Citalopram Pregnancy and Breastfeeding Warnings

Citalopram is also known as: Celexa

Citalopram Pregnancy Warnings

A possible case of citalopram- induced withdrawal effects has been described in an infant which began within the first few days following delivery. Symptoms included apneas, superficial breathing, sleep disorders, and hypotonia which changed to hypertonia before all symptoms gradually subsided and completely disappeared after 3 weeks. The 33- year- old mother had received citalopram 40 mg daily throughout the pregnancy. The results of a cohort study indicate that 30% of neonates who had prolonged exposure to SSRIs in utero experience symptoms, in a dose- response manner, of a neonatal abstinence syndrome (e.g., tremor, gastrointestinal or sleep disturbances, hypertonicity, high- pitched cry) after birth. The authors suggest that infants exposed to SSRIs should be closely monitored for a minimum of 48 hours after birth.

Citalopram has been assigned to pregnancy category C by the FDA. Citalopram and its metabolites have been shown to cross the placenta. Human spontaneous abortion has been reported by the manufacturer. Neonates exposed to citalopram (and other SSRIs and SNRIs) late in the third trimester have developed complications requiring prolonged hospitalization, respiratory support, and tube feeding. (Such complications can arise immediately upon delivery.) Reported clinical findings have included respiratory distress, cyanosis, apnea, seizures, temperature instability, feeding difficulty, vomiting, hypoglycemia, hypotonia, hypertonia, hyperreflexia, tremor, jitteriness, irritability, and constant crying. (These features are consistent with either a direct toxic effect of SSRIs and SNRIs, or possibly a drug discontinuation syndrome.) In some cases, the clinical picture is consistent with serotonin syndrome. The results of a prospective comparative study (n=396 pregnant women) indicate that citalopram use during embryogenesis is not associated with an apparent major teratogenic risk in humans. However, citalopram should be given during pregnancy and particularly during the third trimester, only if the potential benefits outweigh the potential risks to the fetus.

Citalopram Breastfeeding Warnings

Citalopram is excreted in human milk. Side effects have been reported in two nursing infants. The manufacturer recommends that a decision should be made to discontinue nursing or discontinue the drug taking into account the importance of the drug to the mother.

One study has reported that the relative dose to a suckling infant is similar to that reported for fluoxetine, and higher than that reported for fluvoxamine, paroxetine, or sertraline. Two cases have been reported of infants experiencing excessive somnolence, decreased feeding, and weight loss in relation to breast-feeding from a mother receiving citalopram. Milk/serum concentration ratios based on single pairs of samples from the two patients ranged from 1.16 to 1.88. Based on this, the absolute dose a suckling infant may ingest would be in the range of 4.3 to 17.6 micrograms/kg. The relative dose would be 0.7% to 5.9% of the weight- adjusted maternal dose. In one case the infant was reported to have recovered completely once the infants mother discontinued the citalopram. According to another case report, the relative infant citalopram dose from breast milk is approximately 9% of the weight- adjusted maternal dose. A study of seven women taking citalopram and their infants has reported that the plasma concentrations of citalopram and demethylcitalopram in the infants were very low or absent and there were no adverse effects.

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