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Celexa Withdrawal
You will find quite a bit of information on our web site.
Our program has been updated, September 2017, with new
information and an improved program. Our success rate was
already high but our founder, Jim Harper, has improved it
further. A suggestion;
click here
and then download the free pdf file of Jim's book How to Get
Off Psychoactive Drugs Safely.
The
Road Back is a member of California Association of
Alcoholism & Drug Abuse Counselors (CAADAC). We
have been assisting people off psychoactive medication since
1999, and have helped well over 50,000 people off their
drugs. The Road Back is the largest and longest running
outpatient withdrawal program in the world.
You will find on this site the complete book, How
to Get Off Psychoactive Drugs Safely.
Withdrawal off of Celexa does not have to be
difficult and handling current Celexa withdrawal side effects
can be resolved quickly.
To begin, click How to Start
located at the top of the page and select the
chapter you would like to read first. If you
are currently in Celexa withdrawal you may not be up
to reading the entire book How to Get Off
Psychoactive Drugs Safely which is located on the
How to Start page. To make things easier
for you and to help get you to the point of feeling
well again fast, just choose from the following and
when you are up to it come back to our site again
and complete your program.
Nausea - Try drinking a couple of
cups of ginger tea.
Head symptoms to include dizziness, an electrical
known as brain zaps etc, you will need to use the
Omega 3 Supreme TG. The best think to do is get the
Antidepressant Package from the manufacture of the
supplements made for this program. You can just
follow the instructions on each bottle for how to
take but ideally download the free pdf file of the
book.
For supplements
click here
For free pdf of book
click here
Note:
If you are taking Celexa as well as an anti-anxiety
medication (benzodiazepine), the anti-anxiety
medication should be discontinued first. If you are
only discontinuing the Celexa the Celexa must be
reduced very slowly to prevent withdrawal side
effects from the anti-anxiety drug. Celexa slows the
metabolism rate of anti-anxiety drugs and when the
Celexa is removed from the system the anti-anxiety
medication will not take as long to metabolize and
this creates a withdrawal effect from the
anti-anxiety medication.
Celexa
(Citalopram)
Action and Clinical Pharmacology
 Antidepressant
Citalopram hydrobromide is a highly selective and potent
serotonin
(5-hydroxytryptamine 5-HT) reuptake inhibitor with minimal
effects on the
neuronal reuptake of norepinephrine (NE) and dopamine (DA).
The ability
of citalopram to potentiate serotonergic activity in the
central nervous
system via inhibition of the neuronal reuptake of serotonin
is thought to be
responsible for its antidepressant action. Tolerance to the
inhibition of serotonin reuptake is not induced by long term
(14 days) treatment of rats with citalopram.
Citalopram has no or very low affinity for a series of
receptors including serotonin 5-HT1A, 5-HT2,
dopamine D1, and D2, a1-, a2-,
b-adrenergic, histamine H1, muscarinic
cholinergic, benzodiazepine, gamma aminobutyric acid (GABA)
and opioid receptors.
Pharmacokinetics
Absorption
Following the administration of a single oral dose of
citalopram (40 mg) to healthy male volunteers, peak blood
levels occurred at about 4 hours (range 1 to 6 hours). The
absolute bioavailability of citalopram was about 80% (range
52 to 93%) relative to an intravenous dose. Absorption was
not affected by food.
Distribution
After intravenous infusion in healthy male volunteers the
apparent volume of distribution (Vd)b was about
12 L/kg (range 9-17 L/kg), indicating a pronounced tissue
distribution: (Vd)b oral was about 17 L/kg (range
14-17 L/kg). The binding of citalopram and its demethylated
metabolites to human plasma proteins is about 80%.
Steady-state
The single- and multiple dose pharmacokinetics of citalopram
are linear and dose proportional in a dose range of 10 to 60
mg/day. Steady-state plasma levels are achieved in patients
in 1-2 weeks. At a daily dose of 40 mg, the average plasma
concentration is about 83 ng/mL (n=114) with a range from 30
to 200 ng/mL. Citalopram does not accumulate during long
term treatment. A clear relationship between citalopram
plasma levels and therapeutic response or side effects has
not been established.
Metabolism
Citalopram is metabolized in the liver to demethylcitalopram
(DCT), didemethylcitalopram (DDCT), citalopram N-oxide and a
deaninated propionic acid derivative. In vitro studies show
that DCT, DDCT and citalopram-N-oxide also inhibit the
neuronal reuptake of serotonin but are less selective and
less potent than the parent compound and are of minor
clinical importance. Unchanged citalopram is the predominant
compound in plasma. In vitro studies indicated that the
biotransformation of citalopram to its demethyl metabolites
depends on both CYP2C19 and CYP3A4, with a small
contribution from CYP2D6.
