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Celexa withdrawal. How to withdrawal from Celexa safely without Celexa withdrawal side effects. Celexa withdrawal. The web site you are on now, The Road Back, offers information on how to get off Celexa, prevent Celexa withdrawal side effects as well as eliminating current Celexa side effects.

Celexa Withdrawal

You will find quite a bit of information on our web site. Our program has been updated, September 2017, with new information and an improved program. Our success rate was already high but our founder, Jim Harper, has improved it  further. A suggestion; click here and then download the free pdf file of Jim's book How to Get Off Psychoactive Drugs Safely.

The Road Back is a member of California Association of Alcoholism & Drug Abuse Counselors (CAADAC).  We have been assisting people off psychoactive medication since 1999, and have helped well over 50,000 people off their drugs. The Road Back is the largest and longest running outpatient withdrawal program in the world.

You will find on this site the complete book, How to Get Off Psychoactive Drugs Safely.

Withdrawal off of Celexa does not have to be difficult and handling current Celexa withdrawal side effects can be resolved quickly.

To begin, click How to Start located at the top of the page and select the chapter you would like to read first. If you are currently in Celexa withdrawal you may not be up to reading the entire book How to Get Off Psychoactive Drugs Safely which is located on the How to Start page. To make things easier for you and to help get you to the point of feeling well again fast, just choose from the following and when you are up to it come back to our site again and complete your program.

Nausea - Try drinking a couple of cups of ginger tea.

Head symptoms to include dizziness, an electrical known as brain zaps etc, you will need to use the Omega 3 Supreme TG. The best think to do is get the Antidepressant Package from the manufacture of the supplements made for this program. You can just follow the instructions on each bottle for how to take but ideally download the free pdf file of the book.

For supplements click here

For free pdf of book click here

Note: If you are taking Celexa as well as an anti-anxiety medication (benzodiazepine), the anti-anxiety medication should be discontinued first. If you are only discontinuing the Celexa the Celexa must be reduced very slowly to prevent withdrawal side effects from the anti-anxiety drug. Celexa slows the metabolism rate of anti-anxiety drugs and when the Celexa is removed from the system the anti-anxiety medication will not take as long to metabolize and this creates a withdrawal effect from the anti-anxiety medication.

Celexa (Citalopram)

Action and Clinical Pharmacology

On this Web Site find information about Citalopram (Celexa) Celexa. Celexa side effects, warnings, precautions, adverse effects, overdose, withdrawal symptoms and Celexa natural alternatives. Before you begin the spiral down with these drugs, try giving your body what it really wants. Celexa citalopram, asendin, celexa citalopram stress, celexa citalopram anxiety, stress, anxiety, stress celexa citalopram, anxiety celexa citalopram, CELEXA CITALOPRAM, celexa citalopram side effects, side effects celexa citalopram, celexa citalopram dangers, side effects celexa, side effects citalopram, citalopram, stress and anxiety, stress medication, stress relief, relief from stress, stress, celexa citalopram and children, celexa citalopram withdrawls, how to get off celexa citalopram, celexa citalopram therapy, ssri, ssri's, Asendin, celexa citalopram and depression, side effects of celexa citalopram, difference between celexa citalopram and celexa citalopram, celexa citalopram and depression, celexa citalopram and obsessive compulsive disorder, american psychiatric association, mental disorder, mental disorders, dangers of celexa citalopram and celexa citalopram.Antidepressant

Citalopram hydrobromide is a highly selective and potent serotonin 
(5-hydroxytryptamine 5-HT) reuptake inhibitor with minimal effects on the 
neuronal reuptake of norepinephrine (NE) and dopamine (DA). The ability 
of citalopram to potentiate serotonergic activity in the central nervous 
system via inhibition of the neuronal reuptake of serotonin is thought to be 
responsible for its antidepressant action. Tolerance to the inhibition of serotonin reuptake is not induced by long term (14 days) treatment of rats with citalopram.

Citalopram has no or very low affinity for a series of receptors including serotonin 5-HT1A, 5-HT2, dopamine D1, and D2, a1-, a2-, b-adrenergic, histamine H1, muscarinic cholinergic, benzodiazepine, gamma aminobutyric acid (GABA) and opioid receptors.

Pharmacokinetics

Absorption
Following the administration of a single oral dose of citalopram (40 mg) to healthy male volunteers, peak blood levels occurred at about 4 hours (range 1 to 6 hours). The absolute bioavailability of citalopram was about 80% (range 52 to 93%) relative to an intravenous dose. Absorption was not affected by food.

