Celexa (Citalopram): What is it, Uses, Mechanism of action, Celexa vs other SSRI antidepressants, Dosage, Missed dose, Overdose symptoms, Withdrawal symptoms, Storing conditions, Side effects, Sexual side effects, Celexa and Weight gain, Celexa and weight loss, Precautions, Drug interactions, Celexa and alcohol
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- What is Celexa
- Celexa uses
- Mechanism of action
- Half-life as SSRI differentiator
- Celexa vs other SSRI antidepressants
- Missed dose
- Overdose symptoms
- Celexa withdrawal symptoms
- Storing conditions
- Side effects
- Serious side effects
- Sexual side effects
- Celexa and weight gain
- Factors influencing weight gain on Celexa
- Celexa and weight loss
- Celexa precautions
- Celexa drug interactions
- Celexa and alcohol
What is Celexa
Celexa (citalopram hydrobromide), the generic name of which is Citalopram, is an antidepressant drug that belongs to selective serotonin reuptake inhibitors (SSRI) with a chemical configuration unlike other SSRIs or of tri/tetracyclic, or other existing antidepressant agents.
Citalopram`s molecular formula is C20H22BrFN2O.
Celexa (citalopram) is approved to treat the following conditions:
- major depression
- depressive attacks and panic disorders, with or without agoraphobia (in selected countries)
- obsessive-compulsive disorder (in selected countries)
Mechanism of action
The human brain functions through the use of special elements called neurotransmitters, also known as serotonin and norepinephrine. These neurotransmitters convey signals between nerve cells. Research indicates that anomalies in neurotransmitter activity can influence behavior and mood. Although low levels of norepinephrine and serotonin do not necessarily trigger depression, it is broadly believed that increase of these chemicals is correlated with mood improvements in depressed people.
All drugs in selective serotonin reuptake inhibitor class have the same universal mechanism of action. SSRIs appear to ease symptoms of depression by hindering the reuptake (reabsorption) of serotonin by specific nerve cells in human brain. In this way, more serotonin is left available, which augments neurotransmission and elevates the mood. SSRIs are designated as selective since they appear to affect serotonin considerably more when compared to other neurotransmitters. Accordingly, these drugs work by permitting the brain to extract the best use of the decreased amounts of serotonin, which is available at the time. Eventually, the levels serotonin that is produced by the body might normalize, and in some cases, the SSRI can be cut down or altogether withdrawn.
SSRI antidepressants are known to be at least ten times more selective for inhibiting the serotonin reuptake as opposed to norepinephrine reuptake. Yet, SSRIs vary in their selectivity and effectiveness in inhibiting serotonin reuptake and several of them can significantly impact other receptors and transporters in the brain.
The most popular SSRI drugs are:
- Celexa (citalopram)
- Lexapro (escitalopram)
- Prozac (fluoxetine)
- Paxil (paroxetine)
- Zoloft (sertraline)
Each SSRI drug has a unique list of various pharmacologic actions. This explains the differentiation in their tolerability and effectiveness.
Half-life as SSRI differentiator
The half-life of a drug is the time interval needed to reach steady-state plasma concentrations. It can be used to determine the approximate time after which the drug will be eliminated from the body if treatment is stopped.
Celexa has a shorter half-life of 20-35 hours (as opposed to 50-75 hours for other SSRIs). Thus the steady-state concentrations (and therapeutic effect) are achieved much faster.
Antidepressants with comparatively short half-lives are appropriate for patients with multiple co-morbidities and multiple-drug regimens since they can be taken once per day. A shorter half-life allows physicians to shift more quickly to another antidepressant drug if the treatment fails or if undesirable drug effects occur.
Celexa Vs Other SSRIs
Both Celexa and Zoloft have the lowest likelihood of enzyme inhibition, which marks them the optimal SSRIs for patients who are at risk of drug interactions.
Zoloft (sertraline) has a wider range of licensed indications, when compared to Celexa, that include major depressive disorder, PTSD, panic disorder, obsessive-compulsive disorder, a premenstrual dysphoric disorder in adults. The newest indication is the social anxiety disorder.
