# منتديات طلاب الجامعات الأردنية > منتدى طلاب الطب والصيدلة والتخصصات الطبية >  بحث ال Citalopram

## لمسة شقاوة

_Citalopram_


*Generic name**:** Citalopram*
*Brand name:*
*It is sold under the brand-names 
*
*# Celexa (**U.S.**, Forest Laboratories, Inc.),*
*# Cipramil , Citrol, Seropram,Talam (**Europe** and* *Australia**),* 
*# Recital (Israel, Thrima Inc. for Unipharm Ltd.),*
*# Zetalo (**India**),*
*# Celepram, Ciazil (**Australia**),*
*# Zentius (**South America**, Roemmers),*
*# Cilift (**South Africa**)*
*Cipram (**Denmark**, H. Lundbeck A/S) # .*

*cipram* *:* *20 mg*
*ceropram* *:* *20 mg*
*cipramax* *:* *40 mg*
*citalo* *:* *20 mg*
*depram* *:* *40 mg*
*sedopram:* *20 mg*
*
pharmaceutical form*

*Tablets: 10, 20, and 40 mg.*
*Solution: 10 mg/5 ml*
*
pharmacokinetics*:

*Absorption**The absolute bioavailability of citalopram was about 80%* *(range 52 to 93%)* *relative to an intravenous dose. Absorption was not affected* *by food.

**Distribution**The binding of citalopram and its demethylated m e ta bolites* *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.
*
*me tabolism* *Citalopram is me tabolized in the liver to demethyl* *citalopram (DCT),* *Didemethyl citalopram (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* *inplasma.**In vitro studies indicated that the* *biotransformation of* *citalopram to its demethyl me tabolites depends on both* *CYP2C19 and CYP3A4, with a small contribution from* *CYP2D6. 

**Elimination*
*Half life**:** 35 hours**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.* 



*pharmacodynamics (pharmacological action)
Citalopram is an antidepressant medication that affects neurotransmitters. Citalopram works by preventing the uptake of one neurotransmitter serotonin, by nerve cells after it has been released. Since uptake is an important mechanism for removing released neurotransmitters and terminating their actions on adjacent nerves, the reduced uptake caused by citalopram results in more free serotonin in the brain to stimulate nerve cells. Citalopram is in the class of drugs called selective serotonin reuptake inhibitors (SSRIs), a class that also contains fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft). 


· clinical uses (indications)

#اكتر استعمال لل Citalopram انها مضاد للاكتئاب 

Citalopram is primarily used to treat the symptoms of 
depression

social anxiety disorder, panic disorder or obsessive-
compulsive disorder. 

Also prescribed in Huntington's disease and premenstrual dysphoric disorder.

Citalopram has been found to significantly reduce the symptoms of diabetic neuropathy,

and premature ejaculation. 

dose & regimen
The usual starting dose is 20 mg in the morning or evening. The dose may be increased to 40 mg daily after one week.
A dose of 60 mg has not been shown to be more effective than 40 mg.
As with all antidepressants, it may take several weeks of treatment before maximum effects are seen.
Doses are often slowly adjusted upwards to find the most effective dose. 
citalopram exhibits linear pharmacokinetics and minimal drug interaction potential, making it a better choice for the elderly or comorbid patients.
side effects
fatigue, drowsiness, dry mouth, increased sweating (hyperhidrosis), trembling, headache, dizziness, sleep disturbances, insomnia, cardiac arrhythmia, blood pressure changes, nausea and/or vomiting, diarrhea, heightened anorgasmia in females, impotence and ejaculatory problems in males. In rare cases (around over 1% of cases), some allergic reactions, convulsions, mood changes, anxiety and confusion have been reported. 
Also sedation may be present during treatment of citalopram. If this occurs it is advisable to take the dose at bedtime instead of in the morning.
Another uncommon side effect is bruxism (teeth grinding). When patients start using citalopram they may experience a feeling similar to electricity or minor shocks in their upper body and in their hands. This is caused by the chemical changes occurring in the brain and they pass with time. Occasionally, panic attacks, thoughts of suicide or self-injury may occur or increase in the first few weeks, before the antidepressant effect starts. Citalopram and other SSRIs have been shown to cause sexual side effects in some patients, both males and females. Although usually reversible, these sexual side effects can sometimes last for months, years or possibly indefinitely even after the drug has been completely withdrawn. This disorder is known as Post SSRI Sexual Dysfunction.

