Citalopram

CLINICAL USE


SSRI antidepressant:Depressive illness Panic disorder

DOSE IN NORMAL RENAL FUNCTION

10–60 mg dailyOral drops: 8–48 mg (4 drops = 8 mg liquid = 10 mg tablet)

PHARMACOKINETICS

  • Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :324.4
  • %Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :<80
  • %Excreted unchanged in urine &nbsp &nbsp : 12

  • Volume of distribution (L/kg) &nbsp &nbsp &nbsp :12.3

  • half-life – normal/ESRD (hrs)&nbsp &nbsp &nbsp :36/49.5

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

  • 20 to 50 &nbsp &nbsp : Dose as in normal renal function
  • 10 to 20 &nbsp &nbsp : Dose as in normal renal function
  • <10 &nbsp &nbsp &nbsp &nbsp &nbsp : Dose as in normal renal function. Use with caution

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp:Unlikely to be dialysed. Dose as in GFR <10 mL/min

  • HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Not dialysed. Dose as in GFR <10 mL/min
  • HDF/high flux &nbsp :Not dialysed. Dose as in GFR <10 mL/min
  • CAV/VVHD &nbsp &nbsp &nbsp:Unlikely to be dialysed. Dose as in GFR 10 to 20 mL/min

    IMPORTANT DRUG INTERACTIONS

    Potentially hazardous interactions with other drugsAnalgesics: increased risk of bleeding with aspirin and NSAIDs; risk of CNS toxicity increased with tramadolAnticoagulants: effect of coumarins possibly enhancedAntidepressants: avoid concomitant use with MAOIs and moclobemide, increased risk of toxicity; avoid concomitant use with St John’s wort; possibly enhanced serotonergic effects with duloxetine; can increase tricyclics antidepressant concentration; increased agitation and nausea with tryptophanAnti-epileptics: convulsive threshold loweredAntimalarials: avoid concomitant use with artemether/lumefantrineAntipsychotics: possibly increased clozapine concentrationAntivirals: concentration possibly increased by ritonavirDopaminergics: use selegiline with caution; increased risk of CNS toxicity with rasagiline5 HT 1 agonist: increased risk of CNS toxicity with sumatriptan; possibly increased risk of serotonergic effects with frovatriptanLinezolid: use with care, possibly increased risk of side effectsLithium: increased risk of CNS effects Sibutramine: increased risk of CNS toxicity (avoid concomitant use)

    ADMINISTRATION

    Reconstition

    –

    Route

    Oral

    Rate of Administration

    –

    Comments

    OTHER INFORMATION

    Only 1% of drug is removed by haemodialysisThere is reduced clearance of Citalopram in severe renal failure
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