Citalopram Side Effects
Some side effects of citalopram may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.
For the Consumer
Applies to citalopram: oral solution, oral tablet
Along with its needed effects, citalopram 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 while taking citalopram:Less common
- 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
- 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
- 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
- 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
Some side effects of citalopram 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
- Decrease in sexual desire or ability
- sleepiness or unusual drowsiness
- 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
For Healthcare Professionals
Applies to citalopram: oral solution, oral tablet
Nearly all selective serotonin reuptake inhibitors, mixed serotonin/norepinephrine reuptake inhibitors, and tricyclic antidepressants cause sleep abnormalities to some extent. These antidepressants have marked dose-dependent effects on rapid eye movement (REM) sleep, causing reductions in the overall amount of REM sleep over the night and delays the first entry into REM sleep (increased REM sleep onset latency (ROL)), both in healthy subjects and depressed patients. The antidepressants that increase serotonin function appear to have the greatest effect on REM sleep. The reduction in REM sleep is greatest early in treatment, but gradually returns towards baseline during long-term therapy; however, ROL remains long. Following discontinuation of therapy the amount of REM sleep tends to rebound. Some of these drugs (i.e., bupropion, mirtazapine, nefazodone, trazodone, trimipramine) appear to have a modest or minimal effect on REM sleep.
Nervous system side effects including headache (26%), dry mouth (20%), increased sweating (11%), tremor (8%), dizziness (2%), and sleep abnormalities have been reported. Paresthesia, and migraine have been reported frequently. Hyperkinesia, vertigo, hypertonia, extrapyramidal disorder, leg cramps, involuntary muscle contractions, hypokinesia, neuralgia, dystonia, abnormal gait, hypesthesia and ataxia have been reported infrequently. Neuroleptic malignant syndrome, serotonin syndrome, abnormal coordination, hyperesthesia, ptosis, stupor, and choreoathetosis have rarely been reported. Akathisia, dyskinesia, and grand mal convulsions have been reported to be temporally associated with citalopram treatment.
Gastrointestinal side effects including nausea (up to 21%), diarrhea (8%), and dyspepsia (5%) have been reported. Increased saliva and flatulence have been reported frequently. Gastritis, gastroenteritis, stomatitis, eructation, hemorrhoids, dysphagia, teeth grinding, gingivitis, and esophagitis have been reported infrequently. Colitis, gastric ulcer, cholecystitis, cholelithiasis, duodenal ulcer, gastroesophageal reflux, glossitis, jaundice, diverticulosis, rectal hemorrhage, pancreatitis, and hiccups have rarely been reported. Gastrointestinal hemorrhage has been reported to be temporally associated with the use of citalopram.
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.
Psychiatric side effects including somnolence (18%), insomnia (up to 15%), anxiety (4%), anorexia (4%), agitation (3%), dysmenorrhea (3%), decreased libido (2%), and yawning (2%) have been reported. Impaired concentration, amnesia, apathy, depression, increased appetite, aggravated depression, suicide attempt, and confusion have been reported frequently. Increased libido, aggressive reaction, paranoia, drug dependence, depersonalization, hallucination, euphoria, psychotic depression, delusion, paranoid reaction, emotional lability, panic reaction, and psychosis have been reported infrequently. Catatonic reaction, withdrawal syndrome and melancholia have been reported rarely. Delirium has been reported to be temporally associated with citalopram treatment.
Genitourinary side effects including ejaculatory disorder (primarily ejaculatory delay) (6%), and impotence (3%) have been reported. Amenorrhea has been reported frequently. Female reproductive disorders including galactorrhea, breast pain, breast enlargement, and vaginal hemorrhage have been reported infrequently. Priapism has been reported rarely. A case of spontaneous ejaculation has also been reported.
Respiratory system side effects including upper respiratory tract infection (5%), rhinitis (5%), and sinusitis (3%) have been reported. Coughing has been reported frequently. Bronchitis, dyspnea, and pneumonia have been reported infrequently. Asthma, laryngitis, bronchospasm, pneumonitis and increased sputum have been reported rarely.
Withdrawal effects are generally self-limiting. However, there have been reports of serious discontinuation symptoms. Patients should be monitored for withdrawal symptoms when discontinuing treatment with citalopram. Gradual reduction of the dose is recommended whenever possible. If intolerable symptoms occur due to a decrease in dosage or discontinuation of treatment, then resuming the previously prescribed dose may be appropriate. This may be followed by a more gradual reduction in dosage.
Other side effects occurring upon discontinuation of citalopram have been reported, particularly when the discontinuation has been abrupt. These withdrawal effects have included dysphoric mood, irritability, agitation, dizziness, sensory disturbances including unfavorable smell, anxiety, confusion, headache, lethargy, emotional lability, insomnia, and hypomania.
