Citalopram

Benjamin Clanner-Engelshofen is a freelance writer in the medical department. He studied biochemistry and pharmacy in Munich and Cambridge / Boston (USA) and noticed early on that he particularly enjoyed the interface between medicine and science. That is why he went on to study human medicine.

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The active ingredient citalopram is used to treat depression and other mental disorders and belongs to the group of SSRIs (selective serotonin reuptake inhibitors). It was developed in 1989, approved in Germany in 1996 and is now contained in numerous drugs. In 2011, citalopram was the most frequently prescribed psychotropic drug in Germany. Despite the generally good tolerability, Citalopram can cause tiredness, weight changes and other side effects. Here you can read everything you need to know about the active ingredient citalopram.

This is how citalopram works

The active ingredient citalopram intervenes in the brain metabolism, more precisely in the metabolism of neurotransmitters (such as serotonin). These messenger substances transmit nerve signals between the brain cells by being released from one cell and binding to certain docking points (receptors) of the next cell. The messenger substances are then taken up again in the nerve cell and thus inactivated.

Experts suspect that an insufficient amount of released serotonin plays a role in the development of depressive symptoms. This is where drugs with citalopram or other SSRIs come into play: They selectively inhibit the re-uptake of serotonin in the cells, so that the messenger substance can develop its mood-enhancing and anxiety-relieving effect for longer. In addition to increasing the concentration of the messenger substance, a permanently higher level of irritation also leads to a reduction in the number of receptors. As a result, an equal amount of messenger substance has a stronger effect on the target structure during and after therapy.

Even if the connections have not yet been fully clarified, depression can often be brought under control with citalopram. However, it should be noted that the citalopram effect does not set in until a few weeks after the start of treatment, as the processes described do not occur immediately.

When is citalopram used?

Citalopram is used to treat depression and panic disorder. Outside of these areas of application approved by the drug authorities, citalopram is also used for other mental illnesses (off-label use).

The duration of treatment depends on the success of the recovery and is always determined by the attending physician. It is often one to several years.

This is how citalopram is used

As a rule, citalopram is taken as a film-coated tablet once a day (morning or evening). Since the active ingredient is only half broken down via the liver after 36 hours after it has been absorbed into the bloodstream, a single daily dose is sufficient. The active ingredient is rarely used as an infusion solution (for inpatients).

What are the side effects of citalopram?

The following citalopram side effects are observed, especially in the first two weeks of therapy:

Increased sweating
insomnia
diarrhea

Patients prone to suicidal ideation should be closely monitored for the first two to four weeks of treatment until the antidepressant effects of citalopram appear.

Other citalopram side effects that occur frequently (in one to ten percent of those treated) or very frequently (in more than ten percent of those treated) are:

Weight loss and decreased appetite
Anxiety, nervousness, confusion
Palpitations, impaired vision, impaired hearing

Occasionally (in 0.1 to 1 percent of those treated) citalopram triggers weight gain and an increase in appetite.

Since the active ingredient acts directly in the central nervous system, there are also many other side effects known to be of minor importance. This list only represents the most important side effects of citalopram.

What should be considered when taking citalopram?

The active ingredient citalopram should not be used in children and adolescents under 18 years of age. People over 65 years of age should only receive half the dose normally used.

Since citalopram is broken down by the liver, treatment must be started with a low dose in patients with impaired liver function. This is followed by a slow dose increase while observing the liver values up to the individually tolerated final dose of citalopram.

pregnancy

During pregnancy, citalopram should only be taken if absolutely necessary and after careful risk-benefit assessment. This is because the active ingredient crosses the placenta and can trigger withdrawal symptoms in newborns, especially when used in the last third of pregnancy.

Discontinue citalopram

Such withdrawal symptoms (such as malaise, nausea, headache) can also occur in adult patients after abrupt discontinuation of therapy. If you want to stop citalopram, the dose should therefore be reduced gradually ("tapering"). Often times, the dose reduction is planned and monitored by the doctor when the patient is discontinued in order to keep any citalopram side effects as low as possible.

Interactions with other substances

Simultaneous use of citalopram and alcohol should be avoided because sensitivity to alcohol is increased during therapy. Patients report severe hangover experiences and severe malaise after consuming common amounts of alcohol while on citalopram therapy.

Citalopram must not be used together with so-called MAO inhibitors (also antidepressants). Otherwise, life-threatening serotonin syndrome can develop. This manifests itself through symptoms such as overheating, muscle stiffness, tremors, confusion, irritability up to delirium and coma.

Likewise, drugs that also affect the serotonin balance should be avoided during therapy. Some other medications for migraines (triptans), opioid pain relievers (tramadol, fentanyl), serotonin precursors as a mild sleep aid or to improve mood (tryptophan, 5-HTP) should only be used after consulting a doctor or pharmacist because it Serotonin syndrome can also occur here.

Citalopram causes a change in the heartbeat (so-called QT time prolongation) in some people. It must not be taken with other drugs that also increase the QT time. Otherwise it can lead to cardiac arrhythmias with serious consequences and subsequent cardiac arrest. Common drugs that lead to a prolongation of the QT time are, for example, certain antibiotics (azithromycin, erythromycin, ciprofloxacin, clarithromycin, cotrimoxazole), asthma drugs (salbutamol, terbutaline), drugs against fungal infections (fluconazole, ketoconazole) and the common cold , Pseudoephedrine, phenylephrine, phenylpropanolamine). If the patient himself experiences irregular heartbeats or similar side effects, a doctor should be informed.

This is how you get drugs with the active ingredient citalopram

The active ingredient citalopram is usually only prescribed after an examination by a specialist in psychiatry or neurology, who usually also recommends psychotherapy to accompany therapy. After the active ingredient works in the central nervous system, it can only be obtained from the pharmacy. Because citalopram can interact with many other active ingredients, patients should inform their doctor and pharmacist about any other medication they are taking.

How long has citalopram been known?

In search of a new anticonvulsant (anti-epileptic), Citalopram was developed by the Danish company Lundbeck. When it was discovered that the active ingredient did not have an anti-epileptic effect, but an anti-depressant effect, it was patented in 1989. The patent expired in 2003, whereupon numerous other pharmaceutical companies developed drugs containing citalopram. However, Lundbeck countered with a maneuver that is not atypical in the world of the pharmaceutical industry: Since citalopram is available in two forms, which are mirror images of each other in terms of structure, of which usually only one is the (more) effective, Lundbeck has again the more powerful form (escitalopram) patented and thus effectively extended its patent protection by several years.

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