Does Citalopram require renal adjustment? (+3 precautions)
By
Ivan Kahwa
Author bio
Mr Ivan Kahwa is a chemist and phytopharmaceutical scientist with expertise in chemistry, pharmacology, phytochemistry, and Nanobiotechnology. He writes and reviews content on these topics.
Mr Ivan Kahwa’s Highlights:
Guest Researcher at the University of Leipzig, Senior Research Fellow/Scientist, and Lecturer at the Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology.
Professional Experience:
Mr Ivan joined PHARMBIOTRAC as a research fellow/scientist during his master of science tenure. He contributed to the development of most of the phytopharmaceutical products in the project. Furthermore, he participated in carrying out the pharmacological activities of the developed products in laboratory animals such as mice and rats in order to develop proper doses hence leading to pre-clinical studies.
With the above relevant research experience, Ivan started to work with the University of Leipzig on collaborative projects with Mbarara University to develop the chemistry of Ugandan Medicinal plants and their pharmacological activities. This was coupled with several consultative positions by different German NGOs. Mr. Kahwa is also a supporting in the teaching and learning at the Departments of Pharmacy and Pharmaceutical Sciences, Faculty of Medicine, Mbarara University of Science and Technology.
With the increase in antimicrobial resistance globally, Ivan retooled his thinking towards developing new naturally derived antibiotic regimens from Ugandan propolis with the assistance of nanotechnology to improve their delivery to microbial cells. Kahwa has also published over 28 articles in peer-reviewed journals and he is currently reviewing for many journals.
Education:
2023-2027: PhD in Pharmaceutical Sciences (ongoing) with a focus on Pharmaceutical Microbiology and Nanobiology at Mbarara University of Science and Technology.
2022: 2Msc. in Pharmacognosy and Natural Medicine Science at Mbarara University of Science and Technology.
2018: Bachelor of Science (Chemistry) at Mbarara University of Science and Technology.
Publications:
▪ Iqbal, S., Jabeen, F., Kahwa, I., & Omara, T. 2023. Suberosin Alleviates Thiazolidinedione-Induced Cardiomyopathy in Diabetic Rats by Inhibiting Ferroptosis via Modulation of ACSL4-LPCAT3 and PI3K-AKT Signaling Pathways. Cardiovascular Toxicology. https://doi.org/10.1007/s12012-023-09804-7
▪ Gupta, A. K., Yadav, R., Sharma, S., Sawale, J., & Kahwa, I. 2023. Anti-ageing Activity and Antioxidant Activity of Methanol Extracts of Leaves and Flowers of Salvia officinalis and Rosmarinus officinalis. Journal of Young Pharmacists, 15(3), 448–455. https://doi.org/10.5530/jyp.2023.15.60
▪ Tolo, C.U., Kahwa, I., Nuwagira, U., Weisheit, A. and Ikiriza, H., 2023. Medicinal plants used in treatment of various diseases in the Rwenzori Region, Western Uganda. Ethnobotany Research and Applications, 25, pp.1-16.
https://ethnobotanyjournal.org/index.php/era/article/view/4683
▪ Kahwa, I., Ajayi, C.O., Yadav, R., Chauhan, N.S., Shah, K., Abdelgadir, A.A., Shegena, E.A., Daniel, S., Omara, T., Asiimwe, J.B. and Ikiriza, H., 2023. Pharmacognostic and phytochemical studies as an invaluable approach for correct identification of medicinal plants: The case of Artemisia vulgaris L. substituted for Artemisia annua L. in Western Uganda. TMR Integr Med, 7, p.e23004.
https://doi.org/10.53388/TMRIM202307004
▪ Nalimu, F., Oloro, J., Kahwa, I. and Ogwang, P.E., 2021. Review on the phytochemistry and toxicological profiles of Aloe vera and Aloe ferox. Future Journal of Pharmaceutical Sciences, 7, pp.1-21.
https://doi.org/10.1186/s43094-021-00296-2
▪ Elamin, O.H.S., Ali, M.A., Elgezuli, I.A.A., Bashir, M.A. and Kahwa, I., 2021. Diagnosis of pre-and post-treatment of echinococcus granulosus with counter current immune electrophoresis and bacterial co-agglutination. Journal of Microbiology and Infectious Diseases, 11(02), pp.88-94.