Zoloft may be the finest choice when beginning treatment for moderate or severe major depression because of its favorable balance between benefits, side effects, and price.
Zoloft is more likely to trigger insomnia and diarrhea than Celexa.
Unlike Celexa, Zoloft is not to be taken with diuretic medications.
Celexa vs. Lexapro
Lexapro (escitalopram) acts a bit quicker than Celexa, and it’s a good choice when the doctor wants to achieve a rapid antidepressant response.
Lexapro (escitalopram) may be better in effectiveness compared with Celexa for treating major depressive disorder.
Lexapro as the newest generation drug in the SSRIs class is also the most expensive SSRI medicine.
Celexa vs. Prozac
Prozac (fluoxetine) begins acting more slowly when compared to Celexa. Therefore, Prozac is the best SSRI for patients with poor compliance or those who are prone to interrupting treatment or missing doses.
Prozac is a more activating SSRI than Celexa, and it shouldn’t be used by patients prone to agitation.
- the age of a person
- the condition being treated
- the severity of your condition
- the reaction to the first dose
- other health conditions that the patient might have
The initial dose is 20 mg split into two parts. The dose might be increased up to 40 mg per day after a week. It should be noted that 60 mg does not deliver more effectiveness than 40 mg. It usually takes several weeks of treatment before the full effects are felt by the patient. Doses are frequently gradually adjusted uphill to find the best dose.
Adult dosage (18–60 years)
- The initial dose is 20 mg.
- Your doctor might recommend an increase in dosage. Doses can be increased only once per week.
- The maximum dose is 40 mg. Higher doses are unnecessary and increase the risk of QT prolongation.
Child dosage (0–17 years)
Celexa is effective and safe for use in children below the age of 18.
Senior dosage (61+ years)
20 mg once daily is the maximum dose. The kidneys of senior adults don’t work as well as they used to, which means it can take your body longer to process medications. Consequently, the drug is eliminated much slower. This escalates your risk of side effects.
- Cytochrome P450 2C19 poor metabolizers: do not take over 20 mg of Celexa once daily.
- People with liver disease: do not take over 20 mg of Celexa daily. The levels of Celexa in your body might increase and cause more side effects in liver disease patients.
Take a missed dose as soon as you remember. Skip the missed dose and continue your usual schedule if it is about the time of the next dose. You do not need to double the dose to catch up with effective dose.
- coordination troubles
- muscle rigidity
- muscle trembling
- speeding heartbeat
If any of these symptoms occur, seek help at the nearest emergency department.
Celexa withdrawal symptoms
You shouldn’t stop taking Celexa without consulting your doctor first. Stopping Celexa too swiftly can produce serious symptoms such as high or low mood, headache, anxiety, feeling restless, irritability, changes in sleep habits, perspiring, nausea, faintness, electric shock-like feelings, or confusion. The doctor may recommend lowering the dose gradually as it can be harmful to stop taking medications abruptly.
Store Celexa at room temperature in a dry, dark place. The storage place must be inaccessible to children and pets. Do not pour citalopram into a drain or flush it down the toilet.
Adult’s side effects can include:
- dry mouth
- respiratory infections
- trouble sleeping
- sexual troubles
The side effects experienced by children are all of the above as well as:
- abnormal muscle movement or agitation
- heavy menstrual periods
- increased thirstiness
- frequent urination
- nose bleeds
- slowed growth rates
If these effects are minor, they might disappear within a couple of weeks. If the effects are more severe, you should consult your pharmacist or doctor.
Serious side effects
Get in touch with your doctor immediately if serious side effects manifest themselves.
