Generic Citalopram (Citalopram hydrobromide)

Introduction

Citalopram is a selective serotonin reuptake inhibitor (SSRI) prescribed primarily for the treatment of major depressive disorder (MDD). The medication contains the active compound citalopram hydrobromide and is supplied as oral tablets in strengths of 10 mg and 20 mg. It belongs to the antidepressant class of drugs and is marketed under brand names such as Celexa and Cipram. In addition to its approved indication for depression, citalopram is also authorized for certain anxiety disorders, and clinicians sometimes consider it for off-label uses after careful risk-benefit assessment.

What is Citalopram?

Citalopram is a synthetic, racemic SSRI that increases serotonin availability in the central nervous system by blocking its reuptake into presynaptic neurons. The drug was first synthesized in the s by Lundbeck and received FDA approval in 1998. It is manufactured by several pharmaceutical companies worldwide; the generic formulation contains citalopram hydrobromide as the sole active ingredient, while brand-name versions such as Celexa are marketed by the original developer.

The medication is provided as a film-coated tablet intended for oral administration once daily, with the two available strengths (10 mg and 20 mg) allowing flexible titration.

How Citalopram Works

Citalopram binds to the serotonin transporter (SERT) located on the presynaptic neuronal membrane. By inhibiting SERT, the drug reduces the reabsorption of serotonin (5-HT) from the synaptic cleft, leading to increased extracellular serotonin concentrations. Elevated serotonin enhances neurotransmission in pathways implicated in mood regulation, anxiety control, and cognition.

Therapeutic effects typically emerge after 2-4 weeks of continuous dosing, reflecting the time needed for downstream neuroplastic changes. The drug has a half-life of approximately 35 hours in healthy adults, allowing once-daily dosing. Metabolism occurs primarily via the hepatic cytochrome P450 enzyme CYP2C19, with minor contributions from CYP3A4 and CYP2D6. Clearance is reduced in the elderly and in patients with hepatic impairment, necessitating dose adjustments.

Conditions Treated with Citalopram

• Major Depressive Disorder (MDD): Citalopram restores serotonergic tone, alleviating depressive symptoms such as low mood, anhedonia, and impaired concentration. Clinical trials demonstrate response rates comparable to other SSRIs with a favorable tolerability profile.
• Generalized Anxiety Disorder (GAD): By enhancing serotonergic neurotransmission, citalopram reduces excessive worry and physical anxiety symptoms. It is approved for GAD in several jurisdictions, including the European Union.
• Panic Disorder: The medication mitigates panic attacks and anticipatory anxiety, likely through modulation of fear circuits mediated by serotonin.

These indications are supported by extensive regulatory review (FDA, EMA) and are reflected in the drug’s prescribing information.

Off-Label and Investigational Uses of Citalopram

• Premenstrual Dysphoric Disorder (PMDD): Small-scale studies suggest that citalopram may lessen mood swings and irritability associated with PMDD. The evidence is limited, and regulatory approval is absent.
• Obsessive-Compulsive Disorder (OCD): Though higher-dose SSRIs are the first-line treatment, some clinicians prescribe citalopram off-label for mild-to-moderate OCD when patients cannot tolerate other agents.
• Chronic Pain Syndromes: Research indicates that serotonergic modulation can influence pain perception; citalopram has been examined as an adjunct in neuropathic pain, but results are inconclusive.

All off-label applications should be undertaken only under the direct supervision of a qualified healthcare professional, as safety and efficacy have not been formally established by regulatory agencies.

Is Citalopram the Right Medication for You?

Citalopram is generally appropriate for adults with a confirmed diagnosis of MDD, GAD, or panic disorder who have not responded to non-pharmacologic interventions or who require pharmacotherapy. It is especially useful in patients who prefer a once-daily regimen and who have a history of tolerating SSRIs without severe adverse reactions.