https://doi.org/10.5799/jmid.951600
Published book Chapter
▪ Kahwa, I., Ayesiga, I., Nakalema, S., Alinaiswe, R., Mbabazi, R. and Iqbal, S., 2023. Natural products in the management of onchocerciasis. In Natural Products in Vector-Borne Disease Management (pp. 63-80). Academic Press. Book Chapter.
https://doi.org/10.1016/B978-0-323-91942-5.00012-4
Submitted manuscripts Under Review:
▪ Comparison of the Wound Healing Activity of the Leaf and Leaf Ash Extracts of Vernonia amygdalina in Rats. Journal name: Clinical Phytoscience
▪ Ethnobotanical Survey of Medicinal plants used in the management of cancer in Uganda. Journal name: Journal of Herbal Medicine
▪ Ethnobotanical survey and phytochemical screening of medicinal plants used in treatment of epilepsy by PROMETRA-Uganda Traditional Health Practitioners in Mpigi District, Uganda. Journal name: Journal of Ethnopharmacology
Submitted book chapters under review
1.Book title: Algae as a Natural Solution for Water-Food-Energy Nexus, Section 4: Microalgae and cyanobacteria for food applications, Chapter 4.6: Safety, toxicological and allergenic aspects of using algae for food. Authors: Christine Kyarimpa, Tom Omute, Caroline K. Nakiguli, Alice V. Khanakwa4, Christopher Angiro, Ivan Kahwa, Fortunate Ahumuza, Timothy Omara*. Publisher: Springer Nature Singapore Pte Ltd. 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore.
2.Book title: Nutraceuticals Inspiring the Contemporary Therapy for Lifestyle Diseases. Chapter: Nutraceutical applications of Seaweeds and their Phytocompounds in Nutrition and Treatment of Diseases. Authors: Ivan Kahwa, Timothy Omara , Innocent Ayesiga , Gael Noel Neh Neba Ambe , Zehbanaz Javidbhai Panwala , Rachel Mbabazi , Shabnoor Iqbal , Christine Kyarimpa , Christine Betty Nagawa , Kamal Shah ,Nagendra Singh Chauhan* Publisher: CRC Press
You can view my works on the following professional sites:
Research Gate: https://www.researchgate.net/profile/Ivan-Kahwa
Google Scholar: https://scholar.google.com/citations?user=tOwrvqoAAAAJ&hl=en
ORCID: https://orcid.org/0000-0002-6440-3437
Linkedin: https://de.linkedin.com/in/ivan-kahwa-865450159
In this article, we will discuss whether renal adjustment is required in patients taking Citalopram (Celexa) or not. We will further discuss when you need renal adjustment for Citalopram, and what precautions you should take if you are using Citalopram for depression in renal impairment patients.
Does Citalopram require renal adjustment?
No, Citalopram does not necessarily require renal adjustment. Dose reduction is not warranted in individuals with moderate renal impairment. However, in cases where both hepatic and renal functions are compromised, the dose may be adjusted according to the individual’s needs (1).
Citalopram is an antidepressant drug, primarily described for treating major depressive disorder, anxiety, and obsessive-compulsive disorder. It belongs to a class of SSRIs, that works by increasing the level of serotonin in the brain.
It is mainly metabolized by the liver through cytochrome P450 enzymes. The metabolites are then excreted in the urine. The drug does not have any significant impact on kidney function and has been shown to be safe for use in patients with renal impairment.
What does research suggest?
According to research, Citalopram does not require renal adjustment even in patients with compromised renal function due to its insignificant impact on the pharmacokinetics of the drug (2).
SSRIs are the most prescribed drugs used for depression in end-stage renal disease patients. These drugs are bound to proteins and are not filtered by dialysis, therefore no dose adjustment is required in ESRD patients (3).
Another study suggested that Citalopram can be used to treat depression in chronic kidney disease patients without affecting their quality of life in the usual recommended dose (4).
