citalopram (Oral route)Pronunciation
Antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults in short-term studies with major depressive disorder (MDD) and other psychiatric disorders. Short term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24, and there was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older. This risk must be balanced with the clinical need. Monitor patients 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. Not approved for use in pediatric patients .
Commonly used brand name(s)
In the U.S.
Available Dosage Forms:
Therapeutic Class: Antidepressant
Pharmacologic Class: Citalopram
Uses For citalopram
Citalopram is used to treat mental depression. It belongs to a group of medicines known as selective serotonin reuptake inhibitors (SSRIs). These medicines are thought to work by increasing the activity of the chemical serotonin in the brain.
citalopram is available only with your doctor's prescription.
Before Using citalopram
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For citalopram, the following should be considered:
Tell your doctor if you have ever had any unusual or allergic reaction to citalopram or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Appropriate studies have not been performed on the relationship of age to the effects of citalopram in the pediatric population. Safety and efficacy have not been established.
Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of citalopram in the elderly. However, elderly patients are more likely to have hyponatremia (low sodium in the blood), which may require caution and an adjustment in the dose for patients receiving citalopram.
|All Trimesters||C||Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.|
Studies in women breastfeeding have demonstrated harmful infant effects. An alternative to this medication should be prescribed or you should stop breastfeeding while using citalopram.
Interactions with Medicines
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking citalopram, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using citalopram with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Methylene Blue
Using citalopram with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Antithrombin III Human
- Arsenic Trioxide
- Dermatan Sulfate
- Flufenamic Acid
- Magnesium Salicylate
- Mefenamic Acid
- Niflumic Acid
- Pentosan Polysulfate Sodium
- Perflutren Lipid Microsphere
- Salicylic Acid
- Sodium Phosphate
- Sodium Phosphate, Dibasic
- Sodium Phosphate, Monobasic
- St John's Wort
- Tiaprofenic Acid
Using citalopram with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Interactions with Food/Tobacco/Alcohol
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Other Medical Problems
The presence of other medical problems may affect the use of citalopram. Make sure you tell your doctor if you have any other medical problems, especially:
- Bipolar disorder (mood disorder with alternating episodes of mania and depression), or risk of or
- Bleeding problems or
- Heart attack, recent or
- Heart failure, uncompensated or
- Heart rhythm problems (e.g., congenital long QT syndrome, QT prolongation, slow heartbeat) or
- Hyponatremia (low sodium in the blood) or
- Mania or hypomania, history of or
- Seizures, history of—Use with caution. May make these conditions worse.
- Hypokalemia (low potassium in the blood) or
- Hypomagnesemia (low magnesium in the blood)—Should be corrected first before using citalopram.
- Kidney disease, severe or
- Liver disease—Use with caution. The effects may be increased because of slower removal of the medicine from the body.
Proper Use of citalopram
Take citalopram only as directed by your doctor, to benefit your condition as much as possible. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.
citalopram should come with a Medication Guide. Read and follow these instructions carefully. Ask your doctor or pharmacist if you have any questions.
Citalopram may be taken with or without food. If your doctor tells you to take it at a specific time, follow your doctor's instructions.
If you are using the oral liquid, shake the bottle well before measuring each dose. Use a marked measuring spoon, oral syringe or medicine cup to measure each dose. The teaspoons and tablespoons that are used for serving and eating food do not measure exact amounts.
You may have to take citalopram for 4 weeks before you begin to feel better. Your doctor will check your progress at regular visits during this time. Also, you may need to keep taking citalopram for 6 months or longer to help prevent the return of the depression.
The dose of citalopram will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of citalopram. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
- For oral dosage forms (solution and tablets):
- For depression:
- Adults—At first, 20 milligrams (mg) once a day, taken either in the morning or evening. Your doctor may gradually increase your dose if needed. However, the dose usually is not more than 40 mg per day.
- Older adults—20 mg once a day, taken either in the morning or evening.
- Children—Use and dose must be determined by your doctor.
- For depression:
If you miss a dose of citalopram, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.
Keep out of the reach of children.
Do not keep outdated medicine or medicine no longer needed.
Ask your healthcare professional how you should dispose of any medicine you do not use.
Precautions While Using citalopram
It is very important that your doctor check your progress at regular visits, to allow for changes in your dose and to help reduce any side effects. Blood tests may be needed to check for unwanted effects.
Do not take citalopram within 14 days of taking an MAO inhibitor (MAOI) such as isocarboxazid (Marplan®), phenelzine (Nardil®), procarbazine (Matulane®), selegiline (Eldepryl®), or tranylcypromine (Parnate®). Do not take an MAO inhibitor within 14 days of taking citalopram. If you do, you may have extremely high blood pressure or convulsions (seizures). Also, you should not use pimozide (Orap®) while you are taking this citalopram.
For some children, teenagers, and young adults, citalopram can increase thoughts of suicide. Tell your doctor right away if you start to feel more depressed and have thoughts about hurting yourselves. Report any unusual thoughts or behaviors that trouble you especially if they are new or get worse quickly. Make sure the doctor knows if you have trouble sleeping, get upset easily, have a big increase in energy, or start to act reckless. Also tell the doctor if you have sudden or strong feelings, such as feeling nervous, angry, restless, violent, or scared. Let the doctor know if you or anyone in your family has bipolar disorder (manic-depressive) or has tried to commit suicide.
citalopram can cause changes in heart rhythms, such as a condition called QT prolongation. It may change the way your heart beats and cause fainting or serious side effects in some patients. Contact your doctor right away if you have any symptoms of heart rhythm problems, such as fast, pounding, or irregular heartbeats.