General side effects including fatigue (5% to 6%), fever (2%), and asthenia (1%) have been reported. Hot flushes, rigors, alcohol intolerance, syncope, and influenza-like symptoms have been reported infrequently. Hay fever has been reported rarely. Chest pain has been reported to be temporally associated with the use of citalopram. Serotonin syndrome has been reported in two patients who were concomitantly receiving linezolid (a reversible nonselective MAOI).
While not reported for citalopram, in one study using the healthcare data from the province of Ontario, Canada reviewing 8,239 patients treated for hip fractures, the adjusted odds ratio for hip fracture was 2.4 for exposure to selective serotonin reuptake inhibitors (including fluoxetine, fluvoxamine, paroxetine, and sertraline), compared to participants who had no exposure to antidepressants. A similar odds ratio for hip fracture may be present for patients using citalopram.
Musculoskeletal system side effects including arthralgia (2%), and myalgia (2%) have been reported. Arthritis, muscle weakness, and skeletal pain have been reported infrequently. Bursitis and osteoporosis have rarely been reported. Rhabdomyolysis has been reported to be temporally associated with citalopram treatment.
Cardiovascular side effects including tachycardia, postural hypotension, and hypotension have been reported frequently. Hypertension, bradycardia, edema (extremities), angina pectoris, extrasystoles, cardiac failure, flushing, myocardial infarction, cerebrovascular accident, and myocardial ischemia have been reported infrequently. Transient ischemic attack, phlebitis, atrial fibrillation, cardiac arrest, bundle branch block, thrombocytopenia, ventricular arrhythmia, Torsades de pointes, and angioedema have rarely been reported. Prolonged QT interval has been reported to be temporally associated with citalopram treatment.
Endocrine side effects including hypothyroidism, goiter, and gynecomastia have rarely been reported. Several cases of the syndrome of inappropriate secretion of antidiuretic hormone have been reported. Three cases of hyponatremia secondary to the syndrome of inappropriate secretion of antidiuretic hormone have also been reported. Prolactinemia has been reported to be temporally associated with citalopram treatment.
Two studies have reported that concurrent use of a nonsteroidal anti-inflammatory drug or aspirin potentiated the risk of bleeding. These studies focused on upper gastrointestinal bleeding. However, the manufacturer has reported that there is reason to believe that bleeding at other sites may be similarly potentiated. Patients should be warned about the risk of bleeding from concurrent use of citalopram and NSAIDS, aspirin, or other drugs that affect coagulation.
Hematologic side effects including purpura, anemia, epistaxis, leukocytosis, leukopenia, and lymphadenopathy have been reported infrequently. Pulmonary embolism, granulocytopenia, lymphocytosis, lymphopenia, hypochromic anemia, coagulation disorder, and gingival bleeding have rarely been reported. Decreased prothrombin, hemolytic anemia, and thrombosis have been reported to be temporally associated with citalopram treatment.
Bleeding episodes have been reported in patients treated with psychotropic drugs that interfere with serotonin reuptake. Subsequent epidemiological studies have reported an association between the use of psychotropic drugs that interfere with serotonin reuptake and the occurrence of upper gastrointestinal bleeding.
The results of one study appear to indicate that treatment with selective serotonin reuptake inhibitors (i.e., paroxetine, sertraline, citalopram) may cause an increase in serum total cholesterol, HDL cholesterol, and/or LDL cholesterol. However, additional studies are necessary to confirm these findings.
Numerous cases of hyponatremia have been reported following treatment with a selective serotonin reuptake inhibitor (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 the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) via release of antidiuretic hormone.
Metabolic and nutritional side effects including weight increase or decrease have been reported frequently. Increased hepatic enzymes, thirst, dry eyes, increased alkaline phosphatase, and abnormal glucose tolerance have been reported infrequently. Bilirubinemia, hypokalemia, hyponatremia, obesity, hypoglycemia, hepatitis, and dehydration have rarely been reported. An increase in serum cholesterol has been reported following use of citalopram.
Dermatologic side effects including rash and pruritus have been reported frequently. Photosensitivity reaction, urticaria, acne, skin discoloration, eczema, alopecia, dermatitis, dry skin, and psoriasis have been reported infrequently. Hypertrichosis, decreased sweating, melanosis, keratitis, cellulitis, and pruritus ani have rarely been reported. Ecchymosis has been reported to be temporally associated with the use of citalopram. One case of escitalopram-induced cutaneous leukocytoclastic vasculitis has been reported.
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.
The ocular side effect of abnormal accommodation has been reported frequently. Conjunctivitis, and eye pain have been reported infrequently. Mydriasis, photophobia, diplopia, abnormal lacrimation and cataract have been reported infrequently. Epidermal necrolysis and erythema multiforme have been reported rarely. Nystagmus has been reported to be temporally associated with citalopram treatment.
Several side effects on senses have been reported. Taste perversion has been reported frequently. Tinnitus has been reported infrequently. Taste loss has rarely been reported.
Hepatic side effects including necrosis have been reported rarely.
Renal side effects including acute renal failure have been reported.
Hypersensitivity side effects including anaphylaxis and allergic reaction have been reported.
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