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    Citalopram molecular structure

    Citalopram Stats & Data

    Celexa Cipramil
    NPS DataHub
    MW324.4
    FormulaC20H21FN2O
    CAS59729-33-8
    IUPAC1-(3-dimethylaminopropyl)-1-(4-fluorophenyl)-3H-2-benzofuran-5-carbonitrile
    SMILESN#Cc1ccc2c(COC2(CCCN(C)C)c2ccc(F)cc2)c1
    InChIKeyWSEQXVZVJXJVFP-UHFFFAOYSA-N
    Chemical Class Phthalane

    Pharmacology

    DrugBank
    Half-life About 35 hours . State Solid

    Description

    Citalopram belongs to a class of antidepressant agents known as selective _serotonin-reuptake inhibitors_ (SSRIs) and is widely used to treat the symptoms of depression. Its chemical structure is unrelated to that of other SSRIs or of tricyclic, tetracyclic, or other prescribed antidepressants . Citalopram is also known as _Celexa_, and available in tablet and solution forms . This drug was initially approved by the FDA in 1998 .

    Mechanism of Action

    The mechanism of action of citalopram results from its inhibition of CNS neuronal reuptake of serotonin (5-HT) . The molecular target for citalopram is the serotonin transporter (solute carrier family 6 member 4, _SLC6A4_), inhibiting its serotonin reuptake in the synaptic cleft . Citalopram binds with significantly less affinity to histamine, acetylcholine, and norepinephrine receptors than tricyclic antidepressant drugs . This drug has no or neglible affinity for _5-HT1A_, _5-HT2A_, _dopamine D_1 and _D2_, _α1-_, _α2_-, and_ β­ adrenergic_, _histamine H1_, _gamma-aminobutyric acid_ (GABA), _muscarinic_, _cholinergic_, and _benzodiazepine_ receptors. Antagonism of _muscarinic_, _histaminergic_, and _adrenergic receptors_ is thought to be associated with several anticholinergic, sedative, and cardiovascular effects of other psychotropic drugs .

    Pharmacodynamics

    Citalopram belongs to a class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs). It has been found to relieve or manage symptoms of depression, anxiety, eating disorders and obsessive-compulsive disorder among other mood disorders. The antidepressant, anti-anxiety, and other actions of citalopram are linked to its inhibition of CNS central uptake of serotonin . Serotonergic abnormalities have been reported in patients with mood disorders. Behavioral and neuropsychological of effects of serotonin include the regulation of mood, perception, reward, anger, aggression, appetite, memory, sexuality, and attention, as examples. The onset of action for depression is approximately 1 to 4 weeks. The complete response may take 8-12 weeks after initiation of citalopram . <i>In vitro</i> studies demonstrate that citalopram is a strong and selective inhibitor of neuronal serotonin reuptake and has weak effects on norepinephrine and dopamine central reuptake. The chronic administration of citalopram has been shown to downregulate central norepinephrine receptors, similar to other drugs effective in the treatment of major depressive disorder. Citalopram does not inhibit monoamine oxidase .

    Metabolism

    Citalopram is metabolized mainly in the liver via <i>N</i>-demethylation to its main metabolite, _demethylcitalopram_ by CYP2C19 and CYP3A4 . Other metabolites include _didemethylcitalopram_ via CYP2D6 metabolism, and _citalopram <i>N</i>-oxide_ via monoamine oxidase enzymes and aldehyde oxidase. It is a deaminated propionic acid derivative . After a single dose of citalopram, peak blood concentrations occur at approximately 4 hours . This drug in is found mainly unchanged in the plasma as citalopram. Cytochrome P450 (CYP) 3A4 and 2C19 isozymes appear to be heavily involved in producing _demethylcitalopram_. Demethylcitalopram appears to be further <i>N</i>-demethylated by CYP2D6 to didemethylcitalopram. Citalopram metabolites exert little pharmacologic activity in comparison to the parent drug and are not likely to contribute to the clinical effect of citalopram .