Distribution
After intravenous infusion in healthy male volunteers the apparent volume of distribution (Vd)b was about 12 L/kg (range 9-17 L/kg), indicating a pronounced tissue distribution: (Vd)b oral was about 17 L/kg (range 14-17 L/kg). The binding of citalopram and its demethylated metabolites to human plasma proteins is about 80%.

Steady-state
The single- and multiple dose pharmacokinetics of citalopram are linear and dose proportional in a dose range of 10 to 60 mg/day. Steady-state plasma levels are achieved in patients in 1-2 weeks. At a daily dose of 40 mg, the average plasma concentration is about 83 ng/mL (n=114) with a range from 30 to 200 ng/mL. Citalopram does not accumulate during long term treatment. A clear relationship between citalopram plasma levels and therapeutic response or side effects has not been established.

Metabolism
Citalopram is metabolized in the liver to demethylcitalopram (DCT), didemethylcitalopram (DDCT), citalopram N-oxide and a deaninated propionic acid derivative. In vitro studies show that DCT, DDCT and citalopram-N-oxide also inhibit the neuronal reuptake of serotonin but are less selective and less potent than the parent compound and are of minor clinical importance. Unchanged citalopram is the predominant compound in plasma. In vitro studies indicated that the biotransformation of citalopram to its demethyl metabolites depends on both CYP2C19 and CYP3A4, with a small contribution from CYP2D6.

Elimination
The elimination half life of citalopram (t1/2b) is approximately 37 hours (range 30-42 hours) which allows recommendation of once-daily dosing. The systemic citalopram plasma clearance (Cl5) is 0.33 L/min. Citalopram is eliminated primarily via the liver (85%) and the remainder via the kidneys; approximately 12% (range 6-21%) of the daily dose is excreted in urine as unchanged citalopram.

Special Populations:  

Elderly Patients
Elderly patients (4 males and 7 females aged 73-90 years), received a 20 mg/day dose of citalopram for 3-4 weeks. In the elderly, steady state plasma levels were elevated (106 ng/mL), half-life prolonged (1.5-3.75 days) and clearance decreased (0.08-0.3 L/min). Elevation of citalopram plasma levels occurred at an earlier age in females than in males, In this population, lower doses and a lower maximum dose of citalopram are recommended.

Reduced Hepatic Function
The pharmacokinetics of citalopram were compared in patients with reduced hepatic function (3 female and 6 male patients aged 41-60 years) to those seen in 12 healthy male volunteers (aged 21-43 years), In patients with reduced hepatic function the half-life of citalopram was approximately doubled (83 hours versus 37 hours), steady state citalopram concentrations increased by 61% and oral clearance decreased by 37%. Consequently the use of citalopram in patients with reduced hepatic function should be approached with caution and lower maximal doses should be prescribed (see PRECAUTIONS and DOSAGE AND ADMINISTRATION).

Reduced Renal Function
In patients with mild to moderate reduction of the renal function (4 females and 3 males, aged 30-55 years), citalopram was being eliminated more slowly than in 12 healthy male volunteers (aged 21-43 years), half-lives being 49 hours versus 37 hours. However, mild to moderate renal impairment had no major influence on the kinetics of citalopram. At present, no information is available for chronic treatment of patients with severely reduced renal function (creatinine clearance <20 mL/min). 

Indications and Clinical Use  

Citalopram hydrobromide is indicated for the symptomatic relief of depressive illness.

The relapse rate was significantly lower in citalopram-treated patients than in placebo-treated patients in two placebo-controlled studies, that were conducted over a 24-week period in patients who responded to 6 or 8 weeks of acute treatment with citalopram (see CLINICAL TRIALS under ACTION AND CLINICAL PHARMACOLOGY.) Nevertheless, the physician who elects to use citalopram for extended periods should periodically reevaluate the long-term usefulness of the drug for the individual patient.

Contraindications  

Citalopram hydrobromide is contraindicated in patients with known hypersensitivity to citalopram hydrobromide or the excipients of the drug product.

Monoamine Oxidase Inhibitors
In patients, receiving selective serotonin reuptake inhibitors (SSRIs) in combination with a monoamine oxidase inhibitor (MAOI), there have been reports of serious, sometimes fatal, reactions including hyperthermia, rigidity, myoclonus, autonomic instability with possible rapid fluctuations of vital signs, and mental status changes, including extreme agitation progressing to delirium and coma. These reactions have also been reported in patients who have recently discontinued SSRI treatment and have been started on a MAOI. Some cases presented with features resembling serotonin syndrome. Therefore, it is recommended that citalopram should not be used in combination with a MAOI or within 14 days of discontinuing treatment with a MAOI. Similarly, at least 14 days should elapse after discontinuing citalopram treatment before starting a MAOI.

