OVERDOSAGE
Human Experience
In clinical trials of citalopram, there were reports of
citalopram overdose, including overdoses of up to 2000mg, with no associated
fatalities. During the postmarketing evaluation of citalopram, Celexa overdoses,
including overdoses of up to 6000 mg, have been reported. As with other SSRI's,
a fatal outcome in a patient who has taken an overdose of citalopram has been
rarely reported.
Symptoms most often accompanying citalopram overdose, alone or in combination
with other drugs and/or alcohol, included dizziness, sweating, nausea, vomiting,
tremor, somnolence, and sinus tachycardia. In more rare cases, observed symptoms
included amnesia, confusion, coma, convulsions, hyperventilation, cyanosis,
rhabdomyolysis, and ECG changes (including QTc prolongation, nodal rhythm,
ventricular arrhythmia, and very rare cases of torsade de pointes). Acute renal
failure has been very rarely reported accompanying overdose.
Management of Overdose
Establish and maintain an airway to ensure adequate ventilation
and oxygenation. Gastric evacuation by lavage and use of activated charcoal
should be considered. Careful observation and cardiac and vital sign monitoring
are recommended, along with general symptomatic and supportive care. Due to the
large volume of distribution of citalopram, forced diuresis, dialysis,
hemoperfusion, and exchange transfusion are unlikely to be of benefit. There are
no specific antidotes for Celexa.
In managing overdosage, consider the possibility of multiple-drug
involvement. The physician should consider contacting a poison control center
for additional information on the treatment of any overdose.
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DRUG ABUSE AND DEPENDENCE
Controlled Substance Class
Celexa (citalopram HBr) is not a controlled substance.
Physical and Psychological Dependence
Animal studies suggest that the abuse liability of Celexa is low.
Celexa has not been systematically studied in humans for its potential for
abuse, tolerance, or physical dependence. The premarketing clinical experience
with Celexa did not reveal any drug-seeking behavior. However, these
observations were not systematic and it is not possible to predict, on the basis
of this limited experience, the extent to which a CNS-active drug will be
misused, diverted, and/or abused once marketed. Consequently, physicians should
carefully evaluate Celexa patients for history of drug abuse and
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