Citalopram STELLA 20 mg

Rx

Indications

• Treatment of major depressive episodes.
• Treatment of panic disorder with or without agoraphobia.

Dosage

• Adults
  Major depressive episodes: A single dose of 20 mg daily, depend on response, may be increased to a maximum of 40 mg daily; treatment should continue until the patient has been free of symptoms for 4 – 6 months to give adequate protection against the possibility of a relapse.
  Panic disorder: A single dose of 10 mg for first week before increasing the dose to 20 mg daily, depend on response, may be increased to maximum 40 mg daily; continue treatment for several months.
• Older people (> 65 years of age):
  Half of the recommended dose.
• Reduced hepatic function mild – moderate or poor metabolisers regarding CYP2C19:
  10 mg daily for the first two weeks, may be increased to a maximum of 20 mg daily.
• Stopping treatment:
  Gradually reduced over a period of at least one to two weeks.
  If intolerable symptoms occur following a dosage decrease/discontinuation of treatment: resuming the previously prescribed dose; continue decreasing the dose, but at a more gradual rate.
• Reduced renal function
  Mild to moderate: Dosage adjustment is not necessary;
  Severe (ClCr < 20 ml/min): Do not use.
• Children and adolescents under 18 years of age:
  Do not use.

Usage

• Taken with or without food, but with fluid, either in the morning or in the evening.

• Known hypersensitivity to any ingredient in the formulation.
• The combination with linezolid unless there are facilities for close observation and monitoring of blood pressure.
• Patients with know QT-interval prolongation or congenital long QT syndrome.
• The co-administration with medicinal products that are known to prolong the QT-interval.
• Citalopram should not be given to patients receiving monoamine oxidase inhibitors (MAOIs).

Very common

• Agitation, nervousness;
• Lethargy, insomnia, tremor, dizziness, headache, somnolence;
• Abnormal accommodations;
• Palpitations; dry mouth, nausea, constipation;
• Increased sweating;
• Asthenia.

Common

• Appetite decreased, weight decreased;
• Libido decreased, abnormal orgasm (female), anxiety, confusional state, apathy, impaired concentration, abnormal dreams, memory loss;
• Paraesthesia, sleeping disorders, migraine, taste disturbance, disturbance in attention;
• Visual disturbance;
• Tinnitus; tachycardia;
• Hypotension, hypertension, orthostatic hypotension; diarrhoea, vomiting, dyspepsia, abdominal pain, flatulence, increased salivation;
• Pruritus, rash;
• Myalgia, arthralgia;
• Polyuria, micturition disorder;
• Impotence, ejaculation disorder, ejaculation failure, dysmenorrhea;
• Fatigue, pyrexia.

• Caution when using Citalopram STELLA 20 mg for patients with diabetes; unstable epilepsy (avoid using); controlled epilepsy; significant bradycardia, recent acute myocardial infarction/uncompensated heart failure; reduced kidney and liver function; angle-closure glaucoma or history of glaucoma; elderly patients; pregnancy (consideration of the benefit/risk); nursing women.
• Electrolyte disturbances should be corrected before treatment with citalopram is started.
• Risk of suicidal/suicide thoughts or clinical worsening.
• Citalopram should be discontinued if there is an increase in seizure frequency; signs of cardiac arrhythmia; enter a manic phase in patients with manic – depressive illness; serotonin syndrome (rare).
• Withdraw symptoms seen on discontinuation of treatment.
• Concurrent administration of citalopram and ECT (electro-convulsive therapy).
• There have been reports of prolonged bleeding time and/or bleeding abnormalities.
• Treatment of psychotic patients with depressive episodes may increase psychotic symptoms.
• Patients with rare hereditary problems of galactose intolerance, total lactase deficiency or glucose-galactose malabsorption should not take this medicine.
• Patients should be aware of how they react to drug before driving or operating machinery.