Precautions  

Suicide
The possibility of a suicide attempt is inherent in depression and may persist until remission occurs. Therefore, high risk patients should be closely supervised throughout therapy with Citalopram hydrobromide and consideration should be given to the possible need for hospitalization. In order to minimize the opportunity for overdosage, prescription for citalopram should be written for the smallest quantity of drug consistent with good patient management.

Activation of Mania/Hypomania
In placebo-controlled trials with citalopram, some of which included patients with bipolar disorder, mania/hypomania was reported in 0.1% of 1027 patents treated with citalopram versus none of the 426 patients treated with placebo. Activation of mania/hypomania has also been reported in a small proportion of patients with major affective disorders treated with other marketed antidepressants. If a patient enters a manic phase, citalopram should be discontinued.

Seizures
Citalopram has not been systematically evaluated in patients with a seizure disorder. These patients were excluded from clinical studies during the premarketing testing of citalopram. In clinical trials, seizures occurred in 0.25% of patients treated with citalopram and in 0.23% patients treated with placebo. Like other antidepressants, citalopram should be used with caution in patients with a history of seizure disorder.

Serotonin Syndrome
Rarely, the occurrence of serotonin syndrome has been reported in patients receiving SSRIs. A combination of symptoms, possibly including agitation, confusion, tremor, myoclonus and hyperthermia, may indicate the development of this condition.

5-HT1 Agonists
There have been rare postmarketing reports describing patients with weakness, hyperreflexia and incoordination, following the concomitant use of a SSRI and the antimigraine drug sumatriptan, a 5-HT1 agonist. Such interaction should be considered if citalopram is to be used in combination with a 5-HT1 agonist.

Hyponatremia
Hyponatremia and SIADH (syndrome of inappropriate antidiuretic hormone secretion) have been reported with citalopram use as a rare adverse event.

Pregnancy and Nursing Mothers
The safety of citalopram during pregnancy and lactation has not been established. Therefore, citalopram should not be used during pregnancy, unless, in the opinion of the physician, the expected benefits to the patient markedly outweigh the possible hazards to the fetus. Citalopram is excreted in human milk. Citalopram should not be administered to nursing mothers unless, in the opinion of the treating physician, the expected benefits to the patient markedly outweigh the possible hazards to the child.

Pediatric Use
Safety and effectiveness in patients below the age of 18 have not been established.

Geriatric Use
In premarketing clinical trials, 800 elderly patients (>=65 years of age) have been treated with citalopram. Of these patients 298 were >=75 years old. In a pharmacokinetic study (n=11, age 73 to 90 years), clearance was substantially decreased and half-life prolonged (see PHARMACOKINETICS). In a 6-week placebo-controlled study, approximately equal numbers of patients received citalopram at 20 or 30 mg per day, as the final dose. In about 5% of patients, the final dose was 10 mg per day (see CLINICAL TRIALS). Consequently, elderly patients should be administered lower doses and a lower maximum dose.

Hepatic Impairment
Citalopram clearance was significantly decreased and plasma concentrations, as well as elimination half-life significantly increased (see PHARMACOKINETICS). Consequently, the use of citalopram in hepatically impaired patients should be approached with caution and a lower maximum dosage is recommended.

Renal Impairment
No dosage adjustment is needed in patients with mild to moderate renal impairment. To date, no information is available on the pharmacokinetic or pharmacodynamic effects of citalopram in patients with severely reduced renal function (creatinine clearance <20 mL/min).

Use in Patients with Cardiac Disease
Citalopram has not been systematically evaluated in patients with a recent history of myocardial infarction or unstable heart disease. Patients with these diagnoses were generally excluded from clinical trials during the drugs premarketing assessment. However, the electrocardiograms of patients, who received citalopram in clinical trials, indicate that citalopram was not associated with the development of clinically significant ECG abnormalities.

In clinical trials, citalopram caused small but statistically significant decreases in heart rate (see ECG under ADVERSE REACTIONS) Consequently, caution should be observed when citalopram is initiated in patients with pre-existing slow heart rate.

Use in Diabetic Patients
Citalopram has not been systematically evaluated in diabetic patients since diabetes constituted an exclusion criterion. Although 13 patients did receive insulin during the studies, this number is too small to determine whether citalopram affects the response to insulin. Rare events of hypoglycemia were reported. Citalopram should be used with caution in diabetic patients on insulin or other antidiabetic drugs.

