Celexa Side Effects

Generic Name: citalopram

Note: This page contains information about the side effects of citalopram. Some of the dosage forms included on this document may not apply to the brand name Celexa.

Not all side effects for Celexa may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.

For the Consumer

Applies to citalopram: oral solution, oral tablet

In addition to its needed effects, some unwanted effects may be caused by citalopram (the active ingredient contained in Celexa). In the event that any of these side effects do occur, they may require medical attention.

You should check with your doctor immediately if any of these side effects occur when taking citalopram:

Less common
  • Agitation
  • blurred vision
  • confusion
  • fever
  • increase in the frequency of urination or amount of urine produced
  • lack of emotion
  • loss of memory
  • menstrual changes
  • skin rash or itching
  • trouble breathing
Rare
  • Behavior change similar to drunkenness
  • bleeding gums
  • breast tenderness or enlargement or unusual secretion of milk (in females)
  • chills
  • convulsions (seizures)
  • diarrhea
  • difficulty with concentrating
  • dizziness or fainting
  • drowsiness
  • increased hunger
  • increased thirst
  • irregular heartbeat
  • lack of energy
  • lethargy
  • nosebleed
  • 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
  • shivering
  • slow or irregular heartbeat (less than 50 beats per minute)
  • sore throat
  • stupor
  • sweating
  • 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
Incidence not known
  • Abdominal or stomach pain
  • back or leg pains
  • black, tarry stools
  • bloating
  • bloody stools
  • chest pain
  • confusion as to time, place, or person
  • constipation
  • cough
  • darkened urine
  • difficult or fast breathing
  • difficulty with swallowing
  • drooling
  • fast, slow, or irregular heartbeat
  • general body swelling
  • hive-like swelling on the face, eyelids, lips, tongue, or throat
  • hives
  • holding false beliefs that cannot be changed by fact
  • impaired consciousness, ranging from confusion to coma
  • indigestion
  • 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
  • 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

Some of the side effects that can occur with citalopram may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

More common
  • Decrease in sexual desire or ability
  • sleepiness or unusual drowsiness
Less common
  • Body aches or pain
  • change in sense of taste
  • gas
  • headache (severe and throbbing)
  • heartburn
  • increased sweating
  • increased yawning
  • loss of voice
  • pain in the muscles or joints
  • sneezing
  • stuffy or runny nose
  • tingling, burning, or prickly feelings on the skin
  • tooth grinding
  • unusual increase or decrease in weight
  • watering of the mouth
Incidence not known
  • Bruising
  • inability to sit still
  • large, flat, blue or purplish patches in the skin
  • need to keep moving
  • uncontrolled eye movements

For Healthcare Professionals

Applies to citalopram: oral solution, oral tablet

General

The side effects observed with citalopram (the active ingredient contained in Celexa) in clinical trials were generally reported as mild and transient, occurring most frequently in the first 1 to 2 weeks of therapy, and attenuating subsequently. The most commonly reported side effects were nausea, somnolence, dry mouth, increased sweating, tremor, diarrhea, and ejaculation disorder. Side effects associated with treatment discontinuation in short-term placebo-controlled depression trials were asthenia, nausea, dry mouth, vomiting, dizziness, insomnia, somnolence, and agitation. There was a positive dose response reported for diarrhea, dry mouth, fatigue, impotence, insomnia, increased sweating, nausea, somnolence, and yawning.[Ref]

Psychiatric

Very common (10% or more): Insomnia, somnolence
Common (1% to 10%): Abnormal dreams, aggravated depression, agitation, amnesia, anxiety, apathy, confusion, depression, impaired concentration, nervousness, suicide attempt
Uncommon (0.1% to 1%): Aggressive reaction, delusion, depersonalization, drug dependence, emotional lability, euphoria, hallucination, mania, panic reaction, paranoid reaction, paroniria, psychosis, psychotic depression
Rare (less than 0.1%): Catatonic reaction, melancholia, suicide-related events
Frequency not reported: Akathisia, restlessness
Postmarketing reports: Delirium[Ref]

Antidepressants may have a role in inducing worsening of depression and the emergence of suicidality in certain patients during the early phases of treatment. An increased risk of suicidal thinking and behavior in children, adolescents, and young adults (aged 18 to 24 years) with major depressive disorder (MDD) and other psychiatric disorders has been reported with short-term use of antidepressant drugs.