Research conducted on the use of Citalopram for treating depression in kidney patients undergoing hemodialysis demonstrated that the Citalopram treatment required no dosage adjustment (5).
When do you need renal adjustment while taking Citalopram?
The need for renal adjustment of Citalopram should be determined by your healthcare provider.
Although Citalopram is generally considered a safe option for treating depression in patients with renal impairment, dosage adjustments may be required in certain cases depending on individual factors, comorbidities, and the medication history of the patient.
Comorbidities: When treating patients with both renal and hepatic impairment, the dosage of Citalopram can be adjusted as needed.
Individual needs: Some patients may respond differently to medications depending on age, weight, and severity of underlying renal disease. Your healthcare professional should take these factors into consideration when determining the dosage of Citalopram.
Medication history: Renal patients are often taking several medications to address their needs, so it is crucial for healthcare providers to check interactions between Citalopram and other medications that may require dose adjustment for Citalopram.
What precautions should be taken when using Citalopram in renal patients?
Precautions and considerations for renal patients taking Citalopram to manage their underlying depression can be:
Consultation with a healthcare provider: It is important for renal patients to consult their healthcare provider before starting Citalopram to determine the need for dosage adjustment based on their renal function.
Regular follow-ups: Renal patients who are taking Citalopram should adhere to their follow-up appointments with their healthcare provider to monitor their progress and make any necessary adjustments to their treatment regimen.
Monitor side effects: Be aware of the unusual symptoms or potential side effects of Citalopram and report them to your healthcare provider to check if it is affecting your renal health.
Regular communication between patients and their healthcare providers is essential for ensuring the safe and effective use of Citalopram as part of their depression treatment plan. Make sure you stay in touch with your healthcare provider to address any specific health needs you may have.
Conclusion
In this article, we have discussed the use of Citalopram in renal-impaired patients to treat the underlying depression. Further, we have discussed when renal adjustment is required in patients and the precautions that should be taken before starting Citalopram in renal patients.
Was this helpful?
References
1.-
Joffe P, Larsen FS, Pedersen V, Ring-Larsen H, Aaes-Jørgensen T, Sidhu J. Single-dose pharmacokinetics of citalopram in patients with moderate renal insufficiency or hepatic cirrhosis compared with healthy subjects. Eur J Clin Pharmacol. 1998 May;54(3):237-42. doi: 10.1007/s002280050452. PMID: 9681666. https://pubmed.ncbi.nlm.nih.gov/9681666/
2.-
Spigset O, Hägg S, Stegmayr B, Dahlqvist R. Citalopram pharmacokinetics in patients with chronic renal failure and the effect of haemodialysis. Eur J Clin Pharmacol. 2000 Dec;56(9-10):699-703. doi: 10.1007/s002280000205. PMID: 11214779. https://pubmed.ncbi.nlm.nih.gov/11214779/
3.-
Shirazian S, Grant CD, Aina O, Mattana J, Khorassani F, Ricardo AC. Depression in Chronic Kidney Disease and End-Stage Renal Disease: Similarities and Differences in Diagnosis, Epidemiology, and Management. Kidney Int Rep. 2016 Sep 20;2(1):94-107. doi: 10.1016/j.ekir.2016.09.005. PMID: 29318209; PMCID: PMC5720531. https://pubmed.ncbi.nlm.nih.gov/29318209/
4.-
(2007) Antidepressant Treatment Increases Quality of Life in Patients with Chronic Renal Failure, Renal Failure, 29:7, 817-822, DOI:10.1080/08860220701573517 https://www.tandfonline.com/doi/full/10.1080/08860220701573517
5.-
Shayan Shirazian, Candace D. Grant, Olufemi Aina, Joseph Mattana, Farah Khorassani, Ana C. Ricardo, Depression in Chronic Kidney Disease and End-Stage Renal Disease: Similarities and Differences in Diagnosis, Epidemiology, and Management, Kidney International Reports, Volume 2, Issue 1, 2017, Pages 94-107, ISSN 2468-0249, https://doi.org/10.1016/j.ekir.2016.09.005. https://www.sciencedirect.com/science/article/pii/S2468024916300845
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