Citalopram
General
Citalopram is a medicine used for depression (antidepressant). It is an often prescribed remedy, especially for patients with additional mood disorders. It belongs to the group of selective serotonin reuptake inhibitors (SSRIs). This means that it inhibits the uptake of serotonin into the cell. As a result, serotonin accumulates more in the tissue.
Since it was developed back in 1989, its effects and side effects are well known and it is widely used.
Read more on this topic: The role of serotonin / neurotransmitters in depression
pharmacology
Citalopram falls into the group of SSRIs (Selective Serotonin Reuptake Inhibitors) classified. In German one speaks of Serontonin reuptake inhibitors.
Serotonin is a Messenger substance in the brain, which in everyday life is often called Happiness hormone referred to as. A sufficient level of serotonin in the brain lifts and lowers mood fears. However, after a certain time after the distribution of the inactivation Hormoneby taking this back into the cells. This reuptake is inhibited by SSRIs so that serotonin can work longer.
Other drugs from the group of SSRIs are: escitalopram, sertraline, paroxetine, Fluoxetine, Fluvoxamine.
commitment
Citalopram is prescribed for drug therapy of mood disorders. This includes depression, but also bipolar disorder (occurrence of manic and depressive phases).
Citalopram has a mood-enhancing effect here. However, this effect only occurs after a few weeks of regular use.
For the treatment of depression, 20 to 60 mg are taken daily. The dosage must be increased slowly in order to minimize the side effects.
In addition, citalopram is used in higher doses for obsessive-compulsive disorder and panic disorder.
Read more about this under Cipralex®
Dosage of citalopram
Citalopram is used to treat depression and is available in different dosages such as 10mg, 20mg, 30mg and 40mg. When starting therapy with citalopram, a Starting dose from 10mg per day scheduled in the first week. This allows the patient to get used to the drug, as unpleasant side effects such as nausea, diarrhea and severe tiredness can often occur.
The Recommended daily dose lies by 20mg and can be increased if necessary. Further changes to the dose depend on the tolerability of the drug. Kick strong Side effects on, has to get another one Dose reduction be thought about or even switched to another drug.
Of course, the patient should also feel an improvement in their symptoms. Especially his mood, drive and motivation should be lightened by treatment. The patient notices no change or is it about itself very severe depression can the Maximum dose of 40mg can be prescribed per day.
The dose must also be adjusted carefully. The dose must also be adjusted carefully in elderly patients and those with an underlying disease such as impaired kidney function or liver function. You will usually receive a maximum dose of 20mg. When stopping citalopram, care should be taken to reduce the dose gradually. This tapering off of the drug is intended to prevent the occurrence of severe side effects of abrupt discontinuation.
Side effects
When starting therapy with citalopram, the following side effects are common:
- Dry mouth
- nausea
- Restlessness
- nervousness
- Tremble
- Palpitations
- sweat
- Sexual dysfunction.
It is important to know that these side effects often improve after prolonged use. So they shouldn't be a reason for early withdrawal.
Furthermore, taking citalopram leads to a change in the arousal in the heart. The so-called QT time is prolonged. An ECG must therefore be written before starting therapy in order to determine the QT time. In addition, citalopram should not be combined with other drugs that also lead to a prolongation of the QT time.
A temporary increase in the depressive symptoms partly with suicidal ideation can be observed under the antidepressant medication. Here, there should be a close connection to the attending physician in order to be able to intervene in good time.
A rare but life-threatening side effect is the so-called serotonin syndrome. An excess of serotonin and serotonin-like substances lead to the following symptoms:
- Rise in pulse and blood pressure, feeling flu, vomiting and diarrhea, headache, faster breathing
- Hallucinations, impaired consciousness, incoordination, restlessness, anxiety
- Tremors, muscle spasms, epileptic fits
If this occurs, a doctor must be consulted immediately. The patients must be closely monitored (sometimes in an intensive care unit). The causative medication is stopped and medication given to relieve symptoms.
Read more about the topic here: Side effects of citalopram
Dependency
Citalopram is not addictive. However, the body gets used to it abrupt withdrawal to circulatory disorders (dizziness, Nausea, palpitations, headaches, etc.). If the therapy with citalopram is to be stopped, it is recommended to do one slow, gradual reduction of the dose (Sneak out).
pregnancy:
There is evidence that citalopram just like other drugs from the group of SSRIs the Can affect the development of the unborn child. So it was observed that more common to premature birth and breathing problems in the newborn has come.
Because it however, no studies on pregnant women taking citalopram, the effect of the drug on the fetus remains uncertain. Overall, attempts should therefore be made to discontinue citalopram before pregnancy and, if possible, to treat the disease using non-drug methods (e.g. psychotherapy).
Stopping citalopram
Citalopram is a drug, on the package insert it is already pointed out that the patient's own discontinuation of the drug can lead to serious side effects. Those symptoms that can occur as a result of abrupt discontinuation are summarized under the SSRI withdrawal syndrome (e.g. sensory disturbances, fear of heights, tinnitus, sexual dysfunction or brain zaps).
Spontaneous discontinuation can lead to withdrawal symptoms in patients from one day to one week afterwards. These include circulatory problems such as dizziness and disorders of balance.Usually these appear especially when the head or eyes are moved. This is called orthostatic disorders. In many cases they lead to nausea and malaise.
Brain zaps are electric shock-like sensations that radiate to the extremities. Serious disorders can impair motor skills by leading to muscle twitching, muscle spasms, tremors and various tics that the patient can no longer control in everyday life.
It can also lead to gastrointestinal complaints, such as diarrhea, constipation, fatigue or nausea.
Mood swings can also be problematic. Among other things, patients complain of a stronger feeling of depression or manic phases, so that suicidal thoughts or aggressive behavior can be observed.
Withdrawal symptoms can last for weeks to months, and problems can occur even after you stop taking the drug. The attending physician should therefore accompany discontinuation and allow this to occur slowly. One speaks of tapering the dose; accordingly, a patient who takes 10mg per day is initially reduced to 5mg. If it is well tolerated or after several weeks of getting used to, the dose can be reduced further. It can take several months to stop taking the drug, but it has the advantage that it can reduce the risk of withdrawal symptoms.
Unfortunately, side effects cannot be completely ruled out, so a good consultation with the treating doctor is necessary. Moderate symptoms can also be treated with benzodiazepines to make withdrawal easier for the patient. If the symptoms are too severe, discontinuation should be discontinued and citalopram taken at its original dose. You can then try again with small steps of lowering the dose.
Citalopram and alcohol
Like many drugs, the effects of citalopram are influenced by the simultaneous use of other drugs or substances. For example, alcohol should not be consumed during treatment with citalopram. On the one hand, alcohol can influence the effect of the drug and thereby have negative effects on the patient; on the other hand, citalopram can also change the effect of alcohol on the body.
It has been shown that patients who drank even little alcohol during their citaloprant therapy had more severe side effects. There were more symptoms that are very similar to a hangover. Those affected suffered from malaise and nausea.
Citalopram therefore increases the sensitivity to alcohol so that even small amounts are sufficient to produce strong effects. The side effects under the influence of alcohol can vary from patient to patient.
Read more on our website Citalopram and alcohol-are they compatible?
