors. Celexa, containing the selective serotonin reuptake inhibitor (SSRI), citalopram HBr, works in the central nervous system by blocking the reuptake of serotonin in the synaptic cleft. This blockage of reuptake results in an increase in serotonin levels at the receptor site, balancing transmitters and producing an antidepressant effect.
Side-effects and safety profile: Commonly reported non-serious side-effects occurring with Celexa include drowsiness, nausea, insomnia, dry mouth, increased sweating, fatigue, vomiting, headache, diarrhea, dizziness, and weight changes.
Moderate side effects include vivid dreaming, increased frequency of urination, pupil dilation, sedation, cardiac arrhythmia, altered blood pressure, trembling, bruxism, anxiety, and mood changes.
Rare side-effects associated with Celexa include convulsions and hallucinations.
Common sexual side-effects associated with Celexa include impaired sexual drive, ejaculatory anhedonia, anorgasmia, lack of interest in sexual activity, genital anesthesia, and decreased stimuli response. These side effects are usually reversible but they can last for months and years after Celexa withdrawal.
The USFDA has announced a black box warning for prescriptions containing higher than 40 mg doses of citalopram, as there is a higher risk of fatal cardiac complications.
Citalopram should not be prescribed with aspirin or other NSAIDs, warfarin or other anticoagulants because of higher risks of bleeding.
SSRI discontinuation syndrome has been reported with citalopram, so patients withdrawing from Celexa should be closely monitored.
Citalopram carries a black box warning of increased suicidal ideation especially in patients under 24-year-old.
QT Prolongation: Celexa is contraindicated for those patients who have a history of or currently have congenital long QT syndrome.
ECG monitoring is highly recommended during Celexa therapy. Patients with congestive heart failure and bradyarrhythmia issues and patients taking any concomitant medications that prolong the QT interval must be continuously monitored.
Citalopram is contraindicated for patients currently taking MAOIs, as there are higher risks of serotonin syndrome.
Taking citalopram with St John's wort or tryptophan may lead to serotonin syndrome. Tryptophan is a precursor to serotonin which may raise serotonin levels and result in a lethal outcome.
Celexa is contraindicated in pregnant and breastfeeding women.
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