Citapram Tablet

Citapram Tablet is used for: Depressive illness, Bipolar disorder, Panic disorder, Substance abuse disorders, Alcohol dependence, Anxiety disorders including obsessive-compulsive disorder and social phobia, Post-traumatic stress disorder, Premenstrual syndrome, Idiopathic Parkinson's disease and Eating disorder.

Oral Major Depressive Disorder (MDD); Depressive phase of bipolar disorder Adult: Initial dosage is 20 mg once daily; after one week may increase to maximum dosage of 40 mg once daily Panic disorder with or without agoraphobia Adult: Initially, 10 mg/day, increased to 20 mg/day after 1 wk.

Child: Contraindicated.

Renal impairment: No dosage adjustment needed.

May be taken with or without food.

Hypersensitivity, concomitant admin with MAOIs or within 14 days of discontinuing MAOI treatment; children and adolescents <18 yr; treatment of depressive illness; lactation.

Increased risk of suicidal thoughts and behavior in pediatric and young adult patients taking antidepressants. Closely monitor all antidepressant-treated patients for clinical worsening and emergence of suicidal thoughs and behaviors. QT-Prolongation and Torsade de Pointes: Dose-dependent QTc prolongation, Torsade de pointes, ventricular tachycardia, and sudden death have occurred. Avoid use of Citalopram in patients with congenital long QT syndrome, bradycardia, hypokalemia or hypomagnesemia, recent acute myocardial infarction, or uncompensated heart failure and patients taking other drugs that prolong the QTc interval. Monitor electrolytes in patients at high risk for hypokalemia or hypomagnesemia. Discontinue Citalopram in patients with persistent QTc measurements > 500 ms. Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents (e.g., SSRI, SNRI, triptans), but also when taken alone. If occurs, discontinue Citalopram and initiate supportive measures. Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal antiinflammatory drugs, other antiplatelet drugs, warfarin and other anticoagulants may increase this risk. Activation of Mania/Hypomania: Screen patients for bipolar disorder. Seizures: Use with caution in patients with seizure disorder. Angle-Closure Glaucoma: Avoid use of Citalopram in patients with untreated anatomically narrow angles. Hyponatremia: Can occur in association with syndrome of inappropriate antidiuretic hormone secretion. Sexual Dysfunction: Citalopram may cause symptoms of sexual dysfunction.

Pregnancy Available data from published epidemiologic studies and postmarketing reports with citalopram use in pregnancy have not established an increased risk of major birth defects or miscarriage; published studies demonstrated that citalopram levels in both cord blood and amniotic fluid are similar to those observed in maternal serum. There are risks of persistent pulmonary hypertension of the newborn (PPHN) and/or poor neonatal adaptation with exposure during pregnancy; there also are risks associated with untreated depression in pregnancy In animal reproduction studies, citalopram caused adverse embryo/fetal effects at doses that caused maternal toxicity Women who discontinue antidepressants during pregnancy are more likely to experience a relapse of major depression than women who continue antidepressants; consider risk of untreated depression when discontinuing or changing treatment with antidepressant medication during pregnancy and postpartum Neonates exposed to this drug late in third trimester have developed complications requiring prolonged hospitalization, respiratory support, and tube feeding; such complications can arise immediately upon delivery Reported clinical findings have included respiratory distress, cyanosis, apnea, seizures, temperature instability, feeding difficulty, vomiting, hypoglycemia, hypotonia, hypertonia, hyperreflexia, tremor, jitteriness, irritability, and constant crying; these findings are consistent with either a direct toxic effect of SSRIs or possibly, a drug discontinuation syndrome; it should be noted that, in some cases, the clinical picture is consistent with serotonin syndrome Exposure to SSRIs, particularly in month before delivery, associated with <2-fold increase in risk of postpartum hemorrhage; bleeding events related to drugs that interfere with serotonin reuptake have ranged from ecchymosis, hematoma, epistaxis, and petechiae to life-threatening hemorrhages Use in the month before delivery may be associated with an increased risk of postpartum hemorrhage Persistent pulmonary hypertension of the newborn Potential risk of PPHN when used during pregnancy Initial public health advisory, in 2006, was based on a single published study; since then, there have been conflicting findings from new studies, making it unclear whether use of SSRIs during pregnancy can cause PPHN FDA has reviewed the additional new study results and has concluded that, given the conflicting results from different studies, it is premature to reach any conclusion about a possible link between SSRI use in pregnancy and PPHN FDA recommendation: FDA advises health care professionals not to alter their current clinical practice of treating depression during pregnancy and to report any adverse events to the FDA MedWatch program A meta-analysis of 7 observational studies, found exposure to SSRIs in late pregnancy (ie, >20 weeks' gestation) more than doubled the risk of PPHN that could not be explained by other etiologies (eg, congenital malformations, meconium aspiration) (BMJ 2014;348:f6932) Lactation Presence of citalopram in human milk at relative infant doses ranging between 0.7 to 9.4% of maternal weight-adjusted dosage and a milk/plasma ratio ranging between 0.78 to 4.3 reported There are reports of breastfed infants exposed to this drug experiencing irritability, restlessness, excessive somnolence, decreased feeding, and weight loss There is no information about effects of this drug on milk production; developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for this drug and any potential adverse effects on the breastfed child from this drug or from underlying maternal condition Monitor breastfeeding infants for adverse reactions, such as irritability, restlessness, excessive somnolence, decreased feeding, and weight loss

