Citalopram - a review of pharmacological and clinical effects

Objective: To provide clinicians with a critical evaluation of citalopram, a selective serotonin reuptake inhibitor (SSRI) that has been available in Canada since March 1999. Data sources: Commercial searches (MEDLINE and Bib lioTech) and an "in-house" search (InfoDrug) were used to find published En glish-language references for clinical and preclinical publications. There was no restriction of publication dates. Primary index terms used were: pha rmacological properties, receptors, pharmacological selectivity, pharmacoki netics, age-related pharmacokinetics, sex-related pharmacokinetics, renal d ysfunction, hepatic dysfunction, cytochrome activity, drug interactions, ad verse reactions, antidepressant switching, precautions, overdose, drug disc ontinuation, children, geriatric, depression, combination therapy, placebo control, refractory depression, anxiety disorders and medical disorders. St udy selection: A total of 74 studies were reviewed. Twenty-one of these stu dies specifically examined the clinical efficacy and tolerability of citalo pram in depressive disorders as well as other disorders. In depressive diso rders, clinical studies were required to have either placebo or active comp arison controls for a minimum of 3 weeks. For other disorders, in the absen ce of double-blind trials, open-label studies were included. Pharmacologica l studies were limited to animal studies focusing on citalopram's selectivi ty and receptor specificity, and positron emission tomography studies were incorporated to include human pharmacological data. Pharmacokinetic studies focused on the metabolism, safety and tolerability of citalopram, specific ally with reference to adverse reactions, drug interactions and overdose in addition to citalopram's effect on vulnerable populations, such as childre n, the elderly and patients with metabolic diseases. Data extraction: Data on clinical studies were summarized according to test measures, study durat ion and outcome of study. Pharmacokinetic and pharmacodynamic studies were summarized according to properties and interactions. Adverse reactions were extracted to outline citalopram's safety profile. Data synthesis: Citalopr am is an SSRI antidepressant with a more specific and selective pharmacolog ical profile than other antidepressants of its class. It is well tolerated, and drug interactions are not a significant concern. It is also reasonably safe for populations vulnerable to pharmacokinetic effects, such as the el derly and patients with metabolic diseases. In addition to its tolerability , citalopram is effective in the treatment of major depression, other depre ssive disorders and panic disorder. It has the potential to effectively tre at other anxiety disorders and substance-use disorders; in addition, it may be useful in several medical conditions. Conclusions: There is evidence to support the role of citalopram as a well-tolerated and effective SSRI anti depressant. There is a need for further evaluation of its role in psychiatr ic disorders other than major depressive disorder.