Celexa is a brand name of citalopram hydrobromide which is one of the selective serotonin reuptake inhibitor medications (SSRI), and are commonly prescribed for treatment of depression as well as other mental disorders. Cipramil is another brand name of citalopram hydrobromide. Celexa has been approved by the US Food and Drug Administration (FDA) for treatment of major depressive disorders (mental disorders characterized by depressed mood, loss of pleasure in almost all activities and lasting for more than 2 weeks).
Celexa is available in the forms tablets (10mg, 20 mg and 40 mg) and oral solution (10mg/5ml). For adult patients with major depressive disorders, Celexa should be given at an initial dose of 20 mg orally once daily, with or without food, in the evening or morning. The dose can be increased after 1 week to a maximum dose of 40 mg orally once daily. Celexa dosing should be adjusted in patients with severely impaired liver or kidney functions. Celexa has not been approved for use in children.
Common Celexa side effects are nausea, diarrhea, sweating, dry mouth, anxiety, nervousness, decreased libido (sexual drive) and disorders of ejaculation.
Celexa is commonly used off-label for treatment of:
- Panic disorder (sudden attacks of severe fear)
- Obsessive compulsive disorders (mental disorder characterized by obsessive thoughts and compulsive actions)
- Premature ejaculation
- Hot flushes (transient bothersome hot sensation in the skin caused by hormonal imbalance of menopause)
- Premenstrual dystrophic disorder (emotional and physical disorders that occur before menstruation)
- Diabetic neuropathy (damage of nerves due to diabetes mellitus)
Celexa is also used off-label to prevent migraine (episodic attacks of severe headache).
Celexa should be withdrawn gradually as abrupt withdrawal may lead to SSRI withdrawal syndrome, in which the patient experiences insomnia, sweating, nausea, electric shock-like sensations, tremors, confusion, shaking and night mares.
Black Box Warnings: Celexa can elevate the risk for suicide especially in patients under age 24 who have other mental diseases, such as major depressive disorders. The risk may increase when the dose is changes or within the first few months of treatment. All patients receiving Celexa should be observed for symptomatic worsening, suicidal thoughts and unusual changes in behavior mood.
Common Celexa Side Effects:
Central Nervous System (CNS):
- Tremors (involuntary movements that may affect any part of the body especially hands and arms)
- Vivid dreaming (conscious dreaming)
- Mood swings
- Paraesthesia (sensation of pins and needles) has been reported during post-marketing experience
Gastrointestinal Tract (GIT):
- Dry mouth
- Dyspepsia (painful, difficult, or disturbed digestion)
- Anorexia (loss of appetite)
- Flatulence and increased saliva production have been reported during post-marketing experience
- Reduced libido (sexual drive)
- Impotence (inability to achieve or maintain penile erection sufficient for sexual activity)
- Disorders of ejaculation, such as ejaculator anhedonia (loss of pleasure from sexual activity)
- Anorgasmia (inability to achieve orgasm)
- Genital anaesthesia (loss of sensation of genital organs)
- Amenorrhea (cessation of menstruation), galactorrhea (secretion of milk-like substance from the breast unrelated to breast feeding) and vaginal hemorrhage have been reported during post-marketing experience
- The above mentioned reproductive side effects may persist for years after withdrawal of the drug. This phenomenon is called Post SSRI Sexual Dysfunction.
Urinary system: the following side effects have been reported during the post-marketing experience.