Interference with Cognitive and Motor Performance
In studies in normal volunteers, citalopram in doses of 40 mg/day did not impair cognitive function or psychomotor performance. However, psychotropic medications may impair judgement, thinking or motor skills. Consequently, patients should be cautioned against driving a car or operating hazardous machinery until they are reasonably certain that citalopram does not affect them adversely.

Electroconvulsive Therapy (ECT)
The safety and efficacy of the concurrent use of citalopram and ECT have not been studied.

Abrupt Discontinuation  

After 8 weeks of treatment with citalopram, abrupt discontinuation of treatment caused a higher incidence of anxiety, emotional indifference, impaired concentration, headache, migraine, paresthesia, and tremor than was seen in patients who continued on citalopram. These symptoms are not indicative of addiction.

Although it is not known whether gradual discontinuation will prevent the discontinuation symptoms, it is recommended that the dosage of citalopram should be tapered off over 1 to 2 weeks.

Additional Adverse Events Observed During the Premarketing Evaluation of Citalopram  

The events listed below include all adverse events that were reported in the overall development program of citalopram (n=3652). All reported events are included except those already listed in Table 1 and those events which occurred in only one patient. It is important to emphasize that, although the events reported occurred during treatment with citalopram, they were not necessarily caused by it. The events are enumerated using the following criteria: frequent: adverse events that occurred on one or more occasions in at least 1/100 patients; infrequent: adverse events that occurred in less than 1/100 patients but at least in 1/1000 patients; rare: adverse events that occurred in fewer than 1/1000 patients.

Body as a Whole - General Disorders
Frequent: Influenza-like symptoms, nonpathological trauma, pain. Infrequent: Alcohol intolerance, allergic reaction, allergy, chest pain, edema, hot flushes, leg pain, malaise. rigors, syncope. Rare: Peripheral edema, sudden death, traumatic injury.

Cardiovascular Disorders
Frequent: Postural hypotension, tachycardia. Infrequent: Angina pectoris, arrhythmia. bradycardia, cardiac failure, cerebrovascular disorders, edema dependent, extrasystoles, flushing, hypertension, hypotension, myocardial infarction, myocardial ischemia, peripheral ischemia. Rare: Aggravated hypertension, bundle branch block, cardiac arrest, coronary artery disorder, ECG abnormal, heart disorder, phlebitis, supraventricular extrasystoles.

Central and Peripheral Nervous System Disorders
Frequent: Migraine, paraesthesia. Infrequent: Abnormal gait, ataxia, convulsions, dysphonia, dystonia, extrapyramidal disorder, hyperkinesia, hypertonia, hypoesthesia, hypokinesia, involuntary muscle contractions, leg cramps, neuralgia, speech disorder, vertigo Rare: Abnormal coordination, convulsions grand mal, hyperesthesia, ptosis, sensory disturbance, stupor.

Collagen Disorders
Rare: Rheumatoid arthritis.

Endocrine Disorders
Rare: Goiter, gynecomastia, hypothyroidism.

Gastrointestinal System Disorders
Frequent: Flatulence. Infrequent: Colitis, dental abscess, dysphagia, eructation, gastritis, gastroenteritis, gastrointestinal disorder (not specified), hemorrhoids, increased saliva, teeth-grinding, toothache. Rare: Appendicitis, esophagitis, gastric ulcer, gastroesophageal reflux, gingivitis, stomatitis, tooth disorder, ulcerative stomatitis.

Hematopoietic and Lymphatic Disorders
Infrequent: Anemia, epistaxis, leukocytosis, purpura. Rare: Coagulation disorder, gingival bleeding, granuloytopenia, hematoma, leukopenia, lymphadenopathy, lymphocytosis, pulmonary embolism.

Liver and Biliary System Disorders.
Infrequent: Cholecystitis, cholelithiasis, increased gamma-GT, increased SGPT. Rare: Bilirubinemia, increased SGOT, jaundice.

Metabolic and Nutritional Disorders
Frequent: Weight decrease, weight increase. Infrequent: Leg edema, xerophthalmia. Rare: Dehydration, edema, hypoglycemia, hypokalemia, increased alkaline phosphatase, obesity, thirst.

Musculo-Skeletal System Disorders
Infrequent: Arthralgia, arthritis, arthrosis, dystonia, muscle weakness, myalgia. Rare: Bone disorder, bursitis, osteoporosis, tendon disorder.

Neoplasm
Rare: Breast neoplasm malignant female.

Psychiatric Disorders
Frequent: Abnormal dreaming, aggravated depression, amnesia, apathy, confusion, depression, impaired concentration, increased appetite, sleep disorder, suicide attempt. Infrequent: Abnormal thinking, aggressive reaction, delusion, depersonalization, drug abuse, drug dependence, emotional lability, euphoria, hallucination, increased libido, manic reaction, neurosis, paranoid reaction, paroniria, psychosis, psychotic depression. Rare: Catatonic reaction, hysteria, personality disorder.

