Citalopram Hydrobromide

Class: Selective Serotonin-reuptake Inhibitors
VA Class: CN609
Chemical Name: 1-[3-(Dimethylamino)-propyl]-1-(p-fluorophenyl)-5-phthalancarbonitrile
Molecular Formula: C₂₀H₂₁FN₂O
CAS Number: 59729-33-8
Brands: Celexa

Special Alerts:

[Posted 08/24/2011] ISSUE: FDA notified healthcare professionals and patients that the antidepressant citalopram hydrobromide (Celexa) should no longer be used at doses greater than 40 mg per day because it can cause abnormal changes in the electrical activity of the heart. Changes in the electrical activity of the heart (prolongation of the QT interval of the electrocardiogram [ECG]) can lead to an abnormal heart rhythm (including Torsade de Pointes), which can be fatal. Patients at particular risk for developing prolongation of the QT interval include those with underlying heart conditions and those who are predisposed to low levels of potassium and magnesium in the blood.

Studies did not show a benefit in the treatment of depression at doses higher than 40 mg per day. Previously, the citalopram drug label stated that certain patients may require a dose of 60 mg per day. The citalopram drug label has been revised to include the new drug dosage and usage recommendations, as well as information about the potential for QT interval prolongation and Torsade de Pointes. See the FDA Drug Safety Communication Data Summary at: for additional information.

BACKGROUND: Citalopram hydrobromide (Celexa) is in a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs).

RECOMMENDATION: Citalopram causes dose-dependent QT interval prolongation. Citalopram should no longer be prescribed at doses greater than 40 mg per day. Citalopram should not be used in patients with congenital long QT syndrome. Patients with congestive heart failure, bradyarrhythmias, or predisposition to hypokalemia or hypomagnesemia because of concomitant illness or drugs, are at higher risk of developing Torsade de Pointes. See the FDA Drug Safety Communication for additional recommendations for healthcare professionals and patients. For more information visit the FDA website at: and .

• Suicidality


• 
  

  Antidepressants may increase risk of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults (18–24 years of age) with major depressive disorder and other psychiatric disorders; balance this risk with clinical need.^{d e} Citalopram is not approved for use in pediatric patients.¹ (See Pediatric Use under Cautions.)

  
  


• 
  

  In pooled data analyses, risk of suicidality was not increased in adults >24 years of age and apparently was reduced in adults ≥65 years of age with antidepressants compared with placebo.^{d e}

  
  


• 
  

  Depression and certain other psychiatric disorders are themselves associated with an increased risk of suicide.^{d e f}

  
  


• 
  

  Appropiately monitor and closely observe all patients who are started on citalopram therapy for clinical worsening, suicidality, or unusual changes in behavior; involve family members and/or caregivers in this process.^{d e f} (See Worsening of Depression and Suicidality Risk under Cautions.)

  
  

Introduction

Antidepressant; selective serotonin-reuptake inhibitor (SSRI).¹

Uses for Citalopram Hydrobromide

Pending revision, the material in this section should be considered in light of more recently available information in the MedWatch notification at the beginning of this monograph.

Major Depressive Disorder

Management of major depressive disorder.¹

Efficacy in hospital settings not established.¹

Obsessive-Compulsive Disorder

Has been used in the management of obsessive-compulsive disorder†.^{172 173 174 175 176 183 184 186}

Panic Disorder

Has been used in the management of panic disorder† with or without agoraphobia†.^{28 29 174 189 288 289}

Social Phobia

Has been used in the management of social phobia† (social anxiety disorder).^{350 351 352 353 354 355}

Alcohol Dependence

Has been used in the management of alcohol dependence†.^{40 42 43 44 45 46 47}

Premature Ejaculation

Has been used for the management of premature ejaculation†.²⁷³

May be less effective than some other SSRIs (e.g., paroxetine).²⁷³

Eating Disorders

Has been used in the management of bulimia nervosa† or anorexia nervosa† with equivocal efficacy.^{15 16}

