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Physician’s Resource The physician’s psychoactive medication resource guide 25% of your patients taking an antidepressant will have weight gain and the weight gain is directly caused by the antidepressant.
Citalopram Brand Name (Celexa) Celexa withdrawal. Celexa withdrawal side effects, Celexa withdrawal warnings, Celexa withdrawal precautions, Celexa withdrawal adverse effects, overdose, withdrawal symptoms and Celexa natural alternatives. Before you begin the spiral down with Celexa, try giving your body what it really wants. While taking Celexa or discontinuing Celexa several adverse reactions occur. They can range from anxiety/insomnia to fatigue and debilitating head symptoms. The book How to Get Off Psychiatric Drugs safely by James Harper N.C. describes in detail what to do for your patients. Your patients will also be able to take the step-by-step instructions found in this book and put them to use instantly. This book is written for physicians, pharmacists and patients. You can click here and get the book from Amazon.com Whether you want your patient to remain on Celexa or discontinue Celexa, getting relief from the adverse drug reactions is essential. How to Get Off Psychiatric Celexa Safely has the answers. Celexa Withdrawal and Celexa Side Effects. Latest News: SSRI Antidepressants May Up Stroke Risk After Menopause Date Published: Thursday, December 17th, 2009 Post-menopausal women taking selective serotonin reuptake inhibitor (SSRI) antidepressants have a small, though statistically higher risk of stroke, according to a newly published study. SSRIs include the drugs Prozac, Paxil, Zoloft, Lexapro, and Celexa. Antidepressant use in the US has more than quintupled since the early 1990s, and SSRIs have replaced older medications called tricyclic antidepressants, which can be toxic the heart. According to a press release announcing this latest study, SSRI antidepressants have fewer side effects in general and are known to have aspirin-like effects on bleeding, which could protect against clot- related cardiovascular disorders. But not much is known about how SSRIs affect the heart. This is especially true in the case of postmenopausal women, who are at increased risk for both heart disease and depression. The study, which was published in the December 14 Archives of Internal Medicine, involved 136,000 participants in the Women’s Health Initiative (WHI). None of the women were taking antidepressants when they enrolled in the WHI. The women included in the analysis had their first follow-up visit either one or three years after enrolling in WHI. At that time, 5,500 women reported taking either tricyclic or SSRI antidepressants. After six years, there was no association between antidepressant use and heart disease. However, researchers did find that women taking SSRIs had a 45 percent increase in risk of stroke and a 32 percent increase in risk of dying from any cause during follow up, compared with nonusers. Use of older tricyclic antidepressants wasn’t linked to stroke, but it did increase by 67 percent the risk of death during follow-up. The authors of the study said it wasn’t clear if the increased risk was the result of antidepressants or depression itself. Depression is a known risk factor for cardiovascular problems. “There are a lot of things this study couldn’t tell us, such as whether this risk truly is attributable to the drugs and not to depression itself and whether participants were being treated for depression or for anxiety, which also has cardiovascular risks,” Jordan W. Smoller, MD, ScD, of the Massachusetts General Hospital (MGH) Department of Psychiatry, the study’s lead author, said in a press release. “We also don’t know whether there is any similar association in younger women or in men, since they were not part of this study.” The authors of the study called for more research into the relationship between antidepressants and death.
Celexa - Alert from the F.D.A. FDA ALERT [07/2005]: Suicidal Thoughts or Actions in Children and Adults Patients with depression or other mental illnesses often think about or attempt suicide. Closely watch anyone taking antidepressants, especially early in treatment or when the dose is changed. Patients who become irritable or anxious, or have new or increased thoughts of suicide or other changes in mood or behavior (or their care givers) should contact their healthcare professional right away. Children Taking antidepressants may increase suicidal thoughts and actions in about 1 out of 50 people 18 years or younger. FDA has approved Zoloft for use in children only if they have obsessive-compulsive disorder. Adults Several recent scientific publications report the possibility of an increased risk for suicidal behavior in adults who are being treated with