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citalopram (si-tal-oh-pram)
CeleXA
Classification
Therapeutic: antidepressants
Pharmacologic: selective serotonin reuptake inhibitors (SSRIs)
Pregnancy Category C
Indications
Depression. Unlabeled Use: Premenstrual dysphoric disorder (PMDD). Obsessive-compulsive disorder (OCD). Panic disorder. Generalized anxiety disorder
(GAD). Posttraumatic stress disorder (PTSD). Social anxiety disorder (social phobia).
Action
Selectively inhibits the reuptake of serotonin in the CNS. Therapeutic Effects: Antidepressant action.
Pharmacokinetics
Absorption: 80% absorbed after oral administration.
Distribution: Enters breast milk.
Metabolism and Excretion: Mostly metabolized by the liver (10% by CYP3A4
and 2C19 enzymes); excreted unchanged in urine.
Half-life: 35 hr.
TIME/ACTION PROFILE (antidepressant effect)
ROUTE
ONSET
PEAK
DURATION
PO
1–4 wk
unknown
unknown
Contraindications/Precautions
Contraindicated in: Hypersensitivity; Concurrent use of MAO inhibitors or MAOlike drugs (linezolid or methylene blue); Concurrent use of pimozide; Congenital
long QT syndrome, bradycardia, hypokalemia, hypomagnesemia, recent myocardial
infarction, decompensated heart failure (qrisk of QT interval prolongation); Concurrent use of QT interval prolonging drugs.
⫽ Canadian drug name.
⫽ Genetic Implication.
Plate # 0-Composite
pg 1 # 1
Use Cautiously in: History of mania; History of suicide attempt/ideation (qrisk
during early therapy and during dose adjustment); History of seizure disorder; Illnesses or conditions that are likely to result in altered metabolism or hemodynamic
responses; Severe renal or hepatic impairment (maximum dose of 20 mg/day in patients with hepatic impairment); Poor metabolizers of CYP2C19 (qrisk of QT interval prolongation) (maximum dose of 20 mg/day); Concurrent use of CYP2C19 inhibitors (qrisk of QT interval prolongation) (maximum dose of 20 mg/day); OB: Use
during third trimester may result in neonatal serotonin syndrome requiring prolonged hospitalization, respiratory and nutritional support; Lactation: Present in
breast milk and may result in lethargy withpfeeding in infants; weigh risk/benefits;
Pedi: Mayqrisk of suicide attempt/ideation especially during early treatment or
dose adjustment in children/adolescents (unlabeled for pediatric use); Geri: p
doses recommended (maximum dose of 20 mg/day in patients ⬎60 yr).
Adverse Reactions/Side Effects
CNS: NEUROLEPTIC MALIGNANT SYNDROME,
SUICIDAL THOUGHTS, apathy, confusion,
drowsiness, insomnia, weakness, agitation, amnesia, anxiety,plibido, dizziness, fatigue, impaired concentration,qdepression, migraine headache. EENT: abnormal
accommodation. Resp: cough. CV: TORSADE DE POINTES, postural hypotension, QT
interval prolongation, tachycardia. GI: abdominal pain, anorexia, diarrhea, dry
mouth, dyspepsia, flatulence,qsaliva, nausea, altered taste,qappetite, vomiting.
GU: amenorrhea, dysmenorrhea, ejaculatory delay, erectile dysfunction, polyuria.
Derm: sweating, photosensitivity, pruritus, rash. Metab: weight loss, weight gain. F
and E: hyponatremia. MS: arthralgia, myalgia. Neuro: tremor, paresthesia. Misc:
SEROTONIN SYNDROME, fever, yawning.
Interactions
Drug-Drug: May cause serious, potentially fatal reactions when used with
MAO inhibitors; concurrent use contraindicated; allow at least 14 days between citalopram and MAO inhibitors. Concurrent use with MAO-inhibitor like
drugs, such as linezolid or methylene blue mayqrisk of serotonin syndrome;
concurrent use contraindicated; do not start therapy in patients receiving linezolid
or methylene blue; if linezolid or methylene blue need to be started in a patient
receiving citalopram, immediately discontinue citalopram and monitor for signs/
symptoms of serotonin syndrome for 2 wk or until 24 hr after last dose of linezolid or
methylene blue, whichever comes first (may resume citalopram therapy 24 hr after
last dose of linezolid or methylene blue). Concurrent use with pimozide may re-
CAPITALS indicate life-threatening, underlines indicate most frequent.
Strikethrough ⫽ Discontinued.
