BMA Concise Guide to Medicine & Drugs

Citalopram/Escitalopram

Brand name [escitalopram] Cipralex; [citalopram] Cipramil

Used in the following combined preparations None

QUICK REFERENCE

Drug group Antidepressant drug

Overdose danger rating Medium

Dependence rating Low

Prescription needed Yes

Available as generic Yes (citalopram); No (escitalopram)

GENERAL INFORMATION

Citalopram and escitalopram are selective serotonin re-uptake inhibitor (SSRI) antidepressants used for depressive illness and panic disorder; escitalopram is also used for social and generalized anxiety disorders. They gradually improve mood, increase physical activity, and restore interest in everyday pursuits. Both drugs are generally well tolerated, and any gastrointestinal adverse effects, such as nausea, vomiting, or diarrhoea, are dose related and usually diminish with continued use of the drugs. Like other SSRIs, citalopram and escitalopram cause fewer anticholinergic side effects and are less sedating than tricyclic antidepressants. They are also less likely to be harmful in overdose, but can cause drowsiness and impair performance of tasks such as driving.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Tablets, oral drops.

Frequency and timing of doses Once daily in the morning or evening.

Adult dosage range Depressive illness 20–60mg (citalopram); 10–20mg (escitalopram). Panic attacks 10–60mg (citalopram); 5–20mg (escitalopram). Social anxiety disorder 5–20mg (escitalopram). Generalized anxiety disorder 10–20mg (escitalopram).

Onset of effect Some benefit may appear within 7 days, but full benefits may not be felt for 2–6 weeks (panic attacks may take longer to resolve).

Duration of action Antidepressant effect may persist for some weeks following prolonged treatment.

Diet advice None.

Storage Keep in original container at room temperature out of the reach of children.

Missed dose Take as soon as you remember. If your next dose is due within 8 hours, take a single dose now and skip the next.

Stopping the drug Do not stop taking the drug without consulting your doctor. Stopping abruptly can cause withdrawal symptoms.

Exceeding the dose An occasional unintentional extra dose is unlikely to be a cause for concern. If you notice any unusual symptoms, or if a large overdose has been taken, notify your doctor.

POSSIBLE ADVERSE EFFECTS

Common adverse effects include nausea, vomiting, indigestion, diarrhoea or constipation, sexual dysfunction, anxiety, insomnia, headache, tremor, dizziness, drowsiness, dry mouth, and sweating. Such side effects usually diminish with a reduction in dosage. If seizures or a rash occur, consult your doctor immediately. Also, if there are suicidal thoughts or attempts, stop the drug and seek urgent medical help.

INTERACTIONS

Sumatriptan, other 5HT1 agonists, and lithium There is an increased risk of adverse effects when citalopram and escitalopram are taken with these drugs.

St. John’s wort may increase the adverse effects of citalopram and escitalopram.

Monoamine oxidase inhibitors (MAOIs) may cause a severe reaction if taken with citalopram and escitalopram; avoid if MAOIs have been taken in the last 14 days.

Anticoagulants The effect of these drugs may be increased by citalopram and escitalopram. Bruising may occur if citalopram/escitalopram and anticoagulants are used together.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have epilepsy.

· You have diabetes.

· You have liver or kidney problems.

· You have had a manic-depressive illness.

· You have had heart problems.

· You have been taking monoamine oxidase inhibitors (MAOIs) or other antidepressants.

· You are taking other medicines.

Pregnancy Safety in pregnancy not established. Discuss with your doctor.

Breast-feeding The drug may pass into breast milk and may affect the baby. Discuss with your doctor.

Infants and children Not generally recommended under 18 years.

Over 60 Reduced dose may be necessary.

Driving and hazardous work Avoid such activities until you have learned how the drugs affect you because they can cause drowsiness.

Alcohol No special problems.

PROLONGED USE

No problems expected in adults. However, mild withdrawal symptoms may occur if the drug is not stopped gradually. There is also a small risk of suicidal thoughts and self-harm in children and adolescents, although the drug is rarely used for this age group.

Monitoring Any person experiencing drowsiness, confusion, muscle cramps, or seizures should be monitored for low sodium levels in the blood. Under-18s should be monitored for suicidal thoughts and self-harm.