Elimination
The elimination half life of citalopram (t1/2b)
is approximately 37 hours (range 30-42 hours) which allows
recommendation of once-daily dosing. The systemic citalopram
plasma clearance (Cl5) is 0.33 L/min. Citalopram
is eliminated primarily via the liver (85%) and the
remainder via the kidneys; approximately 12% (range 6-21%)
of the daily dose is excreted in urine as unchanged
citalopram.
Special Populations:
Elderly Patients
Elderly patients (4 males and 7 females aged 73-90 years),
received a 20 mg/day dose of citalopram for 3-4 weeks. In
the elderly, steady state plasma levels were elevated (106
ng/mL), half-life prolonged (1.5-3.75 days) and clearance
decreased (0.08-0.3 L/min). Elevation of citalopram plasma
levels occurred at an earlier age in females than in males,
In this population, lower doses and a lower maximum dose of
citalopram are recommended.
Reduced Hepatic Function
The pharmacokinetics of citalopram were compared in patients
with reduced hepatic function (3 female and 6 male patients
aged 41-60 years) to those seen in 12 healthy male
volunteers (aged 21-43 years), In patients with reduced
hepatic function the half-life of citalopram was
approximately doubled (83 hours versus 37 hours), steady
state citalopram concentrations increased by 61% and oral
clearance decreased by 37%. Consequently the use of
citalopram in patients with reduced hepatic function should
be approached with caution and lower maximal doses should be
prescribed (see PRECAUTIONS and DOSAGE AND ADMINISTRATION).
Reduced Renal Function
In patients with mild to moderate reduction of the renal
function (4 females and 3 males, aged 30-55 years),
citalopram was being eliminated more slowly than in 12
healthy male volunteers (aged 21-43 years), half-lives being
49 hours versus 37 hours. However, mild to moderate renal
impairment had no major influence on the kinetics of
citalopram. At present, no information is available for
chronic treatment of patients with severely reduced renal
function (creatinine clearance <20 mL/min).
Indications and Clinical Use
Citalopram hydrobromide is indicated for the symptomatic
relief of depressive illness.
The relapse rate was significantly lower in citalopram-treated
patients than in placebo-treated patients in two
placebo-controlled studies, that were conducted over a
24-week period in patients who responded to 6 or 8 weeks of
acute treatment with citalopram (see CLINICAL TRIALS under
ACTION AND CLINICAL PHARMACOLOGY.) Nevertheless, the
physician who elects to use citalopram for extended periods
should periodically reevaluate the long-term usefulness of
the drug for the individual patient.
Contraindications
Citalopram hydrobromide is contraindicated in patients with
known hypersensitivity to citalopram hydrobromide or the
excipients of the drug product.
Monoamine Oxidase Inhibitors
In patients, receiving selective serotonin reuptake
inhibitors (SSRIs) in combination with a monoamine oxidase
inhibitor (MAOI), there have been reports of serious,
sometimes fatal, reactions including hyperthermia, rigidity,
myoclonus, autonomic instability with possible rapid
fluctuations of vital signs, and mental status changes,
including extreme agitation progressing to delirium and
coma. These reactions have also been reported in patients
who have recently discontinued SSRI treatment and have been
started on a MAOI. Some cases presented with features
resembling serotonin syndrome. Therefore, it is recommended
that citalopram should not be used in combination with a
MAOI or within 14 days of discontinuing treatment with a
MAOI. Similarly, at least 14 days should elapse after
discontinuing citalopram treatment before starting a MAOI.
Precautions
Suicide
The possibility of a suicide attempt is inherent in
depression and may persist until remission occurs.
Therefore, high risk patients should be closely supervised
throughout therapy with Citalopram hydrobromide and
consideration should be given to the possible need for
hospitalization. In order to minimize the opportunity for
overdosage, prescription for citalopram should be written
for the smallest quantity of drug consistent with good
patient management.
Activation of Mania/Hypomania
In placebo-controlled trials with citalopram, some of which
included patients with bipolar disorder, mania/hypomania was
reported in 0.1% of 1027 patents treated with citalopram
versus none of the 426 patients treated with placebo.
Activation of mania/hypomania has also been reported in a
small proportion of patients with major affective disorders
treated with other marketed antidepressants. If a patient
enters a manic phase, citalopram should be discontinued.