These effects (and their symptoms) may include:
Suicidal thoughts or actions
- acting on dangerous impulses
- agitation, anger, restlessness, irritability
- attempts to commit suicide
- acting aggressively or violently
- panic attacks or increased anxiety
- thoughts about suicide or dying
- agitation, hallucinations, difficulty thinking, confusion, and coma
- sweating or fever
- nausea, vomiting, or diarrhea
- coordination problems
- muscle rigidity
- muscle trembling
- speeding heartbeat
- high blood pressure
Heart rhythm deviations (Torsade de Pointes and QT prolongation)
- chest pain
- dizziness or fainting
- shortness of breath
- fast or slow heart rate
- abrupt loss of muscle tone
- abrupt loss of awareness of surroundings
- sudden urination or defecation
- unnatural happiness or irritability
- greatly boosted energy
- severe insomnia
- rushing thoughts
- unusually grand ideas
- reckless behavior
- blurred vision
- double vision
- redness or swelling in or around the eyes
Low blood sodium levels
- confusion, thinking or memory problems,
- inability to concentrate
- weakness or feeling wobbly
Celexa sexual side effects
Undesired consequences for your sexual function can include:
- a change in your sex drive
- problems with arousal, comfort and satisfaction
- erectile problems
- orgasm problems
Celexa, as an antidepressant drug of SSRI type, is rather likely to cause sexual side effects (the probability is around 72%). For some patients, sexual side effects are insignificant or may disappear as their bodies adjust to citalopram. For others, sexual side effects may remain a problem.
Your doctor may suggest one of these strategies:
- Waiting some weeks to see whether sexual side effects disappear.
- Engaging in sexual activity prior to your daily intake of Celexa.
- Modifying the dose of Celexa to lower the risk of sexual side effects.
- Transferring to another antidepressant that is less likely to instigate sexual side effects.
- Adding a drug that improves sexual function, such as sildenafil (Viagra), tadalafil (Cialis) or vardenafil (Levitra).
Discontinuing medication because of sexual side effects is not an unusual problem, and for most patients this means depression reappears. Work with your physician to find an efficient antidepressant or combination of drugs that will ease your sexual side effects while managing your depression.
Celexa and weight gain
There is research showing that anyone taking SSRIs like Celexa for a 6 to 12 months is likely to gain some weight.
Why Celexa causes weight gain
There hasn’t been much academic research carried out as to why antidepressants in general – and SSRIs in particular – make people prone to gaining weight. Most patients were told in the past that Celexa wouldn’t produce any weight gain. However, according to new information it probably will, but most medical experts don’t understand why.
Below are some theories of how Celexa can drive weight gain:
- Appetite increase
- Carbohydrate cravings
- Body’s fat storage
- Drug interactions (in patients with slower metabolism)
- Hormonal abnormalities
- Improved taste
- Motivation deficit
- Side effects (becoming lazier than usual, sleepy, not engaging in physical activity)
Factors influencing weight gain on Celexa
Celexa is available in 10, 20, and 40 mg tablets. Patients taking a rather high dose of 40 mg are more prone to gain weight. Taking a low dose should not cause any noticeable weight gain.
2. Individual factors
These factors encompass things like genetics, hormones, environmental stress, baseline metabolism, dietary intake, sleep patterns, exercise, and habits.
3. Time span
Patients who are taking the drug for only a few months are unlikely to gain any weight. Evidence suggests that most patients gain weight after taking Celexa for 6 months and more.
4. Other drugs
Always consider the impact of other medications on your weight if you’re using multiple medications. They may interact with Celexa to slow your metabolism. Thus the cumulative weight gain that results from combined treatment may surpass that from just taking one drug or the other.
How much weight can I gain from Celexa?
Among other SSRIs, Celexa appears to be the least likely to produce weight gain, according to some recent studies. You can realistically expect an average weight gain of 10 lbs over the course of Celexa treatment (after taking the drug for over 6 months).
Will everyone gain weight while on Celexa?
Those patients taking add-on treatments, such as stimulants increasing activity in the CNS, may gain no weight. Other patients who take especially astute care of their diet and exercise routine may not have trouble with the extra pound. Some studies indicate that 25% of patients taking SSRI antidepressants will gain weight.
Celexa and weight loss
Interestingly, some patients reported losing weight while on Celexa. It is not clear why Celexa triggers weight loss; one explanation is related to side effects such as nausea, diarrhea, and loss of appetite. A second possible explanation is citalopram may enable some overweight patients to regain energy and re-discover motivation to exercise and stay away from emotional eating.
