🧬 Receptor activity
Mechanism of action
The mechanism of action of citalopram is unclear but is presumed to be related to potentiation of serotonergic activity in the central nervous system (CNS) resulting from its inhibition of CNS neuronal reuptake of serotonin (5-HT), potentially through the inhibition of the serotonin transporter (solute carrier family 6 member 4, _SLC6A4_). Citalopram binds with significantly less affinity to histamine, acetylcholine, and norepinephrine receptors than tricyclic antidepressant drugs. Particularly, citalopram has no or very low affinity for 5-HT<sub>1A</sub>, 5-HT<sub>2A</sub>, dopamine D<sub>1</sub> and D<sub>2</sub>, α<sub>1</sub>-, α<sub>2</sub>-, and β-adrenergic, histamine H<sub>1</sub>, gamma aminobutyric acid (GABA), muscarinic cholinergic, and benzodiazepine receptors.
/In/ whole-cell patch clamp recording of heterologous HERG-mediated currents in transfected mammalian cells ... citalopram blocks HERG with an IC(50) of 3.97 uM. This is slightly less potent than fluoxetine in /the same/ system (IC(50) of 1.50 uM). In isolated guinea pig ventricular cardiomyocytes, citalopram inhibited L-type calcium current (I(Ca,L)). The voltage dependence of I(Ca,L) inactivation in the presence of 100 uM citalopram was shifted significantly leftward. As a result, the I(Ca,L) 'window' in citalopram was found to be smaller & leftward-shifted compared to control. /These/ effects ... may help to explain citalopram's good cardiac safety profile, given its propensity to block HERG at excessive dosages. /Salt not specified/
The study was aimed to investigate the effects of the minimal effective doses of acute citalopram (5 mg/kg), (+/-)-8-hydroxydipropylaminotetralin HBr (8-OH-DPAT; 0.1 mg/kg), & their combined treatment on the rat open field & forced swimming behaviour & post-mortem monoamine content. The animals were prospectively divided into the vehicle- and para-chlorophenylalanine (p-CPA)-pretreated (350 mg/kg) groups. Acute citalopram (5 mg/kg), 8-OH-DPAT (0.1 mg/kg), or their combined treatment had no major effect on the rat open field & forced swimming behaviour. The post-mortem catecholamine content in four brain regions studied was unchanged in all treatment groups. The combined 8-OH-DPAT (0.1 mg/kg) & citalopram (5 mg/kg) treatment partially reversed the p-CPA-induced decr of serotonin (5-HT) and 5-hydroxy-indolacetic acid (5-HIAA) content. The present experiments demonstrate that the 5-HT1A receptors mediate some of the selective serotonin reuptake inhibitor-induced biochemical phenomena.
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 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.
Pharmacokinetics
Half-life
The mean terminal half-life of citalopram is about 35 hours.
The antidepressant citalopram (CT), a selective serotonin uptake inhibitor, was given in its labelled form, 14(C)-CT, as a single oral dose in 50 mL aqueous solution (0.1 mmol/30 uCi/1.1 MBq) to four healthy male volunteers. Concentrations of radioactivity in whole blood and plasma were similar. The respective pharmacokinetic parameters were: ... half life = 90.2+/-22.5 and 79.5 +/- 14.9 hr respectively. ...
The elimination half-life of citalopram averages approximately 35 hours in adults with normal renal and hepatic function.
Absorption
The single- and multiple-dose pharmacokinetics of citalopram are linear and dose-proportional in a dose range of 10 to 40 mg/day. Biotransformation of citalopram is mainly hepatic, with a mean terminal half-life of about 35 hours. With once daily dosing, steady state plasma concentrations are achieved within approximately one week. At steady state, the extent of accumulation of citalopram in plasma, based on the half-life, is expected to be 2.5 times the plasma concentrations observed after a single dose. Following a single oral dose (40 mg tablet) of citalopram, peak blood levels occur at about 4 hours. The absolute bioavailability of citalopram was about 80% relative to an intravenous dose, and absorption is not affected by food.
Approximately 12 to 23% of an oral dose of citalopram is found unchanged in the urine, while 10% is found in feces. Following intravenous administrations of citalopram, the fraction of the drug recovered in the urine as citalopram and DCT was about 10% and 5%, respectively.
The volume of distribution of citalopram is about 12 L/kg.
The systemic clearance of citalopram was 330 mL/min, with approximately 20% of that due to renal clearance.