Contraindications include hypersensitivity to citalopram or any component of the tablet, concurrent use of monoamine oxidase inhibitors (MAOIs), and known congenital long QT syndrome. Caution is advised in individuals with cardiac arrhythmias, severe hepatic impairment, or a history of bipolar disorder, as SSRI therapy may precipitate mood switching.

Pregnant or breastfeeding women should discuss potential risks, as limited data suggest possible neonatal adaptation syndrome. Elderly patients often require a reduced starting dose (e.g., 10 mg once daily) because of slower drug clearance.

Risks, Side Effects, and Interactions

Common

• Nausea
• Insomnia or somnolence
• Dry mouth
• Increased sweating
• Sexual dysfunction (decreased libido, delayed ejaculation, anorgasmia)

These effects usually appear within the first two weeks and often improve with continued treatment.

Rare

• Hyponatremia (particularly in older adults)
• Weight loss or gain
• Abnormal dreams

Routine monitoring of electrolytes is advisable for patients at risk of hyponatremia.

Serious

• QT prolongation and cardiac arrhythmias: The risk rises with doses >20 mg/day, electrolyte disturbances, or concomitant QT-prolonging drugs.
• Serotonin syndrome: Occurs when combined with other serotonergic agents (e.g., serotonergic analgesics, triptans, MAOIs).
• Suicidal ideation: As with all antidepressants, increased risk in individuals under 25 during early treatment.

Drug-Drug Interactions

• CYP2C19 inhibitors (e.g., fluoxetine, omeprazole) can increase citalopram plasma levels.
• CYP3A4 inducers (e.g., carbamazepine, rifampin) may reduce efficacy.
• Anticoagulants (e.g., warfarin) may experience altered INR; regular monitoring is recommended.

Drug-Food Interactions

• Grapefruit juice can modestly elevate citalopram concentrations via CYP3A4 inhibition; consumption should be limited.

Patients should avoid alcohol, as it can intensify sedation and impair judgment, especially when initiating therapy.

Use: Dosing, Missed Dose, Overdose

Standard Dosing

• Initiation: 10 mg orally once daily, preferably in the morning to reduce insomnia.
• Titration: After 7 days, the dose may be increased to 20 mg once daily based on clinical response and tolerability.
• Maximum recommended dose: 20 mg/day for most adults; in patients older than 60 years or those with known cardiac risk, the ceiling is 20 mg/day, and many clinicians limit to 10 mg/day.

Missed Dose If a dose is missed and the next scheduled dose is more than 12 hours away, take the missed tablet as soon as remembered. If the time for the next dose is near, skip the missed dose and resume the regular schedule. Do not double-dose to compensate.

Overdose Symptoms of citalopram overdose may include dizziness, tremor, nausea, vomiting, and cardiac arrhythmias. Immediate medical attention is essential. Activated charcoal may be administered if presentation is within one hour of ingestion. Supportive care, cardiac monitoring, and correction of electrolyte abnormalities are standard management steps.

Practical Precautions

• Take with or without food; a consistent routine enhances compliance.
• Avoid operating heavy machinery or driving until you know how citalopram affects you, especially during dose adjustments.
• Do not combine with over-the-counter cold remedies containing dextromethorphan without professional advice.

FAQ

• What should I know about traveling with citalopram?

  • Carry the medication in its original labeled container and keep it in your carry-on luggage to avoid temperature extremes.
  • Bring a copy of the prescribing information or a letter from a healthcare provider in case customs officials request documentation.

• Can citalopram cause weight changes?

  • Some patients experience mild weight loss initially, while others may gain weight after several months of stable dosing.
  • Monitoring diet and physical activity can help manage any unwanted changes.

• What do the tablets look like?

  • The 10 mg tablet is typically a small, round, white or off-white film-coated pill; the 20 mg tablet is often a larger, round, white tablet with a score line for splitting.

• Are there inactive ingredients that might trigger allergies?