Patients with heart problems
Don’t take Celexa if you have heart problems, especially if you have a congenital long QT syndrome. Taking Celexa may position you at higher risk of a serious heart rhythm alteration called QT prolongation, which can lead to sudden death. People with recent heart attack, severe heart failure, and slow heart rate should not take Celexa
Patients with low potassium levels
Taking Celexa while suffering low levels of potassium may position you at higher risk of QT prolongation, which can lead to sudden death.
Patients with low magnesium levels
Don’t take Celexa if you suffer low magnesium levels. Taking Celexa while having low levels of magnesium may position you at higher risk of QT prolongation, which can lead to sudden death.
Patients with kidney disease
Consult with your doctor prior to taking Celexa if you have kidney disease. This medication may accumulate in your kidneys and cause more side effects.
Patients with liver disease
Celexa is processed by the liver. The levels of Celexa in your body might surge if you have liver disease. You may experience more side effects. Don`t take over 20 mg of Celexa daily.
Patients with a history of seizure disorder
Consult with your physician before using Celexa if you have a history of seizures. Citalopram can escalate your risk of seizures.
Celexa and pregnancy
Celexa is a category C pregnancy medication. That means two things:
- There is no significant body of research conducted in humans to be certain how the medication might affect the fetus.
- Research in animals has demonstrated unfavorable effects to the fetus when the mother takes the medication.
Consult with your doctor if you’re pregnant or planning a pregnancy. Celexa should be taken only if the potential benefit validates the hypothetical risk to the fetus.
Women who are breastfeeding
Celexa penetrates into breast milk and affects the breastfed baby.
Consult with your physician if you’re breastfeeding. You may have to choose to stop breastfeeding or stop taking Celexa.
Celexa can instigate changes in the appetite. Children must have their height and weight measured during treatment.
Celexa can cause severe allergic reaction. Symptoms may include:
- difficulty breathing
- swelling of the tongue, mouth, or face
- itchy welts or blisters that could be accompanied by fever or joint pain
In case of an allergic reaction, call your physician right away.
Don’t take Celexa again if you’ve ever experienced an allergic reaction to it.
Celexa drug Interactions
1. Serotonin-enhancing drugs
A potentially lethal condition called serotonin syndrome may ensue when Celexa (citalopram) is taken with other medicines, which can boost serotonin levels in human body. Also, this may occur after an increase in dosage.
Examples of such drugs include:
- triptans migraines medicines:
- methylene blue
- antidepressants of tricyclic type:
- monoamine oxidase inhibitors:
- John’s wort
2. Drugs affecting heart rhythm
Do not take Celexa with drugs that affect your heart rhythm. Taking both Celexa and these drugs may boost your risk of arrhythmia.
Examples of such drugs:
3. Bleeding risk enhancing drugs
Celexa might boost your risk of bruising or bleeding, especially if you’re also taking other drugs increasing bleeding risk.
Other medicines that increase one`s bleeding risk include:
- nonsteroidal anti-inflammatory drugs:
- blood thinners:
4. Tricyclic antidepressants (TCAs)
Caution should be applied when taking Celexa with TCAs. This increases the levels of the TCA in your body and correspondingly higher risk of side effects.
Tricyclic antidepressant drugs include:
5. Drugs that cause drowsiness or sedation
Taking Celexa may boost the effects of medicines causing sedation.
Examples of such medicines include:
6. Inhibitors of Cytochrome P450 2C19
Cytochrome P450 2C19 is a protein that helps to break down drugs, including Celexa. Some medicines are known to inhibit or slow down, the actions of this protein. When Celexa and drugs slowing down the actions of Cytochrome P450 2C19 are taken at the same time, it can result in the excessive amount of citalopram in the human body.
Some examples of the protein`s inhibitors:
Celexa and alcohol
Don’t drink alcohol when taking Celexa. Citalopram can result in increased sleepiness. It can disturb your ability to think clearly, make decisions, or react quickly. Alcohol consumption can boost these effects.
Information by Canadian Pharmacy Experts – www.mycanadianpharmacypro.com