Adverse effects
• CNS: Somnolence, dizziness, insomnia, tremor, nervousness, headache, anxiety, paresthesia, blurred vision
• CV: Palpitations, vasodilation, orthostatic hypotension, hypertension
• Dermatologic: Sweating, rash, redness
• GI: Nausea, dry mouth, constipation, diarrhea, anorexia, flatulence, vomiting
• GU: Ejaculatory disorders
• Respiratory: Sinusitis, URI, cough, rhinitis
Interactions
Drug-drug
• Increased citalopram levels and toxicity if taken with MAOIs; ensure that patient has been off the MAOI for at least 14 days before administering citalopram
• Increased citalopram levels with azole antifungals, macrolides
• Possible severe adverse effects if combined with tricyclic antidepressants, erythromycin; use caution
• Possible increased effects of beta blockers; monitor patient and reduce beta blocker dose as needed
• Possible increased bleeding with warfarin, monitor patient carefully
• Risk of prolonged QT interval and potentially fatal cardiac arrhythmias if combined with pimozide; avoid this combination
Drug-alternative therapy
• Increased risk of severe reaction if combined with St. John’s wort therapy.
Nursing considerations
CLINICAL ALERT!
Name confusion has occurred between Celexa (citalopram), Celebrex (celecoxib), Xanax (alprazolam), and Cerebyx (fosphenytoin); use caution.
Assessment
• History: MAOI use; allergy to drug or any component of the drug; renal or hepatic impairment, elderly, pregnancy, lactation, suicidal tendencies
• Physical: Orientation, reflexes; P, BP, perfusion; bowel sounds, normal output; urinary output; liver evaluation; liver and renal function tests
Interventions
• Administer once a day, in the morning; may be taken with food if desired.
• Encourage patient to continue use for 4–6 wk, as directed, to ensure adequate levels to affect depression.
• Limit amount of drug given in prescription to potentially suicidal patients.
• Establish appropriate safety precautions if patient experiences adverse CNS effects.
• Institute appropriate therapy for patient suffering from depression.
Teaching points
• Take this drug exactly as directed, and as long as directed; it may take a few weeks to realize the benefits of the drug. The drug may be taken with food if desired.
• This drug should not be taken during pregnancy or when nursing a baby; using barrier contraceptives is suggested.
• You may experience these side effects: Drowsiness, dizziness, tremor (use caution and avoid driving a car or performing other tasks that require alertness if you experience daytime drowsiness); GI upset (eat frequent small meals; perform frequent mouth care); alterations in sexual function (it may help to know that this is a drug effect, and will pass when drug therapy is ended).
• Report severe nausea, vomiting; palpitations; blurred vision; excessive sweating.