Adult and pediatric patients receiving antidepressants for MDD, as well as for psychiatric and nonpsychiatric indications, have reported symptoms that may be precursors to emerging suicidality, including anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia, hypomania, and mania. Causality has not been established.[Ref]

Nervous system

Very common (10% or more): Dizziness, headache, migraine
Common (1% to 10%): Amnesia, extrapyramidal disorder, myalgia, paresthesia, tremor
Uncommon (0.1% to 1%): Abnormal gait, ataxia, cerebrovascular accident, convulsions, dystonia, hypoesthesia, neuralgia, speech disorder, syncope, vertigo, hyperkinesia, hypertonia, hypokinesia, transient ischemic attack
Rare (less than 0.1%): Abnormal coordination, dyskinesia, grand mal convulsion, hyperesthesia, stupor
Frequency not reported: Movement disorder
Postmarketing reports: Choreoathetosis, myoclonus[Ref]

Cardiovascular

This drug has been associated with a dose-related QT-interval prolongation; there have been reports of QT-interval prolongation and ventricular arrhythmia, including torsade de pointes, particularly in females, patients with hypokalemia, or with pre-existing QT-interval prolongation, or other cardiac disease.[Ref]

Common (1% to 10%): Chest pain, hypotension, palpitations, postural hypotension, tachycardia
Uncommon (0.1% to 1%): Angina pectoris, atrial fibrillation, bradycardia, cardiac failure, edema (extremities), extrasystoles, flushing, hematomas, hypertension, myocardial infarction, myocardial ischemia
Rare (less than 0.1%): Bundle branch block, cardiac arrest, facial edema, phlebitis, QT prolongation, torsades de pointes
Frequency not reported: Ventricular arrhythmia
Postmarketing reports: Thrombosis[Ref]

Gastrointestinal

Very common (10% or more): Dry mouth, nausea
Common (1% to 10%): Abdominal pain, constipation, diarrhea, dyspepsia, flatulence, increased saliva, taste loss, taste perversion, vomiting
Uncommon (0.1% to 1%): Abnormal bleeding, predominantly of the mucous membranes, dysphagia, eructation, esophagitis, gastrointestinal bleeding, gastritis, gastroenteritis, gingivitis, hemorrhoids, stomatitis, teeth grinding
Rare (less than 0.1%): Colitis, diverticulitis, duodenal ulcer, gastric ulcer, gastroesophageal reflux, gingival bleeding, glossitis, hiccups, rectal hemorrhage
Frequency not reported: Bruxism, gastrointestinal hemorrhage
Postmarketing reports: Pancreatitis[Ref]

A study of 26,005 antidepressant users has reported 3.6 times more upper GI bleeding episodes with the use of SSRIs relative to the population who did not receive antidepressant medications. Upper gastrointestinal tract bleeding was observed in 4.1 times more frequently in patients receiving citalopram.[Ref]

Metabolic

Numerous cases of hyponatremia have been reported following treatment with an SSRI. Risk factors for the development of SSRI- associated hyponatremia including advanced age, female gender, concomitant use of diuretics, low body weight, and lower baseline serum sodium levels have been identified. Hyponatremia tends to develop within the first few weeks of treatment (range 3 to 120 days) and typically resolves within 2 weeks (range 48 hours to 6 weeks) after therapy has been discontinued with some patients requiring treatment. The proposed mechanism for the development of hyponatremia involves SIADH via release of antidiuretic hormone.[Ref]

Common (1% to 10%): Anorexia, decreased/increased weight, increased appetite
Uncommon (0.1% to 1%): Abnormal glucose tolerance, thirst
Rare (less than 0.1%): Dehydration, hypokalemia, hyponatremia, hypoglycemia, obesity[Ref]

Other

Very common (10% or more): Asthenia
Common (1% to 10%): Fatigue, fever, pain, tinnitus
Rare (less than 0.1%): Alcohol intolerance, hayfever, malaise, pyrexia, rigors
Frequency not reported: Serotonin syndrome
Postmarketing reports: Neuroleptic malignant syndrome, spontaneous abortion, withdrawal syndrome[Ref]

Potentially life-threatening serotonin syndrome has been reported with SSRIs and SNRIs as monotherapy, but particularly with concomitant use of other serotonergic drugs and drugs that impair the metabolism of serotonin.[Ref]

Genitourinary

Common (1% to 10%): Abnormal orgasm (female), amenorrhea, decreased libido, dysmenorrhea, ejaculation disorders, impotence, menstrual disorders, polyuria
Uncommon (0.1% to 1%): Breast enlargement, breast pain, dysuria, galactorrhea, increased libido, menorrhagia, micturition frequency, nonpuerperal lactation, vaginal bleeding, vaginal hemorrhage, urinary incontinence, urinary retention
Rare (less than 0.1%): Gynecomastia, hematuria, oliguria
Frequency not reported: Metrorrhagia, priapism[Ref]

Urinary retention and galactorrhea have been reported with other SSRIs.

