Citalopram (Celexa) Prescription

Generic Name: Citalopram Hydrobromide

Brand Names: Celexa, Cipramil, Cipram, Nitalapram

Buying generic Celexa Without Prescription

Celexa uses:

Citalopram HBr, one of the most selective serotonin reuptake inhibitors, is used to treat depression. It works by helping to restore the balance of certain natural chemicals in the brain. Citalopram has also been used to treat eating disorders (e.g., anorexia nervosa, bulimia), social anxiety, premenstrual dysphoric disorder, alcohol dependence, irritable bowel syndrome.

Citalopram may be more tolerable than some other antidepressants. Due to its low liability for interactions, Celexa is quite suitable for elderly. The adverse effects are usually mild and of sedative nature, which makes it especially suitable for continual therapy.

Dosage:

Initiate with 20 mg once daily and titrate up to 40 mg/day; max, 60 mg/day. Increase the dose in increments of 20 mg at intervals of no less than one week. Doses above 40 mg are not ordinarily recommended. Citalopram is administered once daily, in the morning or evening, without regard to food.

Panic disorder: the most effective dosage for panic disorder is 20 to 30 mg per day. [2, 3]

Irritable Bowel Syndrome (IBS): 20-40 mg per day [4].

Elderly: initiate with 20 mg once daily and titrate up to 40 mg/day if needed. Citalopram is usually well tolerated by elderly.

Hepatic impairment: initiate with 20 mg once daily and titrate up to 40 mg/day only if needed.

Maintenance: Periodically reevaluate long-term usefulness if used for extended periods.
If adverse reactions are bothersome, a decrease in dose to 20 mg/day can be considered.

Celexa usually takes about 4-6 weeks before you start noticing any marked improvement.

Discontinuation:

You may suffer discontinuation symptoms if you stop taking citalopram suddenly. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. Many patients tolerate 50% dose reduction for 3 days, then further 50% reduction for 3 days, and then total discontinuation.

If intolerable symptoms emerge during citalopram discontinuation, then resuming the previously prescribed dose may be considered. Subsequently, you may continue decreasing the dose but at a more gradual rate.

Side effects:

The most frequent:
Dry mouth (25%), nausea (25%), somnolence (20%), sweating (15%), fatigue (10%), tremor (10%).

Less common:
Ejaculation disorder (10%), diarrhea (5-10%), agitation (5%), libido decreased (5%), impotence (5%), dyspepsia (5%), anxiety (4%), anorexia (4%), vomiting (4%).

There are case reports of citalopram-induced bruxism [5].

Contraindications:

• Should not be coadministered with MAO inhibitors or within 2 weeks of discontinuing MAO inhibitors.
• Concomitant use with pimozide.

Precautions:

• Children: Safety and efficacy not established.
• Renal, hepatic impairment: Use cautiously at the lower end of the dose range.
• Can cause emotional flattening, slightly impair cognitive and motor function.

Drug interactions:

Although Citalopram has relatively low potential for interactions, do not start new prescription and over-the-counter medicine without informing your doctor. It is a weak inhibitor of liver cytochrome P450 enzymes.

• Anticoagulants/Antiplatelets: increased risk of bleeding.
• Cimetidine: serum levels of citalopram may be increased 40%.
• Serotonergic agents (antidepressants, sibutramine): risk of serotonin syndrome.
• Beta Blockers (carvedilol, metoprolol, propranolol): inhibition of metabolism of beta blockers.

Pregnancy & Lactation:
Citalopram is pregnancy category C.

Some animal studies show adverse effects on embryo/fetal and postnatal development. There are no controlled studies in pregnant women and so far has not been proven to be harmful to the fetus. Not generally recommended for use during pregnancy, especially during first trimester.

Citalopram is excreted in human breast milk. If child becomes irritable or sedated, breast feeding or citalopram may need to be discontinued.

Overdose:
Experience in overdose suggests a wide diapason of safety.

If overdose is suspected, contact your local poison control center or emergency room immediately. Symptoms of overdose may include: tiredness, weakness, sedation, irregular heartbeat, fainting, severe dizziness or lightheadedness.

Missed dose:
If you miss a dose, use it as soon as you remember. However, do not take a double dose.

Storage:
Store at room temperature (59° to 86°F).

Prices:
If you would like to buy Citalopram (Celexa) with no prescription, choose the offer from the above price table. Other antidepressants from SSRI class are also available.

References:

• 1. U.S. Citalopram Prescribing Information
• 2. Wade AG, Lepola U, Koponen HJ, Pedersen V, Pedersen T. Citalopram in panic disorder. Br J Psychiatry. 1997 Jun;170:549-53.
• 3. Leinonen E, Lepola U, Koponen H, Turtonen J, Wade A, Lehto H. Citalopram controls phobic symptoms in patients with panic disorder: randomized controlled trial. J Psychiatry Neurosci. 2000 Jan;25(1):24-32. PubMedCentral
• 4. Masand PS, Gupta S, Schwartz TL, Virk S, Hameed A, Kaplan DS. Citalopram for irritable bowel syndrome: a pilot study. Prim Care Companion J Clin Psychiatry. 2005;7(4):162-6. PubMedCentral
• 5. Wise M. Citalopram-induced bruxism. Br J Psychiatry. 2001 Feb;178:182.

Last modified: March 07, 2013