citalopram

Citalopram is an antidepressant in a group of drugs called selective serotonin reuptake inhibitors (SSRIs).

Citalopram is used to treat depression.

Citalopram may also be used for purposes not listed in this medication guide.

Important information

You should not use citalopram if you also take pimozide, or if you are being treated with methylene blue injection.

Do not use citalopram if you have used an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, tranylcypromine, and others.

Some young people have thoughts about suicide when first taking an antidepressant. Your doctor will need to check your progress at regular visits while you are using citalopram. Your family or other caregivers should also be alert to changes in your mood or symptoms.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Do not give citalopram to anyone younger than 18 years old without the advice of a doctor. Citalopram is not approved for use in children.

Before taking this medicine

You should not use this medicine if you are allergic to citalopram or escitalopram (Lexapro), if you also take pimozide, or if you are being treated with methylene blue injection.

Do not use citalopram if you have taken an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, and tranylcypromine.

To make sure citalopram is safe for you, tell your doctor if you have:

• a bleeding or blood clotting disorder;

• liver or kidney disease;

• narrow-angle glaucoma;

• seizures or epilepsy;

• heart disease, heart failure, a heart rhythm disorder, slow heartbeats, or recent history of heart attack;

• personal or family history of Long QT syndrome;

• an electrolyte imbalance (such as low levels of potassium or magnesium in your blood);

• bipolar disorder (manic depression); or

• a history of drug abuse or suicidal thoughts.

Some young people have thoughts about suicide when first taking an antidepressant. Your doctor will need to check your progress at regular visits while you are using citalopram. Your family or other caregivers should also be alert to changes in your mood or symptoms.

FDA pregnancy category C. Taking an SSRI antidepressant during pregnancy may cause serious lung problems in the baby. However, you may have a relapse of depression if you stop taking your antidepressant. Tell your doctor right away if you become pregnant while taking citalopram. Do not start or stop taking this medicine during pregnancy without your doctor"s advice.

See also: Pregnancy and breastfeeding warnings (in more detail)

Citalopram can pass into breast milk and may harm a nursing baby. You should not breast-feed while you are using citalopram.

Do not give this medicine to anyone under 18 years old without medical advice. Citalopram is not approved for use in children.

How should I take citalopram?

Take citalopram exactly as prescribed by your doctor. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.

It may take 4 weeks or longer before your symptoms improve. Keep using the medication as directed and tell your doctor if your symptoms do not improve after 4 weeks of treatment.

Do not stop using citalopram suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to safely stop using citalopram.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking citalopram?

Ask your doctor before taking a nonsteroidal anti-inflammatory drug (NSAID) for pain, arthritis, fever, or swelling. This includes aspirin, celecoxib, diclofenac, indomethacin, meloxicam, and others, and others. Using an NSAID with citalopram may cause you to bruise or bleed easily.

Drinking alcohol can increase certain side effects of citalopram.

Citalopram may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Citalopram side effects

Get emergency medical help if you have any of these signs of an allergic reaction to citalopram: skin rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have:

• blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;

• headache with chest pain and severe dizziness, fainting, fast or pounding heartbeats;

• severe nervous system reaction - very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, feeling like you might pass out;

• high levels of serotonin in the body - agitation, hallucinations, fever, fast heart rate, overactive reflexes, nausea, vomiting, diarrhea, loss of coordination, fainting; or

• low levels of sodium in the body - headache, confusion, slurred speech, severe weakness, vomiting, feeling unsteady.

Common citalopram side effects may include:

• drowsiness, dizziness, weakness;

• anxiety, feeling shaky, sleep problems (insomnia);

• vision changes;

• nausea, loss of appetite, diarrhea, constipation;

• dry mouth, yawning;

• cold symptoms such as stuffy nose, sneezing, sore throat, cough;

• increased sweating;

• changes in weight; or

• decreased sex drive, impotence, or difficulty having an orgasm.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Citalopram dosing information

Usual Adult Dose for Depression:

Initial dose: 20 mg orally once a day.
Maintenance dose: 20 to 40 mg/day. The initial dose may be increased in 20 mg increments not more often than once a week up to a maximum of 40 mg per day.

Usual Geriatric Dose for Depression:

20 mg/day orally is the maximum recommended dose for patients who are greater than 60 years of age.

Usual Pediatric Dose for Depression:

Children Up To 11 Years:
Initial dose: 10 mg orally once daily; increase dose slowly by 5 mg/day every 2 weeks as clinically needed; dosage range: 20 to 40 mg/day

12 to 18 Years:
Initial: 20 mg orally once daily; increase dose slowly by 10 mg/day every 2 weeks as clinically needed; dosage range: 20 to 40 mg/day

Usual Pediatric Dose for Obsessive Compulsive Disorder:

Children Up To 11 years: Initial: 5-10 mg/day given once daily; increase dose slowly by 5 mg/day every 2 weeks as clinically needed; dosage range: 10 to 40 mg/day.
12 to 18 years: Initial: 10 to 20 mg/day given once daily; increase dose slowly by 10 mg/day every 2 weeks as clinically needed; dosage range: 10 to 40 mg/day.

What other drugs will affect citalopram?

Taking this medicine with other drugs that make you sleepy or slow your breathing can cause dangerous or life-threatening side effects. Ask your doctor before taking citalopram with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.

Many drugs can interact with citalopram. Not all possible interactions are listed here. Tell your doctor about all your medications and any you start or stop using during treatment with citalopram, especially:

• any other antidepressant;

• anagrelide, cimetidine, droperidol, methadone, ondansetron, anagrelide, cimetidine, droperidol, methadone, tramadol;

• St. John"s wort, tryptophan (sometimes called L-tryptophan);

• a blood thinner (warfarin, Coumadin, Jantoven);

• an antibiotic - azithromycin, clarithromycin, erythromycin, levofloxacin, moxifloxacin, pentamidine;

• cancer medicine - arsenic trioxide, doxorubicin, vandetanib;

• anti-malaria medication - chloroquine, halofantrine;

• heart rhythm medicine - amiodarone, disopyramide, dofetilide, dronedarone, flecainide, ibutilide, quinidine, sotalol;

• medicine to treat a psychiatric disorder - chlorpromazine, haloperidol, lithium, thioridazine; or

• migraine headache medicine - sumatriptan, zolmitriptan.

This list is not complete and many other drugs can interact with citalopram. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Give a list of all your medicines to any healthcare provider who treats you.