Seizures
Citalopram has not been systematically evaluated in patients
with a seizure disorder. These patients were excluded from
clinical studies during the premarketing testing of
citalopram. In clinical trials, seizures occurred in 0.25%
of patients treated with citalopram and in 0.23% patients
treated with placebo. Like other antidepressants, citalopram
should be used with caution in patients with a history of
seizure disorder.
Serotonin Syndrome
Rarely, the occurrence of serotonin syndrome has been
reported in patients receiving SSRIs. A combination of
symptoms, possibly including agitation, confusion, tremor,
myoclonus and hyperthermia, may indicate the development of
this condition.
5-HT1 Agonists
There have been rare postmarketing reports describing
patients with weakness, hyperreflexia and incoordination,
following the concomitant use of a SSRI and the antimigraine
drug sumatriptan, a 5-HT1 agonist. Such
interaction should be considered if citalopram is to be used
in combination with a 5-HT1 agonist.
Hyponatremia
Hyponatremia and SIADH (syndrome of inappropriate
antidiuretic hormone secretion) have been reported with
citalopram use as a rare adverse event.
Pregnancy and Nursing Mothers
The safety of citalopram during pregnancy and lactation has
not been established. Therefore, citalopram should not be
used during pregnancy, unless, in the opinion of the
physician, the expected benefits to the patient markedly
outweigh the possible hazards to the fetus. Citalopram is
excreted in human milk. Citalopram should not be
administered to nursing mothers unless, in the opinion of
the treating physician, the expected benefits to the patient
markedly outweigh the possible hazards to the child.
Pediatric Use
Safety and effectiveness in patients below the age of 18
have not been established.
Geriatric Use
In premarketing clinical trials, 800 elderly patients (>=65
years of age) have been treated with citalopram. Of these
patients 298 were >=75 years old. In a pharmacokinetic study
(n=11, age 73 to 90 years), clearance was substantially
decreased and half-life prolonged (see PHARMACOKINETICS). In
a 6-week placebo-controlled study, approximately equal
numbers of patients received citalopram at 20 or 30 mg per
day, as the final dose. In about 5% of patients, the final
dose was 10 mg per day (see CLINICAL TRIALS). Consequently,
elderly patients should be administered lower doses and a
lower maximum dose.
Hepatic Impairment
Citalopram clearance was significantly decreased and plasma
concentrations, as well as elimination half-life
significantly increased (see PHARMACOKINETICS).
Consequently, the use of citalopram in hepatically impaired
patients should be approached with caution and a lower
maximum dosage is recommended.
Renal Impairment
No dosage adjustment is needed in patients with mild to
moderate renal impairment. To date, no information is
available on the pharmacokinetic or pharmacodynamic effects
of citalopram in patients with severely reduced renal
function (creatinine clearance <20 mL/min).
Use in Patients with Cardiac Disease
Citalopram has not been systematically evaluated in patients
with a recent history of myocardial infarction or unstable
heart disease. Patients with these diagnoses were generally
excluded from clinical trials during the drugs premarketing
assessment. However, the electrocardiograms of patients, who
received citalopram in clinical trials, indicate that
citalopram was not associated with the development of
clinically significant ECG abnormalities.
In clinical trials, citalopram caused small but
statistically significant decreases in heart rate (see ECG
under ADVERSE REACTIONS) Consequently, caution should be
observed when citalopram is initiated in patients with
pre-existing slow heart rate.
Use in Diabetic Patients
Citalopram has not been systematically evaluated in diabetic
patients since diabetes constituted an exclusion criterion.
Although 13 patients did receive insulin during the studies,
this number is too small to determine whether citalopram
affects the response to insulin. Rare events of hypoglycemia
were reported. Citalopram should be used with caution in
diabetic patients on insulin or other antidiabetic drugs.
Interference with Cognitive and Motor Performance
In studies in normal volunteers, citalopram in doses of 40
mg/day did not impair cognitive function or psychomotor
performance. However, psychotropic medications may impair
judgement, thinking or motor skills. Consequently, patients
should be cautioned against driving a car or operating
hazardous machinery until they are reasonably certain that
citalopram does not affect them adversely.
Electroconvulsive Therapy (ECT)
The safety and efficacy of the concurrent use of citalopram
and ECT have not been studied.
Abrupt Discontinuation
After 8 weeks of treatment with citalopram, abrupt
discontinuation of treatment caused a higher incidence of
anxiety, emotional indifference, impaired concentration,
headache, migraine, paresthesia, and tremor than was seen in
patients who continued on citalopram. These symptoms are not
indicative of addiction.