Dose Dependency of Adverse Events: The potential relationship between the dose of citalopram and the incidence of an adverse event The incidence of insomnia, increased sweating, and fatigue was dose-related. 
*




*contraindications
Citalopram is contraindicated in individuals taking MAOIs. It is considered relatively safe in overdose, although fatal cases of dosages 840 mg to 1960 mg have been reported. 

interactions
Monoamine Oxidase Inhibitors (MAOI) For interactions between citalopram and MAOI,. 


Metoprolol
Coadministration of citalopram (40 mg/day for 22 days) and the b-adrenergic backing agent metoprolol (single dose of 150 mg), resulted in a two-fold increase in the plasma levels of metoprolol. However, the effect of metoprolol on blood pressure and heart rate was not affected. 


Warfarin Administration of citalopram (40 mg day for 21 days), did not affect either the pharmacokinetics or the pharmacodynamics (prothrombin time) of a single, 1 mg dose of warfarin. 

Digoxin Administration of citalopram (40 mg/day for 21 days) did not affect the pharmacokinetics of digoxin (single dose of 1 mg), although the serum levels of citalopram were slightly lower in the presence of digoxin. 

Imipramine Coadministnation of citalopram (40 mg/day for 10 days) and the tricyclic antidepressant, imipramine (single dose of 100 mg), did not affect the pharmacokinetics of either drug. However, in the presence of citalopram, the concentration of desipramine, the me tabolite of imipramine, increased by approximately 50% and its half-life was prolonged. The results indicate that citalopram does not interfere with the demethylation of imipramine to desipramine but does inhibit the me tabolism of desipramine to its 2-hydroxy me tabolite. Consequently, concomitant treatment with citalopram and imipramine/ desipramine should be undertaken with caution.

Levomepromazme Coadministration of citalopram (40 mg/day for 10 days) and levomepromazine (single dose of 50 mg), did not affect the pharmacokinetics of either drug. 

Lithium Coadministration of citalopram (40 mg/day for 10 days) and lithium (30 mmol/day for 5 days), did not affect the pharmacokinetics of either drug. However, since lithium may increase serotonergic neurotransmission, concomitant treatment with these two drugs should be undertaken with caution.

Cimetidine Citalopram 40 mg/day was administered for 29 days. During the last 8 days of treatment, cimetidine (400 mg bid) was added to the treatment regimen. In the presence of cimetidine, a potent inhibitor of hepatic cytochrome P450 enzymes, the Cmax and AUC of citalopram was increased by 39% and 41%, respectively. Thus, caution should be exercised at the upper end of the dose range of citalopram when it is used concomitantly with high doses of cimetidine. 


Carbamazepine
Carbamazepine, titrated to 400 mg day, was given for 21 days alone and then in combination with citalopram (40 mg day) for an additional 14 days, citalopram did not affect the plasma levels of either carbamazepine, a CYP3A4 substrate, or its me tabolite, carbamazepine-epoxide, However, since carbamazepine is a microsomal enzyme inducer, the possibility that carbamazepine may increase the clearance of citalopram should be considered if the two drugs are given concomitantly. 


Cytochrome P450 Isozymes
Using in vitro models of human liver microsomes, the biotransformation of citalopram to its demethyl me tabolites was shown to depend on both CYP2C19 and CYP3A4, with a small contribution from CYP2D6. Studies have also indicated that citalopram is a weak inhibitor of CYP2D6 and CYP2C19 and a weak or negligible inhibitor of CYP3A4 and CYP1A2. As data are not available from clinical pharmacokinetic studies, the possibility that the clearance of citalopram will be decreased when citalopram is administered with a potent inhibitor of CYP3A4 (e.g., ketoconazole, itraconazole, fluconazole or erythromycin), or a potent inhibitor of CYP2C19 (e.g., omeprazole), should be considered. 


Alcohol Although citalopram did not potentiate the cognitive and psychomotor effects of alcohol in volunteers, the concomitant use of alcohol and citalopram should be avoided. 