antidepressant medications. Even before these reports became available, FDA began a complete review of all available data to determine whether there is an increased risk of suicidal thinking or behavior in adults being treated with antidepressant medications. It is expected that this review will take a year or longer to complete. In the meantime, FDA is highlighting that adults being treated with antidepressant medication, particularly those being treated for depression, should be watched closely for worsening of depression and for increased suicidal thinking or behavior. TAction and Clinical Pharmacology Citalopram hydrobromide is a highly selective and potent serotonin (5-hydroxytryptamine 5-HT) reuptake inhibitor with minimal effects on the neuronal reuptake of norepinephrine (NE) and dopamine (DA). The ability of citalopram to potentiate serotonergic activity in the central nervous system via inhibition of the neuronal reuptake of serotonin is thought to be responsible for its antidepressant action. Tolerance to the inhibition of serotonin reuptake is not induced by long term (14 days) treatment of rats with citalopram. Citalopram has no or very low affinity for a series of receptors including serotonin 5-HT 1A , 5-HT 2 , dopamine D 1 , and D 2 , a 1 -, a 2 -, b- adrenergic, histamine H 1 , muscarinic cholinergic, benzodiazepine, gamma aminobutyric acid (GABA) and opioid receptors. Pharmacokinetics Absorption Following the administration of a single oral dose of citalopram (40 mg) to healthy male volunteers, peak blood levels occurred at about 4 hours (range 1 to 6 hours). The absolute bioavailability of citalopram was about 80% (range 52 to 93%) relative to an intravenous dose. Absorption was not affected by food. Distribution After intravenous infusion in healthy male volunteers the apparent volume of distribution (V d )b was about 12 L/kg (range 9-17 L/kg), indicating a pronounced tissue distribution: (V d )b oral was about 17 L/kg (range 14-17 L/kg). The binding of citalopram and its demethylated metabolites to human plasma proteins is about 80%. Steady-state The single- and multiple dose pharmacokinetics of citalopram are linear and dose proportional in a dose range of 10 to 60 mg/day. Steady-state plasma levels are achieved in patients in 1-2 weeks. At a daily dose of 40 mg, the average plasma concentration is about 83 ng/mL (n=114) with a range from 30 to 200 ng/mL. Citalopram does not accumulate during long term treatment. A clear relationship between citalopram plasma levels and therapeutic response or side effects has not been established. Metabolism Citalopram is metabolized in the liver to demethylcitalopram (DCT), didemethylcitalopram (DDCT), citalopram N-oxide and a deaninated propionic acid derivative. In vitro studies show that DCT, DDCT and citalopram-N-oxide also inhibit the neuronal reuptake of serotonin but are less selective and less potent than the parent compound and are of minor clinical importance. Unchanged citalopram is the predominant compound in plasma. In vitro studies indicated that the biotransformation of citalopram to its demethyl metabolites depends on both CYP2C19 and CYP3A4, with a small contribution from CYP2D6. Elimination The elimination half life of citalopram (t 1/2b ) is approximately 37 hours (range 30-42 hours) which allows recommendation of once-daily dosing. The systemic citalopram plasma clearance (Cl 5 ) is 0.33 L/min. Citalopram is eliminated primarily via the liver (85%) and the remainder via the kidneys; approximately 12% (range 6-21%) of the daily dose is excreted in urine as unchanged citalopram. Special Populations: Elderly Patients Elderly patients (4 males and 7 females aged 73-90 years), received a 20 mg/day dose of citalopram for 3-4 weeks. In the elderly, steady state plasma levels were elevated (106 ng/mL), half-life prolonged (1.5-3.75 days) and clearance decreased (0.08-0.3 L/min). Elevation of citalopram plasma levels occurred at an earlier age in females than in males, In this population, lower doses and a lower maximum dose of citalopram are recommended. Reduced Hepatic Function The pharmacokinetics of citalopram were compared in patients with reduced hepatic function (3 female and 6 male patients aged 41-60 years) to those seen in 12 healthy male volunteers (aged 21-43 years), In patients with reduced hepatic function the half-life of citalopram was approximately doubled (83 hours versus 37 hours), steady state citalopram concentrations increased by 61% and oral clearance decreased by 37%. Consequently the use of citalopram in patients with reduced hepatic function should be approached with caution and lower maximal doses should be prescribed (see PRECAUTIONS and DOSAGE AND ADMINISTRATION). Reduced Renal Function In patients with mild to moderate reduction of the renal function (4 females and 3 