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Citalopram hydrobromide is a selective serotonin reuptake inhibitor. The primary FDA-approved clinical use for citalopram hydrobromide is for treating depression in adults. Off-label uses include alcohol use disorder, coronary arteriosclerosis, obsessive-compulsive disorder, panic disorder, postmenopausal flushing, and premenstrual dysphoric disorder. Citalopram is listed in the WHO model list of essential medicines to treat depressive disorders. Citalopram hydrobromide exerts its antidepressant action by potentiating serotonergic activity in the central nervous system. Multiple studies confirmed that citalopram hydrobromide is a selective serotonin reuptake inhibitor (SSRI) that has minimal effects on norepinephrine and dopamine neuronal reuptake. This activity reviews the indications, mechanism of action, administration, contraindications, monitoring, toxicity associated with citalopram, and the interprofessional team's role in caring for patients with conditions treated with citalopram. Objectives: Identify the FDA-approved and off-label indications for citalopram. Apply evidence-based guidelines and recommendations when selecting citalopram as a treatment option. Assess patients for potential adverse effects associated with citalopram. Collaborate with mental health specialists, pharmacists, and other healthcare team members to optimize citalopram therapy and ensure the best outcomes with minimal adverse events. Access free multiple choice questions on this topic.

Studies reveal that citalopram toxicity is not common, even at doses up to 100 mg. However, there is a chance of developing serotonin hyperactivity at therapeutic doses, primarily if using another serotonergic medication concomitantly. In the event of an intentional overdose, the ingestion of more than 600 mg of citalopram requires 8 hours of cardiac monitoring. At the end of the observation period, the patient can be discharged if the patient is asymptomatic and QTc is less than 450 milliseconds. However, continued inpatient cardiac monitoring is necessary for patients with QTc greater than 450 milliseconds at the end of the observation period.[48] Case reports also describe recurrent seizures associated with massive citalopram overdose. Seizures should be treated with benzodiazepines.[49] Management of serotonin syndrome requires withdrawal of the citalopram and aggressive supportive treatment for hyperthermia and autonomic dysfunction. Cyproheptadine, a serotonin antagonist (5HT2 receptors), can be administered.[50]

Citalopram hydrobromide is a widely prescribed antidepressant by nurse practitioners, primary care providers, psychiatrists, internists, and neurologists. While the drug is effective for depression, its use requires monitoring. Prescribers should be careful as citalopram correlates with suicidality and worsening depression, especially in children, adolescents, and young adults (younger than 24 years old). Also, clinicians should monitor electrolytes and obtain an ECG before starting treatment because of the risk of prolonged QT syndrome. Nurses and pharmacists should counsel and educate patients not to combine the drug with alcohol, sedatives, and other antidepressants. In an overdose, the rapid response team and the emergency clinician should rapidly stabilize the patient. Thus, an interprofessional approach that includes clinicians and pharmacists who operate as an integrated team with open communication is optimal for employing citalopram therapy, resulting in better patient outcomes with fewer adverse events.