Other Drugs
citalopram has been given concomitantly with benzodiazepines (anxiolytics/hypnotics), analgesics (NSAIDs, nonNSAIDs), lithium, antihistamines, antihyperensives or other cardiovascular drugs.* 





*precautions*
*Suicide*
*The possibility of a suicide attempt is inherent in depression and may persist until remission occurs. &In order to minimize the opportunity for overdosage, presc ription for citalopram should be written for the smallest quantity of drug consistent with good patient management.* 
*Activation of Mania/Hypomania*
*If a patient enters a manic phase, citalopram should be discontinued.* 
*Seizures*
*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.* 
*5HT1 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-HT1 agonist. Such interaction should be considered if citalopram is to be used in combination with a 5-HT1 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*
*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 .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 should be observed when citalopram is initiated in patients with pre-existing slow heart rate.* 
*Use in Diabetic Patients*
*Citalopram should be used with caution in diabetic patients on insulin or other antidiabetic drugs.* 
*Interference with Cognitive and Motor Performance:** 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.* 
*Other notes* 
*Patient tips**Therapeutic response may be delayed until several weeks of treatment. Caution re dizziness (NB driving). Avoid alcohol.* 
*Weight Changes*
*Patients treated with citalopram in controlled trials experienced a weight loss of about 0.5 kg compared to no change for placebo patients.* 
*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. 

**Discontinuation of Citalopram Treatment*
*Since some patients may experience discontinuation symptoms when citalopram is stopped abruptly the dose of citalopram should be tapered off over 1 to 2 weeks.

**Symptoms and Treatment of Overdosage*
*Citalopram hydrobromide has a wide margin of safety in overdose. Cases of overdoses involved the ingestion of citalopram either alone or in combination with other drugs and/or alcohol. In clinical trials, with overdoses of citalopram ranging from 180 mg to 2000 mg, all patients recovered. One patient, ingesting over 1500 mg citalopram, had reversible ECG abnormalities, the most important of which was prolongation of QTc.* 
*à**Symptoms most often accompanying citalopram overdose included dizziness, sweating, nausea, vomiting, tremor, and somnolence. In more rare cases, observed symptoms included confusion, loss of consciousness, convulsions, coma, sinus tachycardia, cyanosis, hyperventilation and rhabdomyolysis*

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## mohammad qasaimeh

شكرا لمسة شقاوة لمواضيعك الطبية الحلوة 

وبصراحة الله يعينكم انتو الصيدلة كل حياتكو فارما

ازنخ مادة بالتاريخ  :Eh S(2):

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## لمسة شقاوة

اقتباس:
المشاركة الأصلية كتبت بواسطة mohammad qasaimeh  
_شكرا لمسة شقاوة لمواضيعك الطبية الحلوة 

وبصراحة الله يعينكم انتو الصيدلة كل حياتكو فارما 
ازنخ مادة بالتاريخ_ 





 :Db465236ff:  :Db465236ff:  :Db465236ff:  بس صدقني قد ما كانت موادنا زنخه مو اكتر من موادكم . :SnipeR (62): .احنا مضلومين واخر شي بيجي حد بيستكتر علينا كلمه دكتور او دكتوره  للصيدله  ... :Eh S(2): 

وبدنا يفتتحولنا قسم  في المنتدى لطلاب الطب والصيدله ولا الهندسه احسن منا

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## mohammad qasaimeh

اقتباس:
المشاركة الأصلية كتبت بواسطة لمسة شقاوة  
_اقتباس:
المشاركة الأصلية كتبت بواسطة mohammad qasaimeh  
شكرا لمسة شقاوة لمواضيعك الطبية الحلوة  

وبصراحة الله يعينكم انتو الصيدلة كل حياتكو فارما 
ازنخ مادة بالتاريخ  





 بس صدقني قد ما كانت موادنا زنخه مو اكتر من موادكم ..احنا مضلومين واخر شي بيجي حد بيستكتر علينا كلمه دكتور او دكتوره للصيدله ... 
وبدنا يفتتحولنا قسم في المنتدى لطلاب الطب والصيدله ولا الهندسه احسن منا 

_



لا والله بتستاهلو .. انا شفت بعيني الفارما مادة كثير صعبة و دسمة   :Eh S(2):  .. امتحاني الجاي فارما  :Cry2: 