    Absorption

    Rapidly and well absorbed from the GI tract. Peak plasma concentrations occur within 4 hours of a single orally administered dose. Bioavailability is 80% following oral administration. Food does not affect absorption .

    Indication

    For the treatment of depression, as indicated by the FDA label . Off-label indications include but are not limited to: treatment of sexual dysfunction, post-stroke behavioural changes, ethanol abuse, obsessive-compulsive disorder (OCD) in children, and diabetic neuropathy , , , , , , , .

    Protein Binding

    Citalopram, dimethylcitalopram, and didemethylcitalopram are 80% bound to plasma proteins .

    Elimination

    12-23% of an oral dose of citalopram is found unchanged in the urine, while 10% of the dose is found in the faeces .

    Volume of Distribution

    12 L/kg Citalopram is highly lipophilic and likely widely distributed throughout the body, including the blood-brain-barrier. However, its metabolite, _demethylcitalopram_ does not penetrate the blood-brain-barrier well .

    Clearance

    The systemic clearance of citalopram is 330 mL/min, with approximately 20% renal clearance .

    Measured Affinities

    Guide to PHARMACOLOGY

    Measured binding and functional data for citalopram, curated by the IUPHAR/BPS Guide to PHARMACOLOGY. Each row cites the paper it came from. Lower concentrations mean tighter binding — a value in the sub-nanomolar range indicates a very potent interaction.

    Target Action Measure Value Concentration Species Source
    SERT SLC6A4 Inhibition pKi 8.36 4.37 nM Human PMID 18487050
    NET SLC6A2 Inhibition pKi 3 1,000,000 nM Human PMID 23168018

    Reading this. pKi, pEC50 and pIC50 are negative log molar values, so a higher number means a tighter interaction; the concentration column converts them for you. Values from non-human species are laboratory measurements and do not translate directly to human effect. Receptor affinity is not a dose — it describes what a molecule binds, not how much of it is safe to take.

    Receptor data from the IUPHAR/BPS Guide to PHARMACOLOGY (v2026.2), licensed CC BY-SA 4.0. Matched to this substance by InChIKey.

    Toxicity

    PubChem DrugBank

    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). 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.

    Carcinogenicity

    No indication of carcinogenicity to humans (not listed by IARC).

    Toxicity (DrugBank)

    **Oral (Human) LD**: 56 mg/kg **Intraperitoneal (Mouse) LD50**: 179 mg/kg **Acute toxicity** Symptoms of toxicity include dizziness, sweating, nausea, vomiting, tremor, somnolence, and sinus tachycardia. Rarely, symptoms included amnesia, confusion, coma, convulsions, hyperventilation, cyanosis, rhabdomyolysis, and ECG changes (including QTc prolongation, nodal rhythm, ventricular arrhythmia, and extremely rare cases of cardiac torsade de pointes) may occur. Acute renal failure has been a rare occurrence . In cases of overdose, establish and maintain the airway to ensure adequate ventilation and oxygen delivery. Due to the large volume of distribution of citalopram, forced diuresis, dialysis, hemoperfusion, and exchange transfusion are unlikely to be of benefit. Gastric evacuation by lavage and use of activated charcoal should be considered. Careful observation and cardiac and vital sign monitoring are advised, in addition to supportive care. With the large volume of distribution of citalopram, forced diuresis, dialysis, hemoperfusion, and exchange transfusion are unlikely to be of benefit . **Pregnancy** This drug is categorized as pregnancy category C. In animal reproduction studies, citalopram has been shown to have adverse effects on embryo/fetal and postnatal development, which includes teratogenic effects when given at doses higher than human therapeutic doses.

    Tolerance & Pharmacokinetics

    drugs.wiki

    Tolerance Decay

    Full tolerance 3d Half tolerance 18d Baseline ~30d

    Experience Report Analysis

    Erowid
    58 Reports
    17 Single-substance
    2000–2023 Date Range
    24 With Age Data
    9 Effects Detected

    Demographics

    Gender Distribution

    Age Distribution

    Reports Over Time

    Effect Analysis

    Erowid

    Effects aggregated from 17 experience reports (17 single-substance Erowid)

    17 Reports
    9 Effects Detected
    3 Positive
    3 Adverse
    3 Neutral

    Effect Sentiment Distribution

    Confidence Distribution

    Each bar is the share of reports mentioning the effect; its whisker, and the band on the rows below, is the 95% interval: where the share could plausibly be with other reports of the same kind.

