Seizures citalopram

Seizures Seizures have occurred with fluoxetine (0.1%), fluvoxamine (0.2%), paroxetine (0.1%), sertraline (0.2%), and citalopram (0.3%). Use with care in patients with history of seizures. 

Newer antidepressants (eg, fluoxetine, paroxetine, citalopram, venlafaxine) are mostly SSRIs and are generally safer than the tricyclic antidepressants and monoamine oxidase inhibitors, although they can cause seizures. Bupropion (not an SSRI) has caused seizures even in therapeutic doses. Some antidepressants have been associated with QT prolongation and torsade de pointes arrhythmia. SSRIs may interact with each other or especially with monoamine oxidase inhibitors to cause the serotonin syndrome, characterized by agitation, muscle hyperactivity, and hyperthermia (see Chapter 16). 

In 225 patients who had taken overdoses of antidepressant drugs in suicide attempts, venlafaxine and citalopram were more likely to be associated with seizures than mir-tazapine and nefazodone and 5HT toxicity was more common after overdose of venlafaxine (94). These findings confirm the potential toxicity of venlafaxine in overdose and also suggest a pro-convulsant effect of large doses of citalopram. 

A 19-year-old man with focal epilepsy took carbamazepine 1000 mg/day and lamotrigine 300 mg/day. Because his seizures persisted topiramate was added up to 200 mg/day and the dose of carbamazepine was reduced to 300 mg/day. Behavioral problems started within a week and worsened over the following months. He finally developed obsessive-compulsive disorder. Citalopram was given in doses up to 60 mg/ day and topiramate was tapered within 2 weeks. The symptoms improved. 

Linezolid Hyperpyrexia, hypertension, tachardia, confusion, seizures, and deaths have been reported with agents that inhibit MAO (serotonin syndrome), escitalopram, and citalopram. 

Ingestion-. Nausea, vomiting, abdominal pain, diarrhea, tremor, confusion, agitation, drowsiness, insomnia, flulike syndromes, blurred vision, and in rare cases, seizures and coma. Significant cardiovascular toxicity is unusual (except with citalopram). Effects include mild hypo- or hypertension, tachycardia, and ventricular dysrhythmia. Escitalopram also has been shown to cause dermatologic, gastrointestinal, sexual, respiratory, and other miscellaneous adverse reactions. 

ANS adverse effects and cardiotoxic potential than tricyclics. Tox CNS stimulation, sexual dysfunction, seizures in overdose, serotonin syndrome. Other SSRIs citalopram, paroxetine, sertraline. 

Many noncyclic antidepressants are now available, including trazodone (Desyrel l), nefazodone (Serzone ), fluoxetine (Prozac ), sertraline (Zolotf ), citalopram (Celexa ), escitalopram (Lexapro ), paroxetine (Paxil ), tluvoxamine (Luvox ), venlafaxine (Effexor ), and bupropion (Wellbutrin ). Bupropion is also marketed under the brand name Zyban tor smoking cessation. Mirtazapine (Remeron ), a tetracyclic antidepressant, has recently become available. In general, these drugs are much less toxic than the tricyclic antidepressants (see p 90) and the monoamine oxidase (MAO) inhibitors (p 269), although serious effects such as seizures and hypotension occasionally occur. Noncyclic and tricyclic antidepressants are described in Table 11-7. 

Some, but not all, reports indicate that carbamazepine serum levels can be increased by fluoxetine and fluvoxamine. Toxicity may develop. Citalopram, paroxetine and sertraline do not normally affect carbamazepine, but there is an isolated case of raised carbamazepine levels with sertraline. Citalopram, paroxetine and sertraline levels may be reduced by carbamazepine. The use of carbamazepine with an SSRI has, rarely, led to effects such as hy-ponatraemia, the serotonin syndrome, and parkinsonism. Consideration should be given to the fact that SSRIs have been known to cause seizures. 

An isolated report describes the development of the serotonin syndrome when buspirone was given with citalopram. The combination of buspirone and fluoxetine can be effective, but seizures and worsening of symptoms have been reported. Fluvoxamine may possibly reduce the effects of buspirone. 

Ten of 32 cases of seizures or myoclonus associated with antidepressant treatment reported to the Swedish Adverse Drug Reactions Advisory Committee involved SSRIs (fluvoxamine 6, citalopram 2, paroxetine... 

Isolated reports describe delirium in one patient and a seizure in another when methylphenidate was taken with sertraline. Schizophrenia and symptoms of amfetamine toxicity have also been reported in two patients taking amfetamine and fluoxetine. There is an isolated report of the serotonin syndrome associated with concurrent citalopram and dexamfetamine and another associated with sertraline and etilefrine. There is also a report of adverse effects associated with fluoxetine and phenylpropanolamine. 

Drug overdose Seizures are a recognized, albeit uncommon, complication of overdose with a number of SSRI antidepressants, but the susceptibility factors have not been elucidated. Qf 241 patients who presented with overdose of citalopram, 7.5% had generalized seizures [33 ]. Co-ingested venlafaxine or tricyclic antidepressants increased the risk substantially (QR = 15). In the absence of co-ingested drugs, the minimum citalopram dose associated with seizures was 400 mg, with an increase in the odds ratio for seizures of 1.1 for every 100 mg increment in citalopram dose. 

Waring WS, Gray JA, Graham A. Predictive factors for generalized seizures after deliberate citalopram overdose. Br J Clin Pharmacol 2008 66(6) 861-5. 

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