The estimates of the incidence of untoward sexual experience and performance may underestimate their actual incidence, partly because patients and physicians may be reluctant to discuss this issue. In placebo-controlled clinical trials ejaculation disorder (primarily ejaculation delay) was reported as a treatment-emergent side effect at an incidence of 6% and at least twice the incidence in placebo-treated male patients.[Ref]

Dermatologic

Very common (10% or more): Increased sweating
Common (1% to 10%): Rash, pruritus
Uncommon (0.1% to 1%): Abnormal bleeding of the skin, acne, alopecia, dermatitis, dry skin, eczema, photosensitivity reaction, psoriasis, purpura, skin discoloration, urticaria
Rare (less than 0.1%): Decreased sweating, hypertrichosis, keratitis, melanosis, pruritus ani
Frequency not reported: Ecchymosis
Postmarketing reports: Epidermal necrolysis, erythema multiforme[Ref]

One case of cutaneous leukocytoclastic vasculitis has been reported in a patient receiving escitalopram (dose not stated). The lesions disappeared one week following discontinuation of escitalopram and reappeared upon rechallenge. A similar reaction occurred when the patient was switched to paroxetine.[Ref]

Endocrine

Rare (less than 0.1%): Goiter, hypothyroidism
Frequency not reported: Inappropriate ADH secretion
Postmarketing reports: Prolactinemia[Ref]

Hematologic

Uncommon (0.1% to 1%): Anemia, leucopenia, leukocytosis, lymphadenopathy
Rare (less than 0.1%): Coagulation disorder, granulocytopenia, hemorrhage, hypochromic anemia, lymphocytosis, lymphopenia
Frequency not reported: Thrombocytopenia
Postmarketing reports: Decreased prothrombin, hemolytic anemia[Ref]

Hepatic

Common (1% to 10%): Increased alkaline phosphatase
Uncommon (0.1% to 1%): Increased ALT, GGT, and AST
Rare (less than 0.1%): Bilirubinemia, cholelithiasis, cholecystitis, hepatitis, jaundice
Frequency not reported: Abnormal liver function test
Postmarketing reports: Cholestatic hepatitis, hepatic necrosis[Ref]

Hypersensitivity

Frequency not reported: Anaphylactic reaction, angioedema, hypersensitivity not otherwise specified
Postmarketing reports: Allergic reaction[Ref]

Immunologic

Common (1% to 10%): Influenza-like symptoms[Ref]

Musculoskeletal

Epidemiological studies, primarily in patients aged 50 years or older, have shown an increased risk of bone fractures in patients receiving SSRIs or TCAs.[Ref]

Common (1% to 10%): Arthralgia, back pain
Uncommon (0.1% to 1%): Arthritis, involuntary muscle contractions, leg cramps, muscle weakness, skeletal pain
Rare (less than 0.1%): Bursitis, osteoporosis
Frequency not reported: Akathisia
Postmarketing reports: Rhabdomyolysis[Ref]

Ocular

Common (1% to 10%): Abnormal accommodation, abnormal vision
Uncommon (0.1% to 1%): Conjunctivitis, dry eyes, eye pain, mydriasis
Rare (less than 0.1%): Abnormal lacrimation, cataract, diplopia, photophobia, ptosis
Frequency not reported: Visual disturbance
Postmarketing reports: Angle-closure glaucoma, nystagmus[Ref]

Renal

Rare (less than 0.1%): Pyelonephritis, renal calculus, renal pain
Postmarketing reports: Acute renal failure[Ref]

Respiratory

Common (1% to 10%): Coughing, pharyngitis, rhinitis, sinusitis, upper respiratory tract infection, yawning
Uncommon (0.1% to 1%): Bronchitis, dyspnea, epistaxis, pneumonia
Rare (less than 0.1%): Asthma, bronchospasm, increased sputum, laryngitis, pneumonitis, pulmonary embolism[Ref]

References

1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0

2. Cerner Multum, Inc. "Australian Product Information." O 0

3. "Product Information. Celexa (citalopram)." Forest Pharmaceuticals, St. Louis, MO.

4. von Knorring AL, Olsson GI, Thomsen PH, Lemming OM, Hulten A "A Randomized, Double-blind, Placebo-controlled Study of Citalopram in Adolescents With Major Depressive Disorder." J Clin Psychopharmacol 26 (2006): 311-315

5. Ministerio de Sanidad y Consumo. Gobierno de España "AEMPS. Agencia Española de Medicamentos y Productos Sanitarios. Available from: URL: https://sinaem4.agemed.es/consaem/fichasTecnicas.do?metodo=detalleForm."

6. Dalton SO, Johansen C, Mellemkjaer L, Norgard B, Sorensen HT, Olsen JH "Use of selective serotonin reuptake inhibitors and risk of upper gastrointestinal tract bleeding: a population-based cohort study." Arch Intern Med 163 (2003): 59-64

7. Jacob S, Spinler SA "Hyponatremia associated with selective serotonin-reuptake inhibitors in older adults." Ann Pharmacother 40 (2006): 1618-22

8. Odeh M, Beny A, Oliven A "Severe symptomatic hyponatremia during citalopram therapy." Am J Med Sci 321 (2001): 159-60

9. Flores-Suarez LF, Vega-Memije ME, Chanussot-Deprez C "Cutaneous vasculitis during selective serotonin reuptake inhibitor therapy." Am J Med 119 (2006): e1-3

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