Although it is not known whether gradual discontinuation
will prevent the discontinuation symptoms, it is recommended
that the dosage of citalopram should be tapered off over 1
to 2 weeks.
Additional Adverse Events Observed During the Premarketing
Evaluation of Citalopram
The events listed below include all adverse events that were
reported in the overall development program of citalopram
(n=3652). All reported events are included except those
already listed in Table 1 and those events which occurred in
only one patient. It is important to emphasize that,
although the events reported occurred during treatment with
citalopram, they were not necessarily caused by it. The
events are enumerated using the following criteria:
frequent: adverse events that occurred on one or more
occasions in at least 1/100 patients; infrequent: adverse
events that occurred in less than 1/100 patients but at
least in 1/1000 patients; rare: adverse events that occurred
in fewer than 1/1000 patients.
Body as a Whole - General Disorders
Frequent: Influenza-like symptoms, nonpathological trauma,
pain. Infrequent: Alcohol intolerance, allergic reaction,
allergy, chest pain, edema, hot flushes, leg pain, malaise.
rigors, syncope. Rare: Peripheral edema, sudden death,
traumatic injury.
Cardiovascular Disorders
Frequent: Postural hypotension, tachycardia. Infrequent:
Angina pectoris, arrhythmia. bradycardia, cardiac failure,
cerebrovascular disorders, edema dependent, extrasystoles,
flushing, hypertension, hypotension, myocardial infarction,
myocardial ischemia, peripheral ischemia. Rare: Aggravated
hypertension, bundle branch block, cardiac arrest, coronary
artery disorder, ECG abnormal, heart disorder, phlebitis,
supraventricular extrasystoles.
Central and Peripheral Nervous System Disorders
Frequent: Migraine, paraesthesia. Infrequent: Abnormal gait,
ataxia, convulsions, dysphonia, dystonia, extrapyramidal
disorder, hyperkinesia, hypertonia, hypoesthesia,
hypokinesia, involuntary muscle contractions, leg cramps,
neuralgia, speech disorder, vertigo Rare: Abnormal
coordination, convulsions grand mal, hyperesthesia, ptosis,
sensory disturbance, stupor.
Collagen Disorders
Rare: Rheumatoid arthritis.
Endocrine Disorders
Rare: Goiter, gynecomastia, hypothyroidism.
Gastrointestinal System Disorders
Frequent: Flatulence. Infrequent: Colitis, dental abscess,
dysphagia, eructation, gastritis, gastroenteritis,
gastrointestinal disorder (not specified), hemorrhoids,
increased saliva, teeth-grinding, toothache. Rare:
Appendicitis, esophagitis, gastric ulcer, gastroesophageal
reflux, gingivitis, stomatitis, tooth disorder, ulcerative
stomatitis.
Hematopoietic and Lymphatic Disorders
Infrequent: Anemia, epistaxis, leukocytosis, purpura. Rare:
Coagulation disorder, gingival bleeding, granuloytopenia,
hematoma, leukopenia, lymphadenopathy, lymphocytosis,
pulmonary embolism.
Liver and Biliary System Disorders.
Infrequent: Cholecystitis, cholelithiasis, increased
gamma-GT, increased SGPT. Rare: Bilirubinemia, increased
SGOT, jaundice.
Metabolic and Nutritional Disorders
Frequent: Weight decrease, weight increase. Infrequent: Leg
edema, xerophthalmia. Rare: Dehydration, edema,
hypoglycemia, hypokalemia, increased alkaline phosphatase,
obesity, thirst.
Musculo-Skeletal System Disorders
Infrequent: Arthralgia, arthritis, arthrosis, dystonia,
muscle weakness, myalgia. Rare: Bone disorder, bursitis,
osteoporosis, tendon disorder.
Neoplasm
Rare: Breast neoplasm malignant female.
Psychiatric Disorders
Frequent: Abnormal dreaming, aggravated depression, amnesia,
apathy, confusion, depression, impaired concentration,
increased appetite, sleep disorder, suicide attempt.
Infrequent: Abnormal thinking, aggressive reaction,
delusion, depersonalization, drug abuse, drug dependence,
emotional lability, euphoria, hallucination, increased
libido, manic reaction, neurosis, paranoid reaction,
paroniria, psychosis, psychotic depression. Rare: Catatonic
reaction, hysteria, personality disorder.