males, aged 30-55 years), citalopram was being eliminated more slowly than in 12 healthy male volunteers (aged 21-43 years), half-lives being 49 hours versus 37 hours. However, mild to moderate renal impairment had no major influence on the kinetics of citalopram. At present, no information is available for chronic treatment of patients with severely reduced renal function (creatinine clearance <20 mL/min). Indications and Clinical Use Citalopram hydrobromide is indicated for the symptomatic relief of depressive illness. The relapse rate was significantly lower in citalopram-treated patients than in placebo-treated patients in two placebo-controlled studies, that were conducted over a 24-week period in patients who responded to 6 or 8 weeks of acute treatment with citalopram (see CLINICAL TRIALS under ACTION AND CLINICAL PHARMACOLOGY.) Nevertheless, the physician who elects to use citalopram for extended periods should periodically reevaluate the long-term usefulness of the drug for the individual patient. Contraindications Citalopram hydrobromide is contraindicated in patients with known hypersensitivity to citalopram hydrobromide or the excipients of the drug product. Monoamine Oxidase Inhibitors In patients, receiving selective serotonin reuptake inhibitors (SSRIs) in combination with a monoamine oxidase inhibitor (MAOI), there have been reports of serious, sometimes fatal, reactions including hyperthermia, rigidity, myoclonus, autonomic instability with possible rapid fluctuations of vital signs, and mental status changes, including extreme agitation progressing to delirium and coma. These reactions have also been reported in patients who have recently discontinued SSRI treatment and have been started on a MAOI. Some cases presented with features resembling serotonin syndrome. Therefore, it is recommended that citalopram should not be used in combination with a MAOI or within 14 days of discontinuing treatment with a MAOI. Similarly, at least 14 days should elapse after discontinuing citalopram treatment before starting a MAOI. Precautions Suicide The possibility of a suicide attempt is inherent in depression and may persist until remission occurs. Therefore, high risk patients should be closely supervised throughout therapy with Citalopram hydrobromide and consideration should be given to the possible need for hospitalization. In order to minimize the opportunity for overdosage, prescription for citalopram should be written for the smallest quantity of drug consistent with good patient management. Activation of Mania/Hypomania In placebo-controlled trials with citalopram, some of which included patients with bipolar disorder, mania/hypomania was reported in 0.1% of 1027 patents treated with citalopram versus none of the 426 patients treated with placebo. Activation of mania/hypomania has also been reported in a small proportion of patients with major affective disorders treated with other marketed antidepressants. If a patient enters a manic phase, citalopram should be discontinued. Seizures Citalopram has not been systematically evaluated in patients with a seizure disorder. These patients were excluded from clinical studies during the premarketing testing of citalopram. In clinical trials, seizures occurred in 0.25% of patients treated with citalopram and in 0.23% patients treated with placebo. Like other antidepressants, citalopram should be used with caution in patients with a history of seizure disorder. Serotonin Syndrome Rarely, the occurrence of serotonin syndrome has been reported in patients receiving SSRIs. A combination of symptoms, possibly including agitation, confusion, tremor, myoclonus and hyperthermia, may indicate the development of this condition. 5-HT 1  Agonists There have been rare postmarketing reports describing patients with weakness, hyperreflexia and incoordination, following the concomitant use of a SSRI and the antimigraine drug sumatriptan, a 5-HT 1  agonist. Such interaction should be considered if citalopram is to be used in combination with a 5-HT 1  agonist. Hyponatremia Hyponatremia and SIADH (syndrome of inappropriate antidiuretic hormone secretion) have been reported with citalopram use as a rare adverse event. Pregnancy and Nursing Mothers The safety of citalopram during pregnancy and lactation has not been established. Therefore, citalopram should not be used during pregnancy, unless, in the opinion of the physician, the expected benefits to the patient markedly outweigh the possible hazards to the fetus. Citalopram is excreted in human milk. Citalopram should not be administered to nursing mothers unless, in the opinion of the treating physician, the expected benefits to the patient markedly outweigh the possible hazards to the child. Pediatric Use Safety and effectiveness in patients below the age of 18 have not been