Diabetic Neuropathy

Has been used in the management of diabetic neuropathy†.^{279 280}

Posttraumatic Stress Disorder

Has been used in a limited number of adults with civilian- or combat-related posttraumatic stress disorder† (PTSD).^{281 282}

Citalopram Hydrobromide Dosage and Administration

General

• 
  

  Allow at least 2 weeks to elapse between discontinuance of an MAO inhibitor and initiation of citalopram, and vice versa.¹

  
  


• 
  

  Monitor for possible worsening of depression, suicidality, or unusual changes in behavior, especially at the beginning of therapy or during periods of dosage adjustments.^{d e f} (See Worsening of Depression and Suicidality Risk under Cautions.)

  
  


• 
  

  Sustained therapy may be required; monitor periodically for need for continued therapy.¹

  
  


• 
  

  Avoid abrupt discontinuance of therapy.^{1 13 14 17} To avoid withdrawal reactions, taper dosage gradually.^{13 14 17} (See Worsening of Depression and Suicidality Risk and also see Withdrawal of Therapy under Cautions.)

  
  


• 
  

  Consider cautiously tapering dosage during third trimester of pregnancy prior to delivery.^{1 212 213 382 383} (See Fetal/Neonatal Morbidity and Mortality under Cautions.)

  
  

Administration

Oral Administration

Administer orally once daily (morning or evening) without regard to meals.¹

Dosage

Pending revision, the material in this section should be considered in light of more recently available information in the MedWatch notification at the beginning of this monograph.

Available as citalopram hydrobromide; dosages expressed in terms of citalopram.¹

Adults

Major Depressive Disorder

Oral

Initially, 20 mg once daily.¹ If no clinical improvement is apparent, increase in 20-mg increments at intervals of ≥1 week.¹

Optimum duration not established; may require several months of therapy or longer.^{1 13 107 108 109 110 111 112 113 187}

Obsessive-Compulsive Disorder†

Oral

Initially, 20 mg once daily.^{172 173 174 183} Gradually increase dosage according to clinical response.^{172 173 174 183}

Usual maintenance dosage: 40–60 mg daily.^{21 172 173 174 183}

Panic Disorder†

Oral

Usual initial dosage: 10 mg daily.¹⁷⁴ Increase dosage after ≥1 week in 10- or 20-mg increments up to a dosage of 20–60 mg daily, depending on individual patient response and tolerability.^{28 29 174 288 289}

Usual maintenance dosage: 20–30 mg daily.^{28 29 289}

Prescribing Limits

Adults

Pending revision, the material in this section should be considered in light of more recently available information in the MedWatch notification at the beginning of this monograph.

Major Depressive Disorder

Oral

Maximum of 40 mg daily usually recommended; some patients may require up to 60 mg daily.¹

Obsessive-Compulsive Disorder†

Maximum 60 mg daily.^{21 172 173 174 183}

Panic Disorder†

Maximum 60 mg daily.^{28 29 174 288 289}

Special Populations

Hepatic Impairment

Major Depressive Disorder

Oral

Initially, 20 mg once daily; titrate to 40 mg once daily only in nonresponders.¹

Renal Impairment

Major Depressive Disorder

Oral

No dosage adjustment necessary in patients with mild to moderate renal impairment.¹ Dosage adjustment may not be necessary in patients with severe renal impairment, but caution is recommended.^{1 88} (See Elimination: Special Populations, under Pharmacokinetics.)

Geriatric Patients

Initially, 20 mg once daily; titrate to 40 mg once daily only in nonresponders.¹

Cautions for Citalopram Hydrobromide

Contraindications

• 
  

  Concurrent or recent (i.e., within 2 weeks) therapy with an MAO inhibitor.¹ (See MAO Inhibitors under Cautions and see Interactions.)

