Rx Update

March 1999

Mary Ross, R.Ph., M.B.A.
Peer Review Status: Internally Reviewed

New Emergency Drug Tray Containers
During their recent visit, JCAHO surveyors stated that medication storage security in the patient care areas of the hospital would be enhanced if our Emergency Drug Trays were housed in rigid containers with tamper-evident seals. Accordingly, the Department of Pharmaceutical Care, with input from the Department of Nursing and the Pharmacy and Therapeutics Subcommittee, will implement use of a new container to securely store these medications on all patient care areas throughout the UIHC.

The contents of the trays will remain unchanged, and each drug's location within the tray will also be unchanged.

The Emergency Drug Trays will no longer be wrapped in blue plastic bags. Instead, the metal trays which hold the drugs and medical supplies will be placed inside rigid, gray plastic boxes with hinged lids that open from the top. These boxes will be secured with two plastic "breakaway" seals located on each end of the box top. When these seals are twisted, they will easily break, allowing users to flip open the hinged lids and gain access to the drugs within the tray. An alphabetized list of the emergency medications contained within the box will be posted on the outside surface of the hinged lids. The locator map which identifies the specific positions of medications within the tray will continue to be placed inside the emergency drug tray.

The new containers will gradually be phased into use during the next several months as the trays currently located in patient care areas are used or their contents expire. The conversion should be completed by this summer. Questions about the new Emergency Drug Tray containers should be directed to Steve Nelson, Associate Director of Pharmacy.

Citalopram: A New Selective Serotonin Reuptake Inhibitor
Citalopram (Celexa®-Parke-Davis) is a newly marketed selective serotonin reuptake inhibitor (SSRI) indicated for the treatment of depression. The SSRI class includes citalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline. The SSRIs potentiate serotonergic activity in the CNS resulting from inhibition of CNS neuronal reuptake of serotonin (5HT). Citalopram has been shown to be the most selective reuptake inhibitor of serotonin. SSRIs have a similar potency to tricyclic antidepressants (TCAs), but are generally regarded to be safer and better tolerated.

Adverse effects associated with citalopram in placebo-controlled trials were similar to those reported with the other agents in this class. In comparing citalopram to the other agents, citalopram is associated with an increased incidence of dry mouth and sweating; however, it is associated with a decreased incidence of nausea, diarrhea, and anxiety compared to the other SSRI agents.

Coadministration of citalopram with CYP3A4 (e.g., azoles, macrolides) or CYP2C19 (e.g., omeprazole) inhibitors may result in decreased clearance of citalopram. The level of cytochrome P450 isoenzyme CYP2D6 inhibition, in order of decreasing potency among the SSRIs is as follows: paroxetine> fluoxetine> norfluoxetine> demethylcitalopram> fluvoxamine> sertraline> citalopram. Due to the fact that citalopram is the SSRI with the lowest potential for clinically significant pharmacokinetic interactions with tricyclic drugs, it may be the safest choice when the two classes are used in combination. Otherwise, drug interactions associated with citalopram are similar to those associated with other SSRIs and include the TCAs, MAOIs, and triptans.

The recommended starting dose is 20 mg once daily, which can be titrated up to a maximum daily dose of 60 mg. Citalopram is available as 20 mg and 40 mg tablets.

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