Reproductive Disorders, Female
Infrequent: Amenorrhea, breast pain, lactation nonpuerperal, menorrhagia, menstrual disorder, premenstrual syndrome, salpingitis, unintended pregnancy, vaginal dryness, vaginitis. Rare: Breast enlargement, vaginal hemorrhage.

Reproductive Disorders, Male
Infrequent: Penis disorder, prostatic disorder, testis disorder.

Resistance Mechanism Disorders
Infrequent: Abscess, fungal infection, herpes simplex infection, otitis media, viral infection. Rare: Bacterial infection, moniliasis, sepsis.

Respiratory System Disorders
Infrequent: Bronchitis, coughing, dyspnea, pneumonia. Rare: Asthma, bronchospasm, increased sputum, laryngitis, pneumonitis, respiratory disorder.

Skin and Appendage Disorders
Frequent: Pruritus, rash. Infrequent: Acne, alopecia, dermatitis, dry skin, eczema, photosensitivity reaction, psoriasis, rash erythematous, rash maculo-papular, skin discoloration, urticaria. Rare: Cellulitis, decreased sweating, hypertrichosis, melanosis, pruritus ani.

Special Senses, Vision, Hearing and Vestibular Disorders
Frequent: Abnormal accommodation. Infrequent: Conjunctivitis, earache, eye pain, mydriasis, taste perversion, tinnitus. Rare: Eye abnormality, keratitis, photophobia.

Urinary System Disorders
Frequent: Polyuria. Infrequent: Abnormal urine, cystitis, hematuria, micturition frequency, urinary incontinence, urinary retention, urinary tract infection. Rare: Dysuria, facial edema, oliguria, renal calculus, renal pain.

Events Observed During the Post-Marketing Evaluation of Citalopram  

It is estimated that approximately 8 million patients have been treated with citalopram since market introduction. The following adverse events have been reported to be temporarily associated with citalopram treatment in at least 3 patients and are not described elsewhere in labeling.

Abnormal hepatic function, aggravated condition, aggravated migraine, angioedema, asthma, choreoathetosis, decreased drug level, decreased prothrombin time, dyskinesia, eosinophilia, erythema multiforms, gynecological problems, hepatitis, hyperprolactinemia, hyponatremia, increased drug level, increased prothrombin time, mydriasis, neuroleptic malignant syndrome, neuropathy, pancreatitis, pancytopenia, postural hypotension, serotonin syndrome, SIADH, spontaneous abortion/fetal death, thrombocytopenia, ventricular arrhythmia, Torsade de pointes, withdrawal syndrome.

Adverse Findings Observed in Short-Term, Placebo-Controlled Trials

Adverse Reactions Associated with Discontinuation of Treatment
From the short-term (4 to 6 weeks) placebo-controlled, Phase III clinical trials, 15.9% (163/1027) of the citalopram-treated patients discontinued treatment due to an adverse event. The discontinuation rate in the placebo-treated patients was 7.7% (33/426).

The events associated with discontinuation of citalopram in 1% or more of patients at a rate of at least twice that of placebo, were as follows: Nausea (4.1% versus 0.0%), insomnia (2.4% versus 12%), somnolence (2.4% versus 1.2%), dizziness (2.3% versus 0.7%), vomiting (1.3% versus 0.0%), agitation (1.2% versus 0.0%), asthenia (11% versus 0.5%), and dry mouth (1.1% versus 0.2%).

Incidence of Adverse Events in Placebo-controlled Studies
Table 1 enumerates the incidence of treatment-emergent adverse events that occurred in 1027 depressed patients who received citalopram at doses ranging from 10 to 80 mg/day in placebo-controlled trials of up to 6 weeks in duration. Events included are those occurring in 2% or more of patients treated with citalopram, and for which the incidence in patients treated with citalopram was greater than the incidence in placebo-treated patients. Reported adverse events were classified using the standard World Health Organization (WHO)-based dictionary terminology.

The prescriber should be aware that these figures cannot be used to predict the incidence of adverse events in the course of usual medical practice where patient characteristics and other factors differ from those which prevailed in the clinical trials. Similarly, the cited frequencies cannot be compared with figures obtained from other clinical investigations involving different treatments, uses, and investigators. The cited figures, however, do provide the prescribing physician with some basis for estimating the relative contribution of drug and non-drug favors to the adverse event incidence rate in the population studied.

 

 

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