established. Geriatric Use In premarketing clinical trials, 800 elderly patients (>=65 years of age) have been treated with citalopram. Of these patients 298 were >=75 years old. In a pharmacokinetic study (n=11, age 73 to 90 years), clearance was substantially decreased and half-life prolonged (see PHARMACOKINETICS). In a 6-week placebo-controlled study, approximately equal numbers of patients received citalopram at 20 or 30 mg per day, as the final dose. In about 5% of patients, the final dose was 10 mg per day (see CLINICAL TRIALS). Consequently, elderly patients should be administered lower doses and a lower maximum dose. Hepatic Impairment Citalopram clearance was significantly decreased and plasma concentrations, as well as elimination half-life significantly increased (see PHARMACOKINETICS). Consequently, the use of citalopram in hepatically impaired patients should be approached with caution and a lower maximum dosage is recommended. Renal Impairment No dosage adjustment is needed in patients with mild to moderate renal impairment. To date, no information is available on the pharmacokinetic or pharmacodynamic effects of citalopram in patients with severely reduced renal function (creatinine clearance <20 mL/min). Use in Patients with Cardiac Disease Citalopram has not been systematically evaluated in patients with a recent history of myocardial infarction or unstable heart disease. Patients with these diagnoses were generally excluded from clinical trials during the drugs premarketing assessment. However, the electrocardiograms of patients, who received citalopram in clinical trials, indicate that citalopram was not associated with the development of clinically significant ECG abnormalities. In clinical trials, citalopram caused small but statistically significant decreases in heart rate (see ECG under ADVERSE REACTIONS) Consequently, caution should be observed when citalopram is initiated in patients with pre-existing slow heart rate. Use in Diabetic Patients Citalopram has not been systematically evaluated in diabetic patients since diabetes constituted an exclusion criterion. Although 13 patients did receive insulin during the studies, this number is too small to determine whether citalopram affects the response to insulin. Rare events of hypoglycemia were reported. Citalopram should be used with caution in diabetic patients on insulin or other antidiabetic drugs. Interference with Cognitive and Motor Performance In studies in normal volunteers, citalopram in doses of 40 mg/day did not impair cognitive function or psychomotor performance. However, psychotropic medications may impair judgement, thinking or motor skills. Consequently, patients should be cautioned against driving a car or operating hazardous machinery until they are reasonably certain that citalopram does not affect them adversely. Electroconvulsive Therapy (ECT) The safety and efficacy of the concurrent use of citalopram and ECT have not been studied. Abrupt Discontinuation After 8 weeks of treatment with citalopram, abrupt discontinuation of treatment caused a higher incidence of anxiety, emotional indifference, impaired concentration, headache, migraine, paresthesia, and tremor than was seen in patients who continued on citalopram. These symptoms are not indicative of addiction. Although it is not known whether gradual discontinuation will prevent the discontinuation symptoms, it is recommended that the dosage of citalopram should be tapered off over 1 to 2 weeks. Additional Adverse Events Observed During the Premarketing Evaluation of Citalopram The events listed below include all adverse events that were reported in the overall development program of citalopram (n=3652). All reported events are included except those already listed in Table 1 and those events which occurred in only one patient. It is important to emphasize that, although the events reported occurred during treatment with citalopram, they were not necessarily caused by it. The events are enumerated using the following criteria: frequent: adverse events that occurred on one or more occasions in at least 1/100 patients; infrequent: adverse events that occurred in less than 1/100 patients but at least in 1/1000 patients; rare: adverse events that occurred in fewer than 1/1000 patients. Body as a Whole - General Disorders Frequent: Influenza-like symptoms, nonpathological trauma, pain. Infrequent: Alcohol intolerance, allergic reaction, allergy, chest pain, edema, hot flushes, leg pain, malaise. rigors, syncope. Rare: Peripheral edema, sudden death, traumatic injury. Cardiovascular Disorders Frequent: Postural hypotension, tachycardia. Infrequent: Angina pectoris, arrhythmia. bradycardia, cardiac failure, cerebrovascular disorders, edema dependent, extrasystoles, flushing, hypertension, hypotension, myocardial infarction, myocardial