Like other selective serotonin-reuptake inhibitors, citalopram is a highly lipophilic compound that appears to be rapidly and well absorbed from the GI tract following oral administration. Following a single 40-mg oral dose of citalopram as a tablet, the manufacturer states that peak plasma concentrations averaging approximately 44 ng/mL occur at about 4 hours.
The absolute bioavailability of citalopram is approximately 80% relative to an IV dose. The oral tablets and solution of citalopram reportedly are bioequivalent. Food does not substantially affect the absorption of citalopram.
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, _citalopram <i>N</i>-oxide_ and propionic acid derivative via monoamine oxidase enzymes A and B and aldehyde oxidase. Citalopram metabolites exert little pharmacologic activity in comparison to the parent drug and are not likely to contribute to the clinical effect of citalopram.
In a 2002 study, 11 women took citalopram (20-40 mg/day) during pregnancy; 10 throughtout gestation and 1 starting at 20 weeks' gestation. The mean ratio of two metabolites was significantly higher during pregnancy than at 2 months postdelivery, indicating induction of the CYP2D6 isoenzyme. The trough plasma concentration of citalopram, desmethylcitalopram, and didesmethylcitalopram in the normal new borns were 64%, 66%, and 68% of the maternal concentrations, respectively.
The antidepressant citalopram (CT), a selective serotonin uptake inhibitor, was given in its labelled form, 14(C)-CT, as a single oral dose in 50 mL aqueous solution (0.1 mmol/30 uCi/1.1 MBq) to four healthy male volunteers. Concentrations of radioactivity in whole blood and plasma were similar. ... The HPLC profile of urinary components showed that besides the known metabolites of citalopram, three glucuronides were present. The relative amounts of CT and its metabolites in urine collected for 7 days were: CT (26 %), N-demethyl-CT (DCT, 19%), N,N-didemethyl-CT (DDCT,9%), the N-oxide (7%), the quaternary ammonium glucuronide of CT (CT-GLN, 14%), the N-glucuronide of DDCT (DDCT-GLN, 6%), and the glucuronide of the acid metabolite (CT-acid-GLN, 12%) formed by N,N-dimethyl deamination of CT. CT-GLN was isolated using preparative chromatography and identified by LC-MS-MS and NMR. DDCT-GLN and CT-acid-GLN were identified by LC-MS. This study shows that protracted renal excretion represents the major route of elimination, with a small fraction voided with feces. A considerable portion of the urinary excreted dose consists of N-glucuronides of CT and DDCT together with the O-acyl glucuronide of CT-acid.
This study was conducted to identify enzyme systems eventually catalyzing a local cerebral metab of citalopram. ... The metab of citalopram, of its enantiomers and demethylated metabolites was investigated in rat brain microsomes & in rat and human brain mitochondria. No cytochrome P-450 mediated transformation was observed in rat brain. ... In rat whole brain and in human frontal cortex, putamen, cerebellum & white matter of five brains monoamine oxidase activity was determined by the stereoselective measurement of the production of citalopram propionate. All substrates were metabolized by both forms of MAO, except in rat brain, where monoamine oxidase B activity could not be detected. Apparent Km and Vmax of S-citalopram biotransformation in human frontal cortex by monoamine oxidase B were found to be 266 uM & 6.0 pmol min/mg protein & by monoamine oxidase A 856 uM & 6.4 pmol min/mg protein, respectively. These Km values are in the same range as those for serotonin & dopamine metab by monoamine oxidases. ...
Citalopram ... is N-demethylated to N-desmethylcitalopram partially by CYP2C19 & partially by CYP3A4 & N-desmethylcitalopram is further N-demethylated by CYP2D6 to the likewise inactive metabolite di-desmethylcitalopram. The two metabolites are not active. ... In vitro citalopram does not inhibit CYP or does so only very moderately. A number of studies in healthy subjects and patients have confirmed, that this also holds true in vivo. Thus no change in pharmacokinetics or only very small changes were observed when citalopram was given with CYP1A2 substrates (clozapine & therophylline), CYP2C9 (warfarin), CYP2C19 (imipramine & mephenytoin), CYP2D6 (sparteine, imipramine & amitriptyline) and CYP3A4 (carbamazepine & triazolam). ...
For more Metabolism/Metabolites (Complete) data for Citalopram (7 total), please visit the HSDB record page.
Protein binding
The binding of citalopram (CT), demethylcitalopram (DCT) and didemethylcitalopram (DDCT) to human plasma proteins is about 80%.
External links
Fact-sheets from PsychonautWiki. Harm-reduction reference only — not medical advice.