Citalopram

Citalopram is a prescription medicine used to treat depression. Citalopram is in a class of drugs called selective serotonin reuptake inhibitors (SSRIs). These medications change the levels of chemicals in the brain that affect mood.

CYP2D6 and CYP2C19 are proteins in your body that are involved in the elimination of citalopram and other drugs from your body. Some patients have less of this protein in their bodies, affecting how much of the drug gets eliminated. Levels of CYP2D6 and CYP2C19 can vary greatly between individuals, and those having less of this protein are known as "poor metabolizers." 

CYP2D6 and CYP2C19 testing is done to determine whether you are a poor metabolizer. 

If you are a poor metabolizer, the levels of citalopram in your blood can become too high. As a result you may be at an increased risk of having more side effects from citalopram. 

Your doctor may adjust your dose of citalopram if you are a poor metabolizer.

Citalopram is a prescription medicine used to treat depression.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Citalopram may be found in some form under the following brand names:

• Celexa

Common side effects include:

• nausea
• sleepiness
• weakness
• dizziness
• feeling anxious
• trouble sleeping
• sexual problems
• sweating
• shaking
• not feeling hungry
• dry mouth
• constipation
• diarrhea
• respiratory Infections
• yawning

Other side effects in children and adolescents include:

• increased thirst
• abnormal increase in muscle movement or agitation
• nose bleed
• urinating more often
• heavy menstrual periods
• possible slowed growth rate and weight change. Your child’s height and weight should be monitored during treatment with citalopram. 

Tell your healthcare provider if you have any side effect that bothers you or that does not go away. These are not all the possible side effects of citalopram. For more information, ask your healthcare provider or pharmacist.

Serious side effects have been reported with citalopram.  See "Citalopram Precautions" section.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA­-1088. 

Tell your healthcare provider about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your healthcare provider if you are taking certain drugs such as:

• medicines for heart problems
• medicines that lower the potassium or magnesium levels in your body
• cimetidine (Tagamet)
• medicines for migraine headaches called triptans, such as sumatriptan (Imitrex), rizatriptan (Maxalt), naratriptan (Amerge), zolmitriptan (Zomig), and almotriptan (Axert)
• tricyclic antidepressants (TCAs) such as amitriptyline (Elavil), desipramine (Norpramin), and nortriptyline (Pamelor)
• lithium (Eskalith, Lithobid, lithium citrate)
• antidepressant medicines called selective serotonin reuptake inhibitors (SSRIs)
• antidepressant medicines called selective norepinephrine reuptake inhibitors (SNRIs)
• antipsychotic medicines
• other medicines used to treat mood, anxiety, psychotic, or thought disorders
• tramadol (Ultram)
• over-the-counter products that contain tryptophan or St. John's Wort

This is not a complete list of citalopram drug interactions. Ask your healthcare provider or pharmacist for more information.

Citalopram and other antidepressant medicines may cause serious side effects, including:

1. Suicidal thoughts or actions:

• Citalopram and other antidepressant medicines may increase suicidal thoughts or actions in some children, teenagers, or young adults within the first few months of treatment or when the dose is changed.
• Depression or other serious mental illnesses are the most important causes of suicidal thoughts or actions
• Watch for these changes and call your healthcare provider right away if you notice:
  • New or sudden changes in mood, behavior, actions, thoughts, or feelings, especially if severe.
  • Pay particular attention to such changes when citalopram is started or when the dose is changed.  

Keep all follow-up visits with your healthcare provider and call between visits if you are worried about symptoms.

Call your healthcare provider right away if you have any of the following symptoms, or call 911 if an emergency, especially if they are new, worse, or worry you:

• attempts to commit suicide
• acting on dangerous impulses
• acting aggressive or violent
• thoughts about suicide or dying
• new or worse depression
• new or worse anxiety or panic attacks 
• feeling agitated, restless, angry, or irritable
• trouble sleeping
• an increase in activity or talking more than what is normal for you
• other unusual changes in behavior or mood

Call your healthcare provider right away if you have any of the following symptoms, or call 911 if an emergency. Citalopram may be associated with these serious side effects:

2. Changes in the electrical activity of your heart (QT prolongation and Torsade de Pointes).This condition can be life threatening. Symptoms may include:

• chest pain
• fast or slow heartbeat
• shortness of breath
• dizziness or fainting

3. Serotonin Syndrome or Neuroleptic Malignant Syndrome-like reactions. This condition can be life-threatening. Symptoms may include:

• agitation, hallucinations, coma, or other changes in mental status
• coordination problems or muscle twitching (overactive reflexes)
• racing heartbeat, high or low blood pressure
• sweating or fever
• nausea, vomiting, or diarrhea
• muscle rigidity

4. Severe allergic reactions: 

• trouble breathing
• swelling of the face, tongue, eyes, or mouth
• rash, itchy welts (hives) or blisters, alone or with fever or joint pain

5. Abnormal bleeding. Citalopram and other antidepressant medicines may increase your risk of bleeding or bruising, especially if you take the blood thinner warfarin (Coumadin, Jantoven), a non-steroidal anti-inflammatory drug (NSAIDs, like ibuprofen or naproxen), or aspirin.