  
  


• 
  

  Concurrent pimozide therapy.¹ (See Interactions.)

  
  


• 
  

  Known hypersensitivity to citalopram, escitalopram, or any ingredient in the formulation.^{1 c}

  
  

Warnings/Precautions

Warnings

Pending revision, the material in this section should be considered in light of more recently available information in the MedWatch notification at the beginning of this monograph.

MAO Inhibitors

Concomitant use with MAO inhibitors associated with serious, sometimes fatal reactions, including manifestations resembling serotonin syndrome (e.g., hyperthermia, rigidity, myoclonus, autonomic instability, mental status changes) or neuroleptic malignant syndrome.^{1 316 317} (See Serotonin Syndrome under Cautions and also see Interactions.)

Serotonin Syndrome

Potentially life-threatening serotonin syndrome reported during concurrent therapy with SSRIs or selective serotonin- and norepinephrine-reuptake inhibitors (SNRIs) and other serotonergic drugs (e.g., 5-HT₁ receptor agonists [“triptans”]) or drugs that impair serotonin metabolism (e.g., MAO inhibitors).^{1 316 317 386} Symptoms may include mental status changes (e.g., agitation, hallucinations, coma), autonomic instability (e.g., tachycardia, labile BP, hyperthermia), neuromuscular aberrations (e.g., hyperreflexia, incoordination), and/or GI symptoms (e.g., nausea, vomiting, diarrhea).^{1 316 317 386} (See Interactions.)

Worsening of Depression and Suicidality Risk

Possible worsening of depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior in both adult and pediatric patients with major depressive disorder, whether or not they are taking antidepressants; may persist until clinically important remission occurs.^{d e f g} However, suicide is a known risk of depression and certain other psychiatric disorders, and these disorders themselves are the strongest predictors of suicide.^{d e f}

Appropiately monitor and closely observe patients receiving citalopram for any reason, particularly during initiation of therapy (i.e., the first few months) and during periods of dosage adjustments.^{d e f} (See Boxed Warning and also see Pediatric Use under Cautions.)

Anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia, hypomania, and/or mania may be precursors to emerging suicidality.^{e f} Consider changing or discontinuing therapy in patients whose depression is persistently worse or in those with emerging suicidality or symptoms that might be precursors to worsening depression or suicidality, particularly if severe, abrupt in onset, or not part of patient's presenting symptoms.^{d e f} If decision is made to discontinue therapy, taper citalopram dosage as rapidly as is feasible but consider risks of abrupt discontinuance.^{1 e} (See General under Dosage and Administration.)

Prescribe in smallest quantity consistent with good patient management to reduce risk of overdosage.^{1 e}

Observe these precautions for patients with psychiatric (e.g., major depressive disorder, obsessive-compulsive disorder) or nonpsychiatric disorders.^{1 e}

Bipolar Disorder

May unmask bipolar disorder.^{1 e} (See Activation of Mania or Hypomania under Cautions.) Citalopram is not approved for use in treating bipolar depression.¹

Screen for risk of bipolar disorder by obtaining detailed psychiatric history (e.g., family history of suicide, bipolar disorder, depression) prior to initiating therapy.^{1 e}

Fetal/Neonatal Morbidity and Mortality

Possible complications, sometimes severe and requiring prolonged hospitalization, respiratory support, enteral nutrition, and other forms of supportive care reported in neonates exposed to citalopram, other SSRIs, or SNRIs late in the third trimester; may arise immediately upon delivery.^{1 212 213 380 381 382 383 c}

Increased risk of persistent pulmonary hypertension of the newborn (PPHN) in infants exposed to SSRIs during late pregnancy; PPHN is associated with substantial neonatal morbidity and mortality.^{1 387 388}

Carefully consider potential risks and benefits of treatment when used during third trimester of pregnancy.^{1 381 382 383 c} Consider cautiously tapering dosage during third trimester prior to delivery.^{1 212 213 382 383} (See Pregnancy under Cautions.)