- Urinary incontinence (loss of urine control)
- Frequency of micturation
- Urinary retention
- Dysuria (difficult urination)
- Pyelonephritis (inflammation of the renal pelvis)
- Hematuria (passage of blood with the urine)
Other Celexa Side Effects:
- Insomnia (inability to get enough amount of sleep)
- Somnolence (strong desire for sleep)
- Increased sweating
- Asthenia (loss of energy and strength)
- Frequent urination
- Excessive yawning
- Flu-like symptoms, such as fever, headache, cough, nausea, vomiting and fatigue
- Bruxism (involuntary clenching of the teeth)
- Perverted taste, skeletal pain and muscle weakness have been reported during post-marketing experience
Serious Celexa Side Effects:
Central Nervous System (CNS):
- Elevated risk for suicide
- Serotonin syndrome (life-threatening condition due to increased serotonin levels in the CNS. Symptoms and signs include rapid heart rate, dilated pupils, sweating, exaggerated reflex, high blood pressure, elevated body temperature and shock)
Neuroleptic malignant syndrome (life-threatening neurological condition manifested by decreased level of consciousness, pallor, fever, rigidity of muscle, hallucination and unstable blood pressure and racing heart beats)
Extrapyramidal syndrome (movement disorders characterized by involuntary movements, muscle spasm, restlessness and uncoordinated speech)
- Worsening depression
- Mania (abnormal elevated mood)
- Seizures (convulsions)
Cardiovascular System (CVS):
- Prolongation of the QT interval
- Torsades de pointes (abnormally accelerated heart beats)
The cardiovascular side effects of Celexa can be life-threatening. Symptoms and signs include:
- Fainting or dizziness
- Dyspnea (shortness of breath)
- Chest discomfort
- Slow or fast heartbeats
- Hypoglycemia (decreased blood glucose level)
- Syndrome of inappropriate antidiuretic hormone hypersecretion (retention of water, sodium and other electrolyte in the body due to elevated levels of antidiuretic hormone)
- Hypothyroidism (underactive thyroid gland) and gynecomastia (abnormal enlargement of the male breast) have been reported during post-marketing experience
- Increased risk for bleeding and bruises, especially if Celexa is co-administrated with non-steroidal anti-inflammatory drugs (e.g., aspirin) or anticoagulants (e.g., warfarin)
- Altered platelet functions (platelets are type of blood cells that prevent bleeding)
- Anemia (reduction in red blood cells or hemoglobin) and epistaxis (nosebleed) have been reported during post-marketing experience
Others Serious Side Effects of Celexa:
- Priapism (persistent and or painful penile erection that occurs without sexual stimulation and lasts for more than 4 hours)
- Anaphylactic reaction (life-threatening allergic reaction. Symptoms include skin rash, itching, breathing problems and swelling of the face, eyes, tongue or mouth)
- Neonatal persistent pulmonary hypertension (abnormal elevation of blood pressure in the arteries of the lungs. This side effect occurs if Celexa is used after the 20th week of pregnancy)
- Neonatal serotonin syndrome , especially if Celexa is given during the third trimester of pregnancy
- Hepatitis (inflammation of the liver), abnormal glucose tolerance and dyspnea (shortness of breath) have been reported during post-marketing experience
Celexa Contraindications, Cautions, and Drug Interactions:
- Celexa should not be used in patients with history of allergy to it.
- Celexa should be used with caution in patients with any of the following disorders:
- Congenital QT syndrome
- Uncorrected electrolyte abnormalities
- After the 20th weeks of pregnancy
- Liver impairment
- Severe kidney impairment
- Seizures (convulsions)
- Hyponatremia, especially in elderly patients receiving Celexa
- Mania (manifested by excessive irritability, racing thoughts unusual ideas and trouble sleeping)
- Volume depletion
- Patients under 25 years old
- Elderly patients
Celexa should not be used at the same time with any of the following drugs and chemicals:
- Monoamine oxidase inhibitors (MAOIs)
The above mentioned contraindications, cautions and interactions of Celexa are the most important ones, for a complete list see the manufacture’s prescriber guidelines, and for specific concerns, please consults your healthcare provider.
Pharmacology: Celexa works by inhibiting the neuronal reuptake of serotonin (5-HT) in CNS. Serotonin is a neurotransmitter (brain chemical) that is associated with many functions, such as mood, appetite, sleep and sexual drive.
The absorption of Celexa is not affected by food. The peak blood levels occur at about 4 hours after a single oral dose of 40mg.
Celexa is metabolized in the liver mainly by the enzymes, CYP3A4 and CYP2C19. Its plasma half life is 35 hours.
Celexa is excreted primarily in the urine (10% unchanged) and feces.
Pregnancy and Lactation: Celexa is considered a pregnancy category C medication, i.e., administration of celexa may not be safe during pregnancy. Taking Celexa after the 20th week of pregnancy may lead to neonatal persistent pulmonary hypertension. Neonatal serotonin syndrome may occur if Celexa is given during the third trimester of pregnancy
Celexa is excreted through breast milk. Use of Celexa in a nursing mother was associated with weight loss and drowsiness in infants.