    Too few reports for bars: these effects come from 17 single-substance Erowid reports, and a bar is drawn only from 20 reports or more. With fewer, a percentage cannot tell a common effect from a rare one. Counts are shown instead. Why 20?

    Positive Effects 3

    Stimulation 6 of 17 70%
    Tactile Enhancement 3 of 17 70%
    Color Enhancement 3 of 17 70%

    Adverse Effects 3

    Anxiety 10 of 17 70%
    Confusion 5 of 17 70%
    Nausea 4 of 17 70%
    Show 3 neutral or unclassified mentions
    Sedation 5 of 17
    Auditory Effects 4 of 17
    Dissociation 3 of 17

    Also reported in combinations. In the 41 Citalopram reports where another drug was taken too, 8 (19.5%) mention hospital, emergency services or an overdose, 3 (7.3%) a seizure and 2 (4.9%) psychosis. In the 17 single-substance reports: 2, 1 and 1. These are not in the figures above: they cannot be put down to Citalopram alone, and a mention is not always something that happened to the writer.

    Dosage Distribution

    Dose distribution from experience reports, one dose per report (the first listed). Doses above Q3 + 3×IQR, far above what people typically take, are left out of the median and range and listed under each route: most are real heavy doses or overdoses, not mistakes.

    Median: 20.0 mg IQR: 20.0–40.0 mg n=39

    3 reports gave a dose above the typical range (240–340 mg), so they are not in the figures above. 1 of them mentions hospital, emergency services or an overdose. Listing a dose here does not mean it is safe.

    1 dose more than 50 times the median may be a typing or unit error and is not in the figures either: check the report.

    Show the reports
    • 340 mg · mentions hospital, emergency services or an overdose
    • 280 mg
    • 240 mg · another drug taken too

    Possibly a typing or unit error:

    • 1,400 mg · mentions hospital, emergency services or an overdose

    Real-World Dose Distribution

    Erowid

    From 96 of 100 recorded dose entries: those that state a weight (mg, g or µg), in routes with at least five of them. Values above Q3 + 3×IQR, far above what people typically take, are left out; they can include real heavy doses and overdoses, not only mistakes.

    Oral (n=91)

    Median: 20.0mg 25th: 20.0mg 75th: 40.0mg 90th: 60.0mg

    Common Combinations

    Most co-occurring substances, as a share of all 58 reports filed under Citalopram; whiskers are 95% intervals

    Form / Preparation

    Most common forms and preparations, as a share of the 12 reports that give one

    Too few reports for bars: these forms come from 12 reports, and a bar is drawn only from 20 reports or more. With fewer, a percentage cannot tell a common effect from a rare one. Counts are shown instead. Why 20?

    • Pill / Tablet 12 of 12

    Body-Weight Dosing

    Dose per kg of body weight, one dose per report (the first listed), from reports giving a weight of 30–250 kg. Doses above Q3 + 3×IQR, far above what people typically take, are left out of the median and range and listed under each route.

    Median: 0.336 mg/kg IQR: 0.256–0.579 mg/kg n=38

    3 reports gave a dose above the typical range (3.857–4.41 mg/kg), so they are not in the figures above. 1 of them mentions hospital, emergency services or an overdose. Listing a dose here does not mean it is safe.

    1 dose more than 50 times the median may be a typing or unit error and is not in the figures either: check the report.

    Show the reports

    Possibly a typing or unit error:

    • 25.735 mg/kg · mentions hospital, emergency services or an overdose

    Redose Patterns

    Redosing behavior across 57 reports

    5.3% (95% interval 2 to 14 percent) Redosed
    1.1 Avg Doses
    75m Median Interval
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