Sensitivity Reactions

Hypersensitivity Reactions

Possible anaphylaxis, allergic reactions, and angioedema.¹

If hypersensitivity reaction occurs, discontinue immediately and institute appropriate therapy as indicated.¹

General Precautions

Withdrawal of Therapy

Possibly severe withdrawal reactions (e.g., dysphoric mood, irritability, agitation, dizziness, sensory disturbances, anxiety, confusion, headache, lethargy, emotional lability, insomnia, hypomania); avoid abrupt discontinuance of therapy.^{1 c} Taper dosage gradually (e.g., over a period of several weeks).^{1 13 14 17 c}

Abnormal Bleeding

Possible increased risk of bleeding, including upper GI bleeding; use with caution.^{1 54 55 205 283 284 285 287 377 c}

Concomitant use of an NSAIA (e.g., aspirin) or warfarin may potentiate such risk.^{1 54 55 377 c} (See Interactions.)

Hyponatremia or SIADH

Possible hyponatremia or SIADH.^{1 8 9 206 207 208 344 363}

Activation of Mania or Hypomania

Possible activation of mania/hypomania; use with caution in patients with a history of mania.^{1 236 237 327} (See Bipolar Disorder under Cautions.)

Seizures

Risk of seizures not systematically evaluated; use with caution in patients with a history of seizures.¹

Cognitive/Physical Impairment

Risk of impaired mental alertness or physical coordination required for performing hazardous tasks (e.g., driving, operating machinery).¹

Concomitant Disease

Limited experience; use with caution in patients with altered metabolism or hemodynamics.¹

Prescribing and Dispensing Precautions

Ensure accuracy of prescription; similarity in spelling of Celexa (citalopram hydrobromide), Celebrex (celecoxib), and Cerebyx (fosphenytoin sodium) may result in errors.³⁴⁶

Electroconvulsive Therapy (ECT)

Effects of concomitant use with ECT have not been systematically evaluated.¹

Specific Populations

Pregnancy

Category C.¹ (See Fetal/Neonatal Morbidity and Mortality under Cautions.)

Increased risk of depression relapse observed in women who discontinued antidepressant therapy during pregnancy compared with those who remained on antidepressant therapy.^{1 387 389}

Lactation

Distributed into milk;^{1 5 6 90 91 92 95 96 362} possible serious adverse reactions (e.g., excessive somnolence, decreased feeding, weight loss) in nursing infants.¹ Discontinue nursing or the drug.¹

Pediatric Use

Safety and efficacy not established in children <18 years of age.¹ Results of 2 placebo-controlled trials in children and adolescents with major depressive disorder did not support a claim of efficacy for use of citalopram in pediatric patients with this condition.^{1 379}

FDA warns that a greater risk of suicidal thinking or behavior (suicidality) occurred during first few months of antidepressant treatment (4%) compared with placebo (2%) in children and adolescents with major depressive disorder, obsessive-compulsive disorder (OCD), or other psychiatric disorders based on pooled analyses of 24 short-term placebo-controlled trials of 9 antidepressant drugs (SSRIs and others).^{1 e} However, a more recent meta-analysis of 27 placebo-controlled trials of 9 antidepressants (SSRIs and others) in patients ≤19 years of age with major depressive disorder, OCD, or non-OCD anxiety disorders suggests that the benefits of antidepressant therapy in treating these conditions may outweigh the risks of suicidal behavior or suicidal ideation.^g No suicides occurred in these pediatric trials.^{1 e g}

Carefully consider these findings when assessing potential benefits and risks of citalopram in a child or adolescent for any clinical use.^{1 d e f g} (See Worsening of Depression and Suicidality Risk under Cautions.)

Geriatric Use

No substantial differences in safety and efficacy relative to younger adults; select dosage with caution.¹ (See Geriatric Patients under Dosage and Administration.)