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sult in prolongation of the QTc interval and is contraindicated. QT interval prolonging drugs mayqthe risk of QT interval prolongation and torsade de pointes
(concurrent use should be avoided). CYP2C19 inhibitors, including cimetidine
mayqlevels and the risk of toxicity (maximum dose ⫽ 20 mg/day). Drugs that affect
serotonergic neurotransmitter systems, including tricyclic antidepressants,
SNRIs, fentanyl, buspirone, tramadol and triptansqrisk of serotonin syndrome. Use cautiously with other centrally acting drugs (including alcohol, antihistamines, opioid analgesics, and sedative/hypnotics; concurrent use with alcohol is not recommended). Serotonergic effects may beqby lithium (concurrent
use should be carefully monitored). Ketoconazole, itraconazole, erythromycin,
and omeprazole mayqlevels. Carbamazepine maypblood levels. Mayqlevels of
metoprolol. Use cautiously with tricyclic antidepressants due to unpredictable
effects on serotonin and norepinephrine reuptake.qrisk of bleeding with aspirin,
NSAIDs, clopidogrel, or warfarin.
Drug-Natural Products:qrisk of serotonergic side effects including serotonin
syndrome with St. John’s wort and SAMe.
Route/Dosage
PO (Adults): 20 mg once daily initially, may beqin one week to 40 mg/day (maximum dose); Poor metabolizer of CYP2C19 or concurrent use of CYP2C19 inhibitor— Do not exceed dose of 20 mg/day.
PO (Geriatric Patients): 20 mg once daily initially (do not exceed dose of 20 mg/
day in patients ⬎60 yr).
Hepatic Impairment
Plate # 0-Composite
● Assess for sexual dysfunction (erectile dysfunction; decreased libido).
● Assess for serotonin syndrome (mental changes [agitation, hallucina-
tions, coma], autonomic instability [tachycardia, labile BP, hyperthermia], neuromuscular aberrations [hyperreflexia, incoordination], and/
or GI symptoms [nausea, vomiting, diarrhea]), especially in patients
taking other serotonergic drugs (SSRIs, SNRIs, triptans).
● Lab Test Considerations: Monitor electrolytes (potassium and magnesium)
in patients at risk for electrolyte imbalances prior to and periodically during therapy.
Potential Nursing Diagnoses
Ineffective coping (Indications)
Risk for injury (Side Effects)
Sexual dysfunction (Side Effects)
Implementation
● Do not confuse with Celebrex (celecoxib), Cerebyx (fosphenytoin), or
Zyprexa (olanzapine).
● PO: Administer as a single dose in the morning or evening without regard to food.
Patient/Family Teaching
● Instruct patient to take citalopram as directed. Take missed doses as soon as re-
PO (Adults): 20 mg once daily (do not exceed dose of 20 mg/day).
●
NURSING IMPLICATIONS
Assessment
●
● Monitor mood changes during therapy.
● Assess for suicidal tendencies, especially during early therapy and dose
changes. Restrict amount of drug available to patient. Risk may be increased in children, adolescents, and adults ⱕ24 yr. After starting therapy, children, adolescents, and young adults should be seen by health
care professional at least weekly for 4 wk, every 3 wk for the next 4 wk,
and on advice of health care professional thereafter.
pg 2 # 2
●
●
membered unless almost time for next dose; do not double doses. Do not stop
abruptly; may cause anxiety, irritability, high or low mood, feeling restless or
changes in sleep habits, headache, sweating, nausea, dizziness, electric shock-like
sensations, shaking, and confusion. Advise patient to read the Medication Guide
prior to starting therapy and with each refill in case of changes.
May cause drowsiness, dizziness, impaired concentration, and blurred vision.
Caution patient to avoid driving and other activities requiring alertness until response to the drug is known.
Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking any other Rx, OTC, or herbal products, especially alcohol or other CNS
depressants.
Caution patient to change positions slowly to minimize dizziness.
Advise patient, family, and caregivers to look for suicidality, especially
during early therapy or dose changes. Notify health care professional
immediately if thoughts about suicide or dying, attempts to commit sui-
䉷 2015 F.A. Davis Company
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citalopram
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cide, new or worse depression or anxiety, agitation or restlessness,
panic attacks, insomnia, new or worse irritability, aggressiveness, acting on dangerous impulses, mania, or other changes in mood or behavior or if symptoms of serotonin syndrome occur.
Advise patient to use sunscreen and wear protective clothing to prevent photosensitivity reactions.
Inform patient that frequent mouth rinses, good oral hygiene, and sugarless gum
or candy may minimize dry mouth. If dry mouth persists for more than 2 wk, consult health care professional regarding use of saliva substitute.
Instruct female patients to inform health care professional if pregnancy is planned
or suspected, or if they plan to breast feed. If used during pregnancy should be tapered during third trimester to avoid neontal serotinin syndrome.
Emphasize the importance of follow-up exams to monitor progress.
Evaluation/Desired Outcomes
● Increased sense of well-being.
● Renewed interest in surroundings. May require 1– 4 wk of therapy to obtain anti-
depressant effects.
Why was this drug prescribed for your patient?
⫽ Canadian drug name.
⫽ Genetic Implication.
CAPITALS indicate life-threatening, underlines indicate most frequent.
Strikethrough ⫽ Discontinued.