May increase anticoagulant effect w/ drugs affecting haemostatis (e.g. warfarin). Increased risk of hypomania w/ sibutramine. Increased lowering seizure threshold w/ TCAs and other SSRIs. Potentially Fatal: Increased risk of severe adverse effects (e.g. serotonin syndrome) w/ MAOI. QT interval prolongation w/ subsequent risk of torsade de pointes w/ QT-prolonging drugs (e.g. pimozide, quinidine, procainamide, chlorpromazine, thioridazine, amiodarone, sotalol, moxifloxacin, pentamidine, levomethadyl, methadone). Contraindicated (13) dronedarone fluconazole goserelin isocarboxazid leuprolide mavorixafor phenelzine pimozide procarbazine selegiline selegiline transdermal tranylcypromine ziprasidone

Side effects of Citalopram Hydrobromide : >10% Dry mouth (20%),Nausea (21%),Somnolence (18%),Insomnia (15%),Xerostomia (20%),Increased sweating (11%) 1-10% Tremor (8%),Diarrhea (8%),Ejaculation disorder (6%),Rhinitis (5%),Upper respiratory infection (5%),Dyspepsia (5%),Fatigue (5%),Vomiting (4%),Anxiety (4%),Anorexia (4%),Abdominal pain (3%),Agitation (3%),Impotence (3%),Sinusitis (3%),Dysmenorrhea (3%),Decreased libido (2%),Yawning (2%),Arthralgia (2%),Myalgia (2%),Amenorrhea (>1%),Confusion (>1%),Cough (>1%),Flatulence (>1%),Increased saliva (>1%),Migraine (>1%),Orthostatic hypotension (>1%),Paresthesia (>1%),Polyuria (>1%),Pruritus (>1%),Rash (>1%),Tachycardia (>1%),Weight change (>1%) Potentially Fatal: Increased risk of suicidal thinking and behaviour especially in child and adolescents. Monitor closely for signs of clinical worsening, suicidality or unusual changes in behaviour.

Citalopram is bicyclic phthalane derivative and a selective serotonin re-uptake inhibitor, w/ little or no effect on noradrenaline, dopamine and GABA re-uptake. The inhibitory activity explains the antidepressant property of citalopram. It has no or very low affinity for 5-HT1AA, 5-HT2A, D1 and D2 receptors, alpha 1, alpha2, beta-adrenergic, histamine H1, muscarinic, cholinergic, benzodiazepine and opioid receptors.

Citapram 20mg Tablet manufactured by General Pharmaceuticals Ltd.. Its generic name is Citalopram Hydrobromide. Citapram is availble in Bangladesh. Farmaco BD drug index information on Citapram Tablet is not intended for diagnosis, medical advice or treatment; neither intended to be a substitute for the exercise of professional judgment.