In pooled data analyses, a reduced risk of suicidality was observed in adults ≥65 years of age with antidepressant therapy compared with placebo.^{d e} (See Boxed Warning and also see Worsening of Depression and Suicidality Risk under Cautions.)

Hepatic Impairment

Systemic exposure to citalopram may be increased.¹ (See Elimination: Special Populations, under Pharmacokinetics.) Use with caution.^{1 4}

Renal Impairment

Use with caution in patients with severe renal impairment.^{1 4} (See Renal Impairment under Dosage and Administration and see Elimination: Special Populations, under Pharmacokinetics.)

Common Adverse Effects

Nausea, dry mouth, insomnia, sweating, sexual dysfunction (ejaculatory disorder, impotence, decreased libido), tremor, diarrhea, somnolence, dyspepsia, fatigue, upper respiratory tract infection, and rhinitis.¹

Interactions for Citalopram Hydrobromide

Extensively metabolized in liver, principally by CYP2C19 and 3A4.¹ Does not inhibit CYP2C9, 2E1, or 3A4 in vitro and exhibits only weak inhibition against CYP1A2, CYP2D6, and CYP2C19.^{1 2 3}

Drugs Affecting Hepatic Microsomal Enzymes

Inhibitors of CYP2C19 or 3A4: clinically important pharmacokinetic interaction unlikely since citalopram is metabolized by multiple enzyme systems.¹

Drugs Metabolized by Hepatic Microsomal Enzymes

Substrates of CYP1A2, CYP2D6, and CYP2C19: citalopram expected to have little in vivo effect on substrate metabolism; however, clinical importance unknown.¹

Drugs Affecting Hemostasis

Potential pharmacologic interaction (increased risk of bleeding) with concomitant use of drugs that affect hemostasis.^{1 54 55 377 c} Use with caution.^{1 c}

Drugs Associated with Serotonin Syndrome

Potential pharmacologic (serotonin syndrome) interaction with serotonergic agents.^{1 205 291 292 293 294 295 296 297 312 314 315 316 317 386} Avoid such use, or use with caution.^{1 299 300 386} (See Serotonin Syndrome under Cautions.)

Specific Drugs

Drug	Interaction	Comment
Alcohol	Did not potentiate cognitive and motor effects of alcohol in one study;1 possible serotonergically-mediated pharmacodynamic interaction in CNS20 34 35 36 37 38 39 40 44 45 46 47	Concomitant use not recommended1
Antidepressants, tricyclics (TCAs) (e.g., desipramine, imipramine)	Possible increased plasma TCA concentrations with TCAs that are substrates of CYP2D61 c	Use with caution1
Carbamazepine	Possible increased citalopram clearance1 336 337 348 349
Cimetidine	Increased citalopram AUC and peak plasma concentrations1 7	Clinical importance unknown1 7
Clozapine	Substantial increases in trough plasma clozapine concentrations reported with concomitant citalopramb	Caution advised; monitor closely and consider reduction in clozapine dosage if used concomitantlyb
CNS drugs	Potentially additive CNS effects1	Use with caution1
Cyclosporine	Pharmacokinetic interaction unlikely326
Digoxin	Pharmacokinetic interaction unlikely1 188
Escitalopram	Therapeutic duplication; escitalopram is the more active isomer of racemic citalopramc	Concomitant use not recommendedc
5-HT1 receptor agonists (“triptans”)	Potentially life-threatening serotonin syndrome1 205 294 304 386	Observe carefully if used concomitantly, particularly during treatment initiation, dosage increases, or when another serotonergic agent is initiated1 386
Isoniazid	Possible serotonin syndrome320
Ketoconazole	Decreased peak plasma concentrations and AUC of ketoconazole1 325
Linezolid	Possible serotonin syndrome1 396	Use with caution1 396
Lithium	Enhanced serotonergic effects of citalopram1 169 Pharmacokinetic interaction unlikely168	Use with caution1 168 Monitor serum lithium concentrations; adjust dosage accordingly1
MAO inhibitors	Possible serotonin or neuroleptic malignant syndrome1 316 317 318 c	Concomitant use contraindicated1 Allow at least 2 weeks to elapse between discontinuance of an MAO inhibitor and initiation of citalopram, or vice versa1
Metoprolol	Increased plasma metoprolol concentrations possibly resulting in decreased cardioselectivity1
NSAIAs (e.g., aspirin)	Increased risk of bleeding1 54 55 377 c	Use with caution1 c
Pimozide	Possible increased risk of QTc interval prolongation1 Pharmacokinetic interactions unlikely1	Concomitant use contraindicated1
Ritonavir	Pharmacokinetic interactions unlikelyc
Selegiline	Possible serotonin syndrome294 296 319	Avoid concomitant use303 319 Allow at least 2 weeks to elapse between discontinuance of selegiline and initiation of citalopram, or vice versa303 319
Sibutramine	Possible serotonin syndrome327 386	Use with caution386
Theophylline	No effects evident on theophylline pharmacokinetics 1 329
Triazolam	Pharmacokinetic interactions unlikely1 316 328
Tryptophan and other serotonin precursors	Possible serotonin syndrome1 205	Concomitant use not recommended1
Warfarin	Possible increased PT and risk of bleeding1 190 c	Use with caution1 c

