What is the role of citalopram in intravenous-to-oral switch therapy?

Updated: Jul 30, 2018
  • Author: Shirin A Mazumder, MD, FIDSA; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Recently, the selective serotonin reuptake inhibitor citalopram has been administered as an intravenous infusion to patients with severe depression. The results from both open and double-blinded clinical studies with intravenous citalopram suggest that it is an effective and well-tolerated treatment for depression. Moreover, when infusion treatment is initiated and continued orally, citalopram is at least as effective as clomipramine, doxepin, and viloxazine. As with oral treatment, adverse events are mild to moderate in severity, and 50% of patients report no adverse events.

The high bioavailability of citalopram indicates that the switch from intravenous to oral citalopram prevents a deterioration of symptoms because plasma drug concentrations are maintained. Thus, citalopram, the only selective serotonin reuptake inhibitor available as an intravenous formulation, may be a useful addition in the treatment of patients with severe depression who may benefit from more intensive therapy. [45]

Citalopram (Celexa) enhances serotonin activity because of selective reuptake inhibition at neuronal membrane. The adult dose is 20-40 mg PO qd. It is not indicated in children. Citalopram is a pregnancy category C drug, but use late in the third trimester is associated with complications in newborns and may result in prolonged hospitalization, respiratory support, and tube feeding.

Dose-dependent QT prolongation has been reported with citalopram. Because of the risk for QT prolongation, citalopram is contraindicated in individuals with congenital long QT syndrome and the dose should not exceed 40 mg/d. [46, 47]

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