Reproductive Disorders, Female
Infrequent: Amenorrhea, breast pain, lactation nonpuerperal,
menorrhagia, menstrual disorder, premenstrual syndrome,
salpingitis, unintended pregnancy, vaginal dryness,
vaginitis. Rare: Breast enlargement, vaginal hemorrhage.
Reproductive Disorders, Male
Infrequent: Penis disorder, prostatic disorder, testis
disorder.
Resistance Mechanism Disorders
Infrequent: Abscess, fungal infection, herpes simplex
infection, otitis media, viral infection. Rare: Bacterial
infection, moniliasis, sepsis.
Respiratory System Disorders
Infrequent: Bronchitis, coughing, dyspnea, pneumonia. Rare:
Asthma, bronchospasm, increased sputum, laryngitis,
pneumonitis, respiratory disorder.
Skin and Appendage Disorders
Frequent: Pruritus, rash. Infrequent: Acne, alopecia,
dermatitis, dry skin, eczema, photosensitivity reaction,
psoriasis, rash erythematous, rash maculo-papular, skin
discoloration, urticaria. Rare: Cellulitis, decreased
sweating, hypertrichosis, melanosis, pruritus ani.
Special Senses, Vision, Hearing and Vestibular Disorders
Frequent: Abnormal accommodation. Infrequent:
Conjunctivitis, earache, eye pain, mydriasis, taste
perversion, tinnitus. Rare: Eye abnormality, keratitis,
photophobia.
Urinary System Disorders
Frequent: Polyuria. Infrequent: Abnormal urine, cystitis,
hematuria, micturition frequency, urinary incontinence,
urinary retention, urinary tract infection. Rare: Dysuria,
facial edema, oliguria, renal calculus, renal pain.
Events Observed During the Post-Marketing Evaluation of
Citalopram
It is estimated that approximately 8 million patients have
been treated with citalopram since market introduction. The
following adverse events have been reported to be
temporarily associated with citalopram treatment in at least
3 patients and are not described elsewhere in labeling.
Abnormal hepatic function, aggravated condition, aggravated
migraine, angioedema, asthma, choreoathetosis, decreased
drug level, decreased prothrombin time, dyskinesia,
eosinophilia, erythema multiforms, gynecological problems,
hepatitis, hyperprolactinemia, hyponatremia, increased drug
level, increased prothrombin time, mydriasis, neuroleptic
malignant syndrome, neuropathy, pancreatitis, pancytopenia,
postural hypotension, serotonin syndrome, SIADH, spontaneous
abortion/fetal death, thrombocytopenia, ventricular
arrhythmia, Torsade de pointes, withdrawal syndrome.
Adverse Findings Observed in Short-Term, Placebo-Controlled
Trials
Adverse Reactions Associated with Discontinuation of
Treatment
From the short-term (4 to 6 weeks) placebo-controlled, Phase
III clinical trials, 15.9% (163/1027) of the citalopram-treated
patients discontinued treatment due to an adverse event. The
discontinuation rate in the placebo-treated patients was
7.7% (33/426).
The events associated with discontinuation of citalopram in
1% or more of patients at a rate of at least twice that of
placebo, were as follows: Nausea (4.1% versus 0.0%),
insomnia (2.4% versus 12%), somnolence (2.4% versus 1.2%),
dizziness (2.3% versus 0.7%), vomiting (1.3% versus 0.0%),
agitation (1.2% versus 0.0%), asthenia (11% versus 0.5%),
and dry mouth (1.1% versus 0.2%).
Incidence of Adverse Events in Placebo-controlled Studies
Table 1 enumerates the incidence of treatment-emergent
adverse events that occurred in 1027 depressed patients who
received citalopram at doses ranging from 10 to 80 mg/day in
placebo-controlled trials of up to 6 weeks in duration.
Events included are those occurring in 2% or more of
patients treated with citalopram, and for which the
incidence in patients treated with citalopram was greater
than the incidence in placebo-treated patients. Reported
adverse events were classified using the standard World
Health Organization (WHO)-based dictionary terminology.
The prescriber should be aware that these figures cannot be
used to predict the incidence of adverse events in the
course of usual medical practice where patient
characteristics and other factors differ from those which
prevailed in the clinical trials. Similarly, the cited
frequencies cannot be compared with figures obtained from
other clinical investigations involving different
treatments, uses, and investigators. The cited figures,
however, do provide the prescribing physician with some
basis for estimating the relative contribution of drug and
non-drug favors to the adverse event incidence rate in the
population studied.
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