6. Seizures or convulsions

7. Manic episodes:

• greatly increased energy
• severe trouble sleeping
• racing thoughts
• reckless behavior
• unusually grand ideas
• excessive happiness or irritability
• talking more or faster than usual

8. Changes in appetite or weight.  Children and adolescents should have height and weight monitored during treatment.

9. Low salt (sodium) levels in the blood. Elderly people may be at greater risk for this. Symptoms may include:

• headache
• weakness or feeling unsteady
• confusion, problems concentrating or thinking, or memory problems

Do not stop citalopram without first talking to your healthcare provider. Stopping citalopram too quickly may cause serious symptoms including:

• anxiety, irritability, high or low mood, feeling restless, or changes in sleep habits
• headache, sweating, nausea, dizziness
• electric shock-like sensations, shaking, confusion

Do not take citalopram if you:

• are allergic to citalopram hydrobromide or escitalopram oxalate or any of the ingredients in citalopram. 
• take a Monoamine Oxidase Inhibitor (MAOI). Ask your healthcare provider or pharmacist if you are not sure if you take an MAOI, including the antibiotic linezolid.
• Do not take an MAOI within 14 days of stopping citalopram.
• Do not start citalopram if you stopped taking an MAOI in the last 14 days.

People who take citalopram close in time to an MAOI may have serious or even life-threatening side effects. Get medical help right away if you have any of these symptoms:

• high fever
• uncontrolled muscle spasms
• stiff muscles
• rapid changes in heart rate or blood pressure
• confusion
• loss of consciousness (pass out)

• take the antipsychotic medicine pimozide (Orap) because this can cause serious heart problems.
• have a heart problem including congenital long QT syndrome

Citalopram can cause sleepiness or may affect your ability to make decisions, think clearly, or react quickly. You should not drive, operate heavy machinery, or do other dangerous activities until you know how citalopram affects you. Do not drink alcohol while using citalopram.

Medicines can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of citalopram there are no specific foods that you must exclude from your diet when receiving citalopram.

Before starting citalopram, tell your healthcare provider if you:

• have liver problems
• have kidney problems
• have heart problems
• have or had seizures or convulsions
• have bipolar disorder or mania
• have low sodium levels in your blood
• have a history of a stroke
• have high blood pressure
• have or had bleeding problems
• are pregnant or breastfeeding

Tell your healthcare provider about all the medicines that you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Citalopram and some medicines may interact with each other, may not work as well, or may cause serious side effects. See "Drug Interactions".

Your healthcare provider or pharmacist can tell you if it is safe to take citalopram with your other medicines. Do not start or stop any medicine while taking citalopram without talking to your healthcare provider first.

Tell your healthcare provider if you are pregnant or plan to become pregnant.It is not known if citalopram will harm your unborn baby. Talk to your healthcare provider about the benefits and risks of treating depression during pregnancy.

Tell your healthcare provider if you are breastfeeding or plan to breastfeed. Some citalopram may pass into your breast milk. Talk to your healthcare provider about the best way to feed your baby while taking citalopram.

• Take citalopram exactly as prescribed. Your healthcare provider may need to change the dose of citalopram until it is the right dose for you.
• Citalopram is available in tablet, capsule, and liquid forms. It is usually taken once a day with or without food.
• Measure the oral liquid form with a marked measuring spoon or medicine cup.
• You should avoid alcohol and any stimulants (including caffeine).
• Use caution when performing tasks that require alertness, as citalopram can cause dizziness, anxiety or blurred vision.
• This medicine should come with a Medication Guide. Read and follow these instructions carefully.
• Ask your doctor or pharmacist if you have any questions. Ask your pharmacist for the Medication Guide if you do not have one. Your doctor might ask you to sign some forms to show that you understand this information.
• If you miss a dose of citalopram, take the missed dose as soon as you remember, If it is almost time for the next dose, skip the missed dose and take your next dose at the regular time. Do not take two doses of citalopram at the same time

Citalopram can cause sleepiness or may affect your ability to make decisions, think clearly, or react quickly. You should not drive, operate heavy machinery, or do other dangerous activities until you know how citalopram affects you. Do not drink alcohol while using citalopram.

• Your doctor will tell you how much of this medicine to take and how often. The typical dose for adults is 20-40 mg daily. A lower dose may need to be used if you are elderly or if you have liver problems.
• You may take this medicine with or without food.
• Your dose may need to be changed several times in order to find out what works best for you. Do not take more medicine or take it more often than your doctor tells you to.
• You may need to take this medicine for several weeks before you feel better. Keep taking the medicine as your doctor prescribes.

If you take too much citalopram call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away.

If citalopram is administered by a healthcare provider in a medical setting, it is unlikely that an overdose will occur. However, if overdose is suspected, seek emergency medical attention.

• Store citalopram at 20° to 25°C (68° to 77°F), between 15°C to 30°C (59°F to 86°F).
• Keep citalopram bottle closed tightly.
• Keep citalopram and all medicines out of the reach of children. 

Suicidality and Antidepressant Drugs

Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of citalopram or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Citalopram is not approved for use in pediatric patients.