Citalopram Hydrobromide Pharmacokinetics

Absorption

Bioavailability

Well absorbed following oral administration,^{1 18 62 80 82 97 100 101 339} with peak plasma concentration usually attained within 4 hours.^{1 349}

Absolute oral bioavailability is approximately 80%.^{1 4}

Commercially available tablets and oral solution are bioequivalent.¹

Onset

Antidepressant effect usually occurs within 1–4 weeks.^{1 174}

Food

Food does not affect absorption.¹

Special Populations

In geriatric patients, AUC is increased by 23–30%.^{1 83 85}

Distribution

Extent

Apparently widely distributed in body tissues.^{18 62 80 82 97 339}

Crosses blood-brain barrier.^{62 86 87}

Crosses the placenta.^a

Distributed into breast milk.^{1 5 6}

Plasma Protein Binding

Approximately 80%.^{1 349}

Elimination

Metabolism

Extensively metabolized in the liver to less pharmacologically active metabolites by multiple enzyme systems, including CYP3A4 and CYP2C19.^{1 77 97 278}

Elimination Route

Excreted principally in urine (75%) and feces (10%).¹⁰⁰

Half-life

Approximately 35 hours.⁸³

Special Populations

In geriatric patients, half-life is increased by 30–50%.^{1 83}

Hepatic impairment decreases oral clearance by 37% and doubles half-life.^{1 4}

Mild to moderate renal impairment decreases oral clearance by 17%.¹ Severe renal impairment did not substantially alter pharmacokinetics in one study.⁸⁸

Stability

Storage

Oral

Solution and Tablets

25°C; excursions permitted to 15–30°C.¹

Actions

• 
  

  Racemic (50:50) mixture of the R- and S-enantiomers; inhibition of serotonin (5-HT) reuptake primarily due to the S-enantiomer (escitalopram).^{1 18 20 97}

  
  


• 
  

  Mechanism of action as an antidepressant is presumed to be linked to potentiation of serotonergic activity in the CNS resulting from its inhibition of CNS neuronal reuptake of 5-HT.^{1 20}

  
  


• 
  

  Highly selective SSRI with minimal effects on norepinephrine (NE) and dopamine (DA) neuronal reuptake and no or very low affinity for 5-HT_1A, 5-HT_2A, dopamine D₁ and D₂, α₁-, α₂-, and β-adrenergic, histamine (H₁), gamma aminobutyric acid (GABA), muscarinic cholinergic, and benzodiazepine receptors.^{1 18 20 26 52}

  
  

Advice to Patients

Pending revision, the material in this section should be considered in light of more recently available information in the MedWatch notification at the beginning of this monograph.

