Mosby's 2014 Nursing Drug Reference (97 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(sigh-tal′oh-pram)
Celexa
Func. class.:
Antidepressant
Chem. class.:
Selective serotonin reuptake inhibitor (SSRI)
Do not confuse:
CeleXA
/CeleBREX/Cerebyx/Cerebra/Zyprexa
Inhibits CNS neuron uptake of serotonin but not of norepinephrine; weak inhibitor of CYP450 enzyme system, thus making it more appealing than other products
Major depressive disorder
Unlabeled uses:
Premenstrual disorders, panic disorder, social phobia, impulsive aggression in children, obsessive-compulsive disorder in adolescents; treatment of psychotic symptoms in nondepressed demented patients; anxiety, hot flashes, menopause; adjunct in schizophrenia, PTSD
Hypersensitivity
Precautions:
Pregnancy (C), breastfeeding, geriatric patients, renal/hepatic disease, seizure disorder, hypersensitivity to escitalopram
Black Box Warning:
Children, suicidal ideation
Calculator
• Adult:
PO
20 mg/day
AM
or
PM
, may increase if needed to 40 mg/day after 1 wk; maintenance: after 6-8 wk of initial treatment, continue for 24 wk (32 wk total), reevaluate long-term usefulness (max 40 mg/day)
• Adult:
PO
20 mg/day
• Adult:
PO
20-40 mg/day
• Adult:
PO
10-30 mg/day, used intermittently in premenstrual dysphoria
Available forms:
Tabs 10, 20, 40 mg; oral sol 10 mg/5 ml
•
With food or milk for GI symptoms
•
Crushed if patient is unable to swallow medication whole
•
Dosages at bedtime if oversedation occurs during the day; may take entire dose at bedtime
•
Do not give within 14 days of MAOIs
CNS:
Headache, nervousness, insomnia, drowsiness, anxiety, tremor, dizziness, fatigue, sedation, poor concentration, abnormal dreams, agitation
,
seizures,
apathy, euphoria, hallucinations, delusions, psychosis,
suicidal attempts, neuroleptic malignant-like syndrome reactions
CV:
Hot flashes, palpitations
, angina pectoris,
hemorrhage,
hypertension, tachycardia, 1st-degree AV block, bradycardia,
MI,
thrombophlebitis
EENT:
Visual changes, ear/eye pain, photophobia, tinnitus
GI:
Nausea, diarrhea, dry mouth, anorexia, dyspepsia, constipation, cramps, vomiting, taste changes, flatulence, decreased appetite
GU:
Dysmenorrhea, decreased libido, urinary frequency, UTI
, amenorrhea, cystitis, impotence, urine retention
INTEG:
Sweating, rash, pruritus
, acne, alopecia, urticaria
MS:
Pain
, arthritis, twitching
RESP:
Infection, pharyngitis, nasal congestion, sinus headache, sinusitis, cough, dyspnea, bronchitis
, asthma, hyperventilation, pneumonia
SYST:
Asthenia, viral infection, fever, allergy, chills;
hyponatremia (geriatric patients),
serotonin syndrome
Metabolized in liver by CYP3A4, CYP2C19; excreted in urine; steady state 1 wk; peak 4 hr; half-life 35 hr
Fatal reactions: do not use with MAOIs
Increase:
QTc interval—dofetilide, halofantrine, probucol, pimoside, quinolones, ziprasidone; do not use together
Increase:
effect of tricyclics; use cautiously
Increase:
serotonin syndrome—serotonin receptor agonists, SSRIs, traMADol, lithium, MAOIs, traZODone, SNRIs (venlafaxine, DULoxetine)
Increase:
bleeding risk—NSAIDs, salicylates, thrombolytics, anticoagulants, antiplatelets
Increase:
CNS effects—barbiturates, sedative/hypnotics, other CNS depressants
Increase:
citalopram levels—macrolides, azole antifungals
Increase:
plasma levels of β-blockers
Decrease:
citalopram levels—carBAMazepine, cloNIDine
Increase:
serotonin syndrome—St. John’s wort, SAM-e; fatal reaction may occur; do not use concurrently
Increase:
CNS stimulation—yohimbe
Increase:
serum bilirubin, blood glucose, alk phos
Decrease:
VMA, 5-HIAA
False increase:
urinary catecholamines
Black Box Warning
Mental status: mood, sensorium, affect, suicidal tendencies, increase in psychiatric symptoms, depression, panic
Serotonin syndrome: increased heart rate, sweating, dilated pupils, tremors, twitching, hyperthermia, agitation
•
B/P lying, standing, pulse q4hr; if systolic B/P drops 20 mm Hg, hold product, notify prescriber; take vital signs q4hr in patients with CV disease
•
Weight weekly; appetite may decrease or increase with product
•
Torsades de pointes, QT prolongation:
is dose-dependent, ECG for flattening of T wave, bundle branch, AV block, dysrhythmias in cardiac patients
•
Alcohol consumption; if alcohol is consumed, hold dose until
AM
•
Sexual dysfunction: erectile dysfunction, decreased libido
•
Storage at room temp; do not freeze
•
Assistance with ambulation during therapy, since drowsiness, dizziness occur
•
Safety measures, primarily for geriatric patients
•
Check to confirm PO medication swallowed
•
Sugarless gum, hard candy, frequent sips of water for dry mouth
•
Therapeutic response: decreased depression
•
That therapeutic effect may take 4-6 wk, that patient may have increased anxiety 1st 5-7 days of therapy
•
To use caution when driving, performing other activities that require alertness because of drowsiness, dizziness, blurred vision; to report signs, symptoms of bleeding
•
To avoid alcohol, other CNS depressants
Black Box Warning:
That suicidal ideas, behavior may occur in children or young adults
•
To notify prescriber if pregnant, planning to become pregnant, or breastfeeding
About the effects of serotonin syndrome: nausea/vomiting, tremors; if symptoms occur, to discontinue immediately, notify prescriber