Drug Profile activities for Module 5

Section 1: Life stages as a factor in variability

Before administration of citalopram, a thorough evaluation of personal health details should be carried out. Citalopram dose differs greatly between patients of various ages. The initial daily dose of an adult suffering from depression is set at 20mg. This dosage may however, be increased by 20mg to a maximum dose of 40mg once every week. Maintenance dose of citalopram for adults is 20-40mg (Schatzberg & Nemeroff 2009). Initial daily dose of citalopram for children below the age of 11 years is 10mg. This dosage can however, be increased gradually by 5mg per day after every two weeks for children not responding to the initial doses. For persons between the age of 12 and 18 years the initial dose for this drug is set at 20mg per day. This dose can be increased gradually by 10mg per day every two weeks in accordance with the clinical requirement of a patient (Ayd 2000).

Section 2: Impact of disease states: Dosage adjustment in individuals with hepatic disease

The fact that citalopram is metabolized in the liver implies that disorders affecting the liver can have negative implications on metabolism and clearance of this drug. The rate of elimination of citalopram is usually slower in persons presenting with abnormal hepatic conditions (Schatzberg & Nemeroff 2009). It has also been revealed that steady state concentrations for citalopram at a given dose are almost twice as high in a person presenting with liver disorders as compared to a person whose liver is functioning normally. As a result, people with hepatic disorders should be prescribed with minimal dosages of citalopram in order to minimize potential cases of hepatotoxicity (Schatzberg & Nemeroff 2009). The recommended daily dose of citalopram for people suffering from hepatic conditions is 20mg. The dose may however, be increased by 20mg daily for patients who are not responding (Pato & Zohar 2001).

In comparison to persons with normal renal and hepatic function, the rate of elimination of citalopram and its two major metabolites has been shown to be slightly higher.

Section 3: Drug dependence, misuse and abuse

Citalopram has been approved as a safe drug for management of depressive disorders, but on the other hand prolonged use of this drug can lead to development of drug dependence. Research has revealed that approximately 68% of women and 32% of men taking citalopram hydrobromide may develop drug dependence (Schatzberg & Nemeroff 2009). Health care professionals point out that even though citalopram is a potent medication for depression and depressive disorders it should not be extensively used in patients below 18 years of age due to the high rate of suicide related behavior among patients in this age bracket (Schatzberg & Nemeroff 2009). Despite the fact that there is insufficient clinical data regarding citalopram overdose, a number of deadly incidences associated with citalopram overdose have been reported (Spratto & Woods 2011). Some of the adverse symptoms associated with overdose of citalopram include: convulsion, vomiting, bradycardia, ventricular arrhythmia, stupor, agitation and hypertension (Schatzberg & Nemeroff 2009). A specific antidote for citalopram overdose has not yet been identified. Treatment of citalopram overdose is symptomatic (Aronson 2008). Inducing of vomiting has been recognized as an effective strategy in the management of citalopram overdose. Sodium sulfate, which is an osmotically working laxative, or activated carbon should be given following inducing of vomiting (Aronson 2012). Stomach evacuation is also an effective measure in the management of citalopram overdose. It is also important to monitor vital signs together with assessing possible effects of the drugs on the heart (Spratto & Woods 2011).

Reference List

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Aronson, JK 2012, Side effects of drugs annual: A worldwide yearly survey of new data in adverse drug reactions, Oxford, OX: Elsevier.

Ayd, FJ 2000, Lexicon of psychiatry, neurology, and the neurosciences, Philadelphia, PA: Lippincott Williams & Wilkins

Gschwend, MH 2005, ‘Bioavailability investigation of two different oral formulations of Citalopram, a so-called 'second generation' antidepressant drug’, Arzneimittelforschung, Vol. 55, no. 12, pp. 730-7

Hales, RE 2009, Study guide to psychopharmacology: A Companion to the American psychiatric, Arlington, VA: American Psychiatric Pub.

Spratto, GR & Woods, AL 2011, Delmar nurse's drug handbook 2012, Clifton Park, NY: Cengage Learning.

Pato, MT & Zohar, J 2001, Current treatments of obsessive-compulsive disorder, Washington, DC: American Psychiatric Pub.

Purse, M 2012, Celexa (citalopram), [online] Available at: http://bipolar.about.com/od/celexa/a/meds_celexa.htm [Accessed May 17 2012]

RxList 2012, Celexa, [online] Available at: http://www.rxlist.com/celexa-drug/clinicalpharmacology.htm [Accessed May 17 2012]

Schatzberg, AF & Nemeroff, CB 2009, The American psychiatric publishing, Arlington, VA: American Psychiatric Pub