Sedopram 20 mg

Citalopram 20 mg

Warnings
Black Box Warnings
In short-term studies, antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults (<24 years) taking antidepressants for major depressive disorders and other psychiatric illnesses
This increase was not seen in patients >24 years; a slight decrease in suicidal thinking was seen in adults >65 years
In children and young adults, the risks must be weighed against the benefits of taking antidepressants
Patients should be monitored closely for changes in behavior, clinical worsening, and suicidal tendencies; this should be done during initial 1-2 months of therapy and dosage adjustments
The patient’s family should communicate any abrupt changes in behavior to the health-care provider
Worsening behavior and suicidal tendencies that are not part of the presenting symptoms may require discontinuation of therapy
Not FDA approved for the treatment of bipolar disorder
This drug is not FDA approved for use in pediatric patients

Contraindications
Hypersensitivity
Coadministration with pimozide
Coadministration with serotonergic drugs

  • Concomitant use or within 14 days of MAOIs increases risk of serotonin syndrome
  • Symptoms include tremor, myoclonus, diaphoresis, nausea, vomiting, flushing, dizziness, hyperthermia with features resembling neuroleptic malignant syndrome, seizures, rigidity, autonomic instability with possible rapid fluctuations of vital signs, and mental status changes that include extreme agitation progressing to delirium and coma
  • Starting citalopram in a patient who is being treated with linezolid or IV methylene blue is contraindicated because of an increased risk of serotonin syndrome
  • If linezolid or IV methylene blue must be administered, discontinue SSRI immediately and monitor for CNS toxicity; may resume 24 hr after last linezolid or methylene blue dose, or after 2 weeks of monitoring (5 weeks for fluoxetine), whichever comes first
Cautions
Pregnancy: Conflicting evidence regarding use of SSRIs during pregnancy and increased risk of persistent pulmonary hypertension of the newborn, or PPHN (see Pregnancy)
Neonates exposed to SNRIs/SSRIs late in third trimester: Risk of complications such as feeding difficulties, irritability, and respiratory problems
Clinical worsening and suicide ideation may occur despite medication in adolescents and young adults (18-24 years)
Risk of mydriasis; may trigger angle closure attack in patients with angle closure glaucoma with anatomically narrow angles without a patent iridectomy
Risk of hyponatremia, abnormal bleeding (increased if concomitant aspirin, NSAIDs, or anticoagulants, or hemorrhagic diathesis), and impairment of cognitive and motor functions
Risk of serotonin syndrome or neuroleptic malignant syndrome (NMS)-like reactions have been reported with SSRIs alone or with concomitant use of serotonergic drugs, with drugs that impair metabolism of serotonin, or with antipsychotics or other dopamine antagonists
Activation of mania/hypomania has been reported; use caution when treating patients with history of mania
Increased risk of bone fractures reported with antidepressant use; use caution; consider possibility of fracture it patient presents with bone pain
May cause or exacerbate sexual dysfunction
Use caution when treating patients with history of seizure disorder
Rare cases of hyponatremia and development of SIADH reported with either SSRI or SNRI use
Consider risk of serotonin syndrome if administered concomitantly with other serotonergic drugs including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, amphetamines, and St. John’s Wort
Not recommended in patients with uncompensated heart failure
QT prolongation

  • Dose-dependent QT prolongation reported; do not exceed dose of 40 mg/day
  • Correct hypokalemia and hypomagnesemia before initiating and monitor periodically
  • ECG monitoring recommended in patients with CHF, bradyarrhythmias, or concomitant medications known to prolong QT interval
  • Do not exceed 20 mg/day if administered in CYP2C19 poor metabolizers, or in patients taking concomitant cimetidine or another CYP2C19 inhibitor (eg, fluconazole, omeprazole)
  • Do not exceed 20 mg/day in individuals aged 60 yr or older, or those with hepatic impairment

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Sedopram 20 mg only for the indication prescribed.