طبعا لازمنا منتدى يهتم بالمواد الطبية والصيدلانية .. واذا ما في غير انا وانتي بعملولنا منتدى لحالنا ولو منكفي و منزيد  :Db465236ff: 

انا من زمان كانت عندي هالفكره وعندي كثير مراجع و كتب ممكن ارفعها على المنتدى بس كنت لحالي .. الان انتي معي .. ان شاء الله منرفع الاقتراح للادارة و بصير خير  :SnipeR (62):

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## لمسة شقاوة

اقتباس:
المشاركة الأصلية كتبت بواسطة mohammad qasaimeh  
_اقتباس:
المشاركة الأصلية كتبت بواسطة لمسة شقاوة  
اقتباس:
المشاركة الأصلية كتبت بواسطة mohammad qasaimeh  
شكرا لمسة شقاوة لمواضيعك الطبية الحلوة  

وبصراحة الله يعينكم انتو الصيدلة كل حياتكو فارما 
ازنخ مادة بالتاريخ  





 بس صدقني قد ما كانت موادنا زنخه مو اكتر من موادكم ..احنا مضلومين واخر شي بيجي حد بيستكتر علينا كلمه دكتور او دكتوره للصيدله ... 
وبدنا يفتتحولنا قسم في المنتدى لطلاب الطب والصيدله ولا الهندسه احسن منا 





لا والله بتستاهلو .. انا شفت بعيني الفارما مادة كثير صعبة و دسمة  .. امتحاني الجاي فارما  
طبعا لازمنا منتدى يهتم بالمواد الطبية والصيدلانية .. واذا ما في غير انا وانتي بعملولنا منتدى لحالنا ولو منكفي و منزيد  
انا من زمان كانت عندي هالفكره وعندي كثير مراجع و كتب ممكن ارفعها على المنتدى بس كنت لحالي .. الان انتي معي .. ان شاء الله منرفع الاقتراح للادارة و بصير خير_ 


  :Db465236ff:  :Db465236ff:  :Db465236ff:   اكيد بنكفي وبنزيد ..وانا رح ادعو صاحباتي على المنتدى خاصه لو كان فيه قسم للصيدله والطب ...وانا كمان عندي كتير كتب وبحوث وامتحانات وكتير بنكون بحاجه اجابه على سؤال هيك كلنا بنتعاون ...لو  بدك اي مساعده بامتحانك ..انا جاهزه ..فارما بالنسبه النا متل جدول الضرب صارت :Cry2:  :Cry2:  :Cry2:  ويا ريت لو الاداره توافق ..وموفق بامتحانك ... :Smile:  :Smile:

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## mohammad qasaimeh

> اكيد بنكفي وبنزيد ..وانا رح ادعو صاحباتي على المنتدى خاصه لو كان فيه قسم للصيدله والطب ...وانا كمان عندي كتير كتب وبحوث وامتحانات وكتير بنكون بحاجه اجابه على سؤال هيك كلنا بنتعاون ...لو بدك اي مساعده بامتحانك ..انا جاهزه ..فارما بالنسبه النا متل جدول الضرب صارت ويا ريت لو الاداره توافق ..وموفق بامتحانك ...


شكرا ما بتقصري ، ما تخافي قطعت المادة ذهابا وايابا ستين مره  :Db465236ff: 
وانتي دائما اذا عندك اي سؤال باي موضوع انا جاهز باي وقت .. لازم نتعاون لانه ما حد بحس بالمصيبة الا اللي واقع فيها  :Db465236ff:

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## لمسة شقاوة

اقتباس:
المشاركة الأصلية كتبت بواسطة mohammad qasaimeh  
_شكرا ما بتقصري ، ما تخافي قطعت المادة ذهابا وايابا ستين مره 

وانتي دائما اذا عندك اي سؤال باي موضوع انا جاهز باي وقت .. لازم نتعاون لانه ما حد بحس بالمصيبة الا اللي واقع فيها_ 


 :Db465236ff:  :Db465236ff:  :Db465236ff:  :Db465236ff: 

اوك وانا جاهزه ..وعم جهزلك بهديه :SnipeR (51):  :SnipeR (51):

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