  • Common excipients include lactose, microcrystalline cellulose, and magnesium stearate.
  • Patients with lactose intolerance or known hypersensitivity should verify the full ingredient list with the manufacturer.

• How long does it take for citalopram to leave my system?

  • With a half-life of about 35 hours, it generally requires 5-7 days for the drug to be eliminated after the final dose, though metabolites may persist slightly longer.

• Will citalopram show up on a standard drug test?

  • Citalopram is not routinely screened for in employment or legal drug testing panels.
  • Specialized assays can detect it, but such testing is uncommon.

• Is it safe to use herbal supplements like St. John’s wort with citalopram?

  • St. John’s wort induces CYP3A4 and can lower citalopram levels, potentially reducing efficacy.
  • Moreover, the combination raises the risk of serotonin syndrome; consultation with a clinician is essential before co-administration.

• How does citalopram compare to older antidepressants such as tricyclics?

  • SSRIs, including citalopram, have a more favorable side-effect profile, especially regarding anticholinergic effects, orthostatic hypotension, and cardiotoxicity seen with tricyclic antidepressants.
  • However, tricyclics may be more effective for certain pain syndromes, so treatment choice depends on individual clinical context.

• What storage conditions are recommended for citalopram tablets?

  • Store at room temperature (15 °C-30 °C), away from excess moisture and direct sunlight.
  • Do not refrigerate or freeze; a stable climate prolongs shelf life and maintains tablet integrity.

• Can I switch from another SSRI to citalopram safely?

  • Cross-tapering is often employed: gradually decrease the dose of the current SSRI while initiating citalopram at a low dose, minimizing withdrawal and serotonin excess.
  • The exact schedule should be individualized by a healthcare professional.

• Does citalopram affect hormone-based contraceptives?

  • No clinically significant interaction has been identified between citalopram and oral contraceptives.
  • Nonetheless, maintaining consistent contraceptive use is advisable, as mood fluctuations can influence adherence.

Glossary

Selective Serotonin Reuptake Inhibitor (SSRI)

A class of antidepressants that block the reabsorption of serotonin into neurons, increasing its availability in the brain.

QT Interval

A measurement on an electrocardiogram that reflects the time taken for ventricular depolarization and repolarization; prolongation can predispose to dangerous heart rhythms.

Serotonin Syndrome

A potentially life-threatening condition caused by excessive serotonergic activity, characterized by agitation, hyperthermia, tremor, and autonomic instability.

Cytochrome P450 (CYP) Enzymes

A family of liver enzymes that metabolize many drugs; variations in CYP activity can alter drug concentrations and impact safety.

Buying Citalopram from Our Online pharmacy

Citalopram is available for purchase through our online pharmacy, offering a discreet and reliable way to access the medication when local options are limited or cost-prohibitive.

• Affordability: Prices are set near manufacturer cost, providing a cost-effective alternative to brand-name prescriptions.
• Verified Quality: All tablets are sourced from licensed, internationally accredited suppliers who adhere to strict Good Manufacturing Practice (GMP) standards.
• Discreet Delivery: Packages are shipped in unmarked packaging, with delivery options ranging from express (approximately 7 days) to standard airmail (about 3 weeks).
• Global Access: As a pharmacy broker service, we collaborate with overseas licensed pharmacies, enabling patients worldwide to obtain citalopram where it may not be locally stocked.

Our service emphasizes privacy, safety, and convenience, ensuring that patients can obtain their medication without compromising confidentiality or incurring unnecessary expense.

Disclaimer

The information presented about citalopram is intended for general educational purposes and does not replace professional medical advice. Treatment decisions, including those concerning any off-label use, must be made under the direction of a qualified healthcare professional. Readers are presumed to be competent adults capable of making informed health choices. Our online pharmacy provides a pathway to obtain citalopram for individuals who encounter limited access through conventional pharmacies or whose insurance coverage restricts availability, particularly when seeking generic alternatives. Always seek a qualified clinician’s guidance before initiating, adjusting, or discontinuing any medication.