... Psychotropic Dosing and Monitoring Guidelines. Effects included lethargy, hypotonia, hypothermia, cyanosis, and electrocardiography changes. Phenytoin 8. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. Wolters Kluwer Obstet Gynecol. Altered anticoagulant effects, including increased bleeding, have been reported when SSRIs and SNRIs are coadministered with warfarin. Available for Android and iOS devices.
Biotransformation of citalopram is mainly hepatic, with a mean terminal half-life of about 35 hours.
Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide.
Citalopram should also not be used in patients who are taking other drugs that prolong the QTc interval. Psychotropic Monitoring Inpatient Guidelines ... (carbamazepine), annually and as clinically indicated Carbamazepine level 1 week after start, 3-4 weeks ... (Celexa®) escitalopram (Lexapro®) Fluoxetine (Prozac®) paroxetine (Paxil®) sertraline (Zoloft®) If patients taking citalopram experience symptoms that could indicate the occurrence of cardiac arrhythmias, e.g., dizziness, palpitations, or syncope, the prescriber should initiate further evaluation, including cardiac monitoring.The development of a potentially life-threatening serotonin syndrome has been reported with SNRIs and SSRIs, including Celexa, alone but particularly with concomitant use of other serotonergic drugs (including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, trytophan, buspirone, amphetamines, and St. John’s Wort) and with drugs that impair metabolism of serotonin (in particular, MAOIs, both those intended to treat psychiatric disorders and also others, such as linezolid and intravenous methylene blue).Serotonin syndrome symptoms may include mental status changes (e.g., agitation, hallucinations, delirium, and coma), autonomic instability (e.g., tachycardia, labile blood pressure, dizziness, diaphoresis, flushing, hyperthermia), neuromuscular symptoms (e.g., tremor, rigidity, myoclonus, hyperreflexia, incoordination), seizures and/or gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea). Appendix 12 Oxfordshire PCT/OBMH Good practice monitoring guidelines for SMI patients 51 . An estimated 500,000 pregnancies in the United States each year involve women who have or who will develop psychiatric illness during the pregnancy. Common side effects include nausea and drowsiness. If acceptable alternatives to linezolid or intravenous methylene blue treatment are not available and the potential benefits of linezolid or intravenous methylene blue treatment are judged to outweigh the risks of serotonin syndrome in a particular patient, Celexa should be stopped promptly, and linezolid or intravenous methylene blue can be administered. Celexa may be associated with these serious side effects:Changes in the electrical activity of your heart (QT prolongation and Torsade de Pointes).Serotonin Syndrome. The volume of distribution of citalopram is about 12 L/kg and the binding of citalopram (CT), demethylcitalopram (DCT) and didemethylcitalopram (DDCT) to human plasma proteins is about 80%.Following intravenous administrations of citalopram, the fraction of drug recovered in the urine as citalopram and DCT was about 10% and 5%, respectively. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Patients should be given the opportunity to discuss the contents of the Medication Guide and to obtain answers to any questions they may have.
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