Make sure your doctor knows about all the other medicines you are using. Citalopram may cause serious conditions such as serotonin syndrome and neuroleptic malignant syndrome (NMS)-like reactions when taken with some medicines. Do not use citalopram with linezolid (Zyvox®), lithium, tryptophan, St. John's wort, or some pain or migraine medicines (e.g., rizatriptan, sumatriptan, tramadol, zolmitriptan, Imitrex®, Maxalt®, Ultram®, or Zomig®). Check with your doctor first before taking any other medicines.
Do not suddenly stop taking citalopram without checking with your doctor. Your doctor may want you to gradually reduce the amount you are taking before stopping it completely. This is to decrease the chance of having side effects such as agitation, anxiety, dizziness, a feeling of constant movement of self or surroundings, headache, increased sweating, nausea, trembling or shaking, trouble with sleeping or walking, or unusual tiredness when you stop the medicine.
Citalopram may increase your risk for bleeding problems. Make sure your doctor knows if you are also using other medicines that thin the blood, such as aspirin, NSAID pain or arthritis medicines (e.g., celecoxib, ibuprofen, naproxen, rofecoxib, valdecoxib, Advil®, Aleve®, Celebrex®, Motrin®, or Vioxx®), or warfarin (Coumadin®).
citalopram may cause hyponatremia (low sodium in the blood). This is more common in elderly patients, those who are taking diuretic medicines for high blood pressure, or those who have decreased amounts of fluid in the body due to severe diarrhea or vomiting. Check with your doctor right away if you have confusion, headache, memory problems, trouble concentrating, weakness, or unsteadiness.
It is important to tell your doctor if you are pregnant or planning to become pregnant while using citalopram.
Citalopram has not been shown to add to the effects of alcohol. However, use of alcohol is not recommended in patients who are taking citalopram.
citalopram may cause some people to become drowsy, to have trouble thinking, or to have problems with movement. Make sure you know how you react to citalopram before you drive, use machines, or do anything else that could be dangerous if you are not alert or well-coordinated.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.
citalopram Side Effects
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:More common
- Decrease in sexual desire or ability
- blurred vision
- increase in the frequency of urination or amount of urine produced
- lack of emotion
- loss of memory
- menstrual changes
- skin rash or itching
- trouble with breathing
- behavior change similar to drunkenness
- bleeding gums
- breast tenderness or enlargement or unusual secretion of milk (in females)
- convulsions (seizures)
- difficulty with concentrating
- dizziness or fainting
- dryness of the mouth
- increased hunger
- increased thirst
- irregular heartbeat
- lack of energy
- overactive reflexes
- painful urination
- poor coordination
- purple or red spots on the skin
- rapid weight gain
- red or irritated eyes
- redness, tenderness, itching, burning, or peeling of the skin
- slow or irregular heartbeat (less than 50 beats per minute)
- sore throat, fever, and chills
- swelling of the face, ankles, or hands
- talking or acting with excitement you cannot control
- trembling, shaking, or twitching
- trouble with holding or releasing urine
- unusual or sudden body or facial movements or postures
- unusual tiredness or weakness
- Abdominal or stomach pain
- back or leg pains
- black, tarry stools
- bleeding gums
- bloody stools
- chest pain
- confusion as to time, place, or person
- darkened urine
- difficult or fast breathing
- difficulty with swallowing
- fast, slow, or irregular heartbeat
- general body swelling
- hive-like swelling on the face, eyelids, lips, tongue, or throat
- holding false beliefs that cannot be changed by fact
- impaired consciousness, ranging from confusion to coma
- itching, puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
- loss of appetite
- loss of bladder control
- loss of consciousness
- muscle cramps or spasms
- muscle tightness
- muscle twitching or jerking
- pale skin
- penile erections, frequent or continuing
- recurrent fainting
- rhythmic movement of the muscles
- seeing, hearing, or feeling things that are not there
- shortness of breath
- swelling of the breasts or unusual milk production
- tenderness, pain, swelling, warmth, skin discoloration, and prominent superficial veins over the affected area
- tightness in the chest
- total body jerking
- twitching, twisting, uncontrolled repetitive movements of the tongue, lips, face, arms, or legs
- uncontrolled jerking or twisting movements
- unusual excitement
- vomiting of blood or material that looks like coffee grounds
- yellowing of the eyes or skin
Get emergency help immediately if any of the following symptoms of overdose occur:Symptoms of overdose
- Bluish colored skin or lips
- deep or fast breathing with dizziness
- general feeling of discomfort or illness
- problems with memory
- sleepiness or unusual drowsiness
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:More common
- Sleepiness or unusual drowsiness
- trouble with sleeping
- Body aches or pain
- change in sense of taste
- headache (severe and throbbing)
- increased sweating
- increased yawning
- loss of voice
- pain in the muscles or joints
- stuffy or runny nose
- tingling, burning, or prickly feelings on the skin
- tooth grinding
- unusual increase or decrease in weight
- watering of the mouth
- inability to sit still
- large, flat, blue or purplish patches in the skin
- need to keep moving
- uncontrolled eye movements
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
See also: citalopram side effects (in more detail)
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