Malicon (Citalopram)

Citalopram is an SSRI that acts on mood‑regulating pathways in the central nervous system.

• Major depressive disorder: alleviates depressive symptoms and improves mood in diagnosed patients.

• Citalopram selectively inhibits the serotonin transporter (SERT) on presynaptic neurons, reducing reuptake of serotonin from the synaptic cleft. This increases extracellular serotonin concentrations, enhancing serotonergic neurotransmission and contributing to mood stabilization and relief of depressive symptoms.

Citalopram may cause a range of adverse reactions, from mild to severe.

Common Side Effects

• Nausea: mild gastrointestinal upset often occurring early in therapy.
• Headache: transient tension‑type headaches reported by many patients.
• Dry mouth: reduced salivary flow leading to a dry oral sensation.
• Insomnia or somnolence: sleep disturbances or excessive drowsiness.
• Sexual dysfunction: decreased libido or difficulty achieving orgasm.
• Diarrhea: loose stools that usually resolve with continued use.

Serious or Rare Side Effects

• Serotonin syndrome: potentially life‑threatening condition with agitation, hyperthermia, and neuromuscular abnormalities.
• QT interval prolongation: cardiac conduction changes that may predispose to arrhythmia.
• Suicidal thoughts: emergence of suicidal ideation, especially in young adults.
• Severe allergic reaction: rash, swelling, or anaphylaxis requiring immediate medical attention.
• Hyponatremia: low blood sodium levels that can cause confusion or seizures.
• Bleeding abnormalities: increased risk of gastrointestinal or intracranial bleeding.

Citalopram requires careful monitoring to ensure safe use.

• Suicidal risk assessment: evaluate for emergent suicidal thoughts, particularly during treatment initiation.
• Cardiac monitoring: obtain baseline ECG and monitor QT interval in patients with cardiac risk factors.
• Discontinuation syndrome: taper the dose gradually to avoid withdrawal symptoms.
• Hepatic impairment: adjust dosing and monitor liver function in patients with liver disease.
• Concomitant serotonergic agents: avoid combining with other SSRIs, SNRIs, or MAO inhibitors.
• Store below 25°C: keep in the original packaging, protect from moisture and direct sunlight.

Citalopram can interact with several medication classes, altering efficacy or safety.

Major Interactions (Avoid)

• MAO inhibitors: concurrent use can precipitate serotonin syndrome.
• Other serotonergic drugs (e.g., SSRIs, SNRIs, tramadol, linezolid): increase risk of serotonin toxicity.
• Pimozide: may cause severe cardiac arrhythmias when combined.
• Certain antiarrhythmics (e.g., quinidine): can exacerbate QT prolongation.

Moderate Interactions (Monitor Closely)

• NSAIDs or anticoagulants: heightened bleeding risk.
• CYP2C19 inhibitors (e.g., omeprazole, fluconazole): may raise citalopram plasma levels.
• Alcohol: can intensify central nervous system depression.
• Diuretics: may worsen hyponatremia.
• Antipsychotics (e.g., risperidone): potential additive QT effects.