• 
  

  Risk of suicidality; importance of patients, caregivers, and families being alert to and immediately reporting emergence of suicidality, worsening depression, or unusual changes in behavior, especially during the first few months of therapy or during periods of dosage adjustment.^{1 d e f} FDA recommends providing written patient information (medication guide) explaining risks of suicidality each time the drug is dispensed.^{d e f}

  
  


• 
  

  Risk of psychomotor impairment; importance of exercising caution while operating hazardous machinery, including automobile driving, until they gain experience with the drug's effects.¹

  
  


• 
  

  Risk of concomitant use with alcohol.¹

  
  


• 
  

  Importance of continuing citalopram therapy even if a response is not evident within 1–4 weeks, unless directed otherwise.¹

  
  


• 
  

  Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.¹

  
  


• 
  

  Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses.¹

  
  


• 
  

  Importance of informing patients of risk of serotonin syndrome with concurrent use of citalopram and 5-HT₁ receptor agonists (“triptans”) or other serotonergic agents.^{1 386} Importance of seeking immediate medical attention if symptoms of serotonin syndrome develop.^{1 386}

  
  


• 
  

  Importance of informing patients of other important precautionary information.¹ (See Cautions.)

  
  

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Citalopram Hydrobromide

Routes	Dosage Forms	Strengths	Brand Names	Manufacturer
Oral	Tablets, film-coated	10 mg (of citalopram)*	Celexa	Forest, (also promoted by Pfizer)
		20 mg (of citalopram)*	Celexa (scored)	Forest, (also promoted by Pfizer)
		40 mg (of citalopram)*	Celexa (scored)	Forest, (also promoted by Pfizer)
	Solution	10 mg (of citalopram) per 5 mL*	Celexa (with parabens and propylene glycol)	Forest, (also promoted by Pfizer)
			Citalopram Hydrobromide Oral Solution (with parabens and propylene glycol)	Apotex, Roxane

Comparative Pricing

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 09/2011. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.

CeleXA 10MG Tablets (FOREST): 30/$110.99 or 90/$309.98

CeleXA 20MG Tablets (FOREST): 30/$120.49 or 90/$345.97

CeleXA 40MG Tablets (FOREST): 30/$124.99 or 90/$354.78

Citalopram Hydrobromide 10MG/5ML Solution (ROXANE): 240/$99.99 or 720/$249.95

Citalopram Hydrobromide 40MG Tablets (AMNEAL PHARMACEUTICALS): 30/$26.99 or 90/$74.97

Disclaimer

This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.

The American Society of Health-System Pharmacists, Inc. and Drugs.com represent that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. and Drugs.com make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. and Drugs.com do not endorse or recommend the use of any drug. The information is not a substitute for medical care.

AHFS Drug Information. © Copyright, 1959-2011, Selected Revisions August 24, 2011. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

1. Forest Pharmaceuticals, Inc. Celexa (citalopram hydrobromide) tablets and oral solution prescribing information. St. Louis, MO; 2006 Sep.

2. Lane RM. Pharmacokinetic drug interaction potential of selective serotonin reuptake inhibitors [published erratum appears in Intl Clin Psychopharmacol. 1997; 12:126]. Intl Clin Psychopharmacol. 1996; 11(Suppl 5):31-61.

3. Caccia S. Metabolism of the newer antidepressants: an overview of the pharmacological and pharmacokinetic implications. Clin Pharmacokinet. 1998; 34:281-302. [PubMed 9571301]

4. Joffe P, Larsen FS, Pedersen V et al. Single-dose pharmacokinetics of citalopram in patients with moderate renal insufficiency or hepatic cirrhosis compared with healthy subjects. Eur J Clin Pharmacol. 1998; 54:237-42. [IDIS 409920] [PubMed