ischemia, peripheral ischemia. Rare: Aggravated hypertension, bundle branch block, cardiac arrest, coronary artery disorder, ECG abnormal, heart disorder, phlebitis, supraventricular extrasystoles. Central and Peripheral Nervous System Disorders Frequent: Migraine, paraesthesia. Infrequent: Abnormal gait, ataxia, convulsions, dysphonia, dystonia, extrapyramidal disorder, hyperkinesia, hypertonia, hypoesthesia, hypokinesia, involuntary muscle contractions, leg cramps, neuralgia, speech disorder, vertigo Rare: Abnormal coordination, convulsions grand mal, hyperesthesia, ptosis, sensory disturbance, stupor. Collagen Disorders Rare: Rheumatoid arthritis. Endocrine Disorders Rare: Goiter, gynecomastia, hypothyroidism. Gastrointestinal System Disorders Frequent: Flatulence. Infrequent: Colitis, dental abscess, dysphagia, eructation, gastritis, gastroenteritis, gastrointestinal disorder (not specified), hemorrhoids, increased saliva, teeth-grinding, toothache. Rare: Appendicitis, esophagitis, gastric ulcer, gastroesophageal reflux, gingivitis, stomatitis, tooth disorder, ulcerative stomatitis. Hematopoietic and Lymphatic Disorders Infrequent: Anemia, epistaxis, leukocytosis, purpura. Rare: Coagulation disorder, gingival bleeding, granuloytopenia, hematoma, leukopenia, lymphadenopathy, lymphocytosis, pulmonary embolism. Liver and Biliary System Disorders. Infrequent: Cholecystitis, cholelithiasis, increased gamma-GT, increased SGPT. Rare: Bilirubinemia, increased SGOT, jaundice. Metabolic and Nutritional Disorders Frequent: Weight decrease, weight increase. Infrequent: Leg edema, xerophthalmia. Rare: Dehydration, edema, hypoglycemia, hypokalemia, increased alkaline phosphatase, obesity, thirst. Musculo-Skeletal System Disorders Infrequent: Arthralgia, arthritis, arthrosis, dystonia, muscle weakness, myalgia. Rare: Bone disorder, bursitis, osteoporosis, tendon disorder. Neoplasm Rare: Breast neoplasm malignant female. Psychiatric Disorders Frequent: Abnormal dreaming, aggravated depression, amnesia, apathy, confusion, depression, impaired concentration, increased appetite, sleep disorder, suicide attempt. Infrequent: Abnormal thinking, aggressive reaction, delusion, depersonalization, drug abuse, drug dependence, emotional lability, euphoria, hallucination, increased libido, manic reaction, neurosis, paranoid reaction, paroniria, psychosis, psychotic depression. Rare: Catatonic reaction, hysteria, personality disorder. Reproductive Disorders, Female Infrequent: Amenorrhea, breast pain, lactation nonpuerperal, menorrhagia, menstrual disorder, premenstrual syndrome, salpingitis, unintended pregnancy, vaginal dryness, vaginitis. Rare: Breast enlargement, vaginal hemorrhage. Reproductive Disorders, Male Infrequent: Penis disorder, prostatic disorder, testis disorder. Resistance Mechanism Disorders Infrequent: Abscess, fungal infection, herpes simplex infection, otitis media, viral infection. Rare: Bacterial infection, moniliasis, sepsis. Respiratory System Disorders Infrequent: Bronchitis, coughing, dyspnea, pneumonia. Rare: Asthma, bronchospasm, increased sputum, laryngitis, pneumonitis, respiratory disorder. Skin and Appendage Disorders Frequent: Pruritus, rash. Infrequent: Acne, alopecia, dermatitis, dry skin, eczema, photosensitivity reaction, psoriasis, rash erythematous, rash maculo-papular, skin discoloration, urticaria. Rare: Cellulitis, decreased sweating, hypertrichosis, melanosis, pruritus ani. Special Senses, Vision, Hearing and Vestibular Disorders Frequent: Abnormal accommodation. Infrequent: Conjunctivitis, earache, eye pain, mydriasis, taste perversion, tinnitus. Rare: Eye abnormality, keratitis, photophobia. Urinary System Disorders Frequent: Polyuria. Infrequent: Abnormal urine, cystitis, hematuria, micturition frequency, urinary incontinence, urinary retention, urinary tract infection. Rare: Dysuria, facial edema, oliguria, renal calculus, renal pain. Events Observed During the Post-Marketing Evaluation of Citalopram It is estimated that approximately 8 million patients have been treated with citalopram since market introduction. The following adverse events have been reported to be temporarily associated with citalopram treatment in at least 3 patients and are not described elsewhere in labeling. Abnormal hepatic function, aggravated condition, aggravated migraine, angioedema, asthma, choreoathetosis, decreased drug level, decreased prothrombin time, dyskinesia, eosinophilia, erythema multiforms, gynecological problems, hepatitis, hyperprolactinemia, hyponatremia, increased drug level, increased prothrombin time, mydriasis, neuroleptic malignant syndrome, neuropathy, pancreatitis, pancytopenia, postural hypotension, serotonin syndrome, SIADH, spontaneous abortion/fetal death, thrombocytopenia, ventricular arrhythmia, Torsade de pointes, withdrawal syndrome.