Citalopram: 7 things you should know
Medically reviewed by Carmen Fookes, BPharm. Last updated on Nov 22, 2019.
1. How it works
- Citalopram is a medicine that may be used in the treatment of depression and other mood disorders.
- Experts believe citalopram's effects are due to its ability to rebalance chemicals in the brain, such as serotonin, that are imbalanced in people with anxiety, depression, and other disorders.
- Its activity against other neurotransmitters is much less potent than other antidepressants.
- Citalopram belongs to a group of medicines called Selective Serotonin Reuptake Inhibitors (SSRIs). SSRIs are thought to work by preventing the reuptake of serotonin by nerves, leading to an increase in serotonin concentrations within the nerve synapse (space between two nerves).
- May be used in the treatment of moderate-to-severe depression (Major Depressive Disorder).
- Less likely to cause drowsiness than some other antidepressants.
- Has also been used off-label for other conditions such as anxiety, alcoholism, eating disorders, fibromyalgia, and obsessive-compulsive disorder.
- SSRIs in general, are better tolerated than many other medicines used in the treatment of depression.
- Generic citalopram is available.
If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:
- Insomnia, dry mouth, drowsiness, nausea, increased sweating and sexual dysfunction. Side effects may be more likely with citalopram compared to escitalopram, a related drug.
- May increase the risk of suicidal thoughts or behavior in young adults (similar to other antidepressants).
- Interaction or overdosage may cause serotonin syndrome (symptoms include agitation, hallucinations, fast heart rate, dizziness, muscle tremor, nausea, vomiting, diarrhea).
- May cause a discontinuation syndrome if abruptly stopped or interrupted (symptoms include nausea, vomiting, diarrhea, headaches, sweating, tremors, vivid dreams, insomnia).
- May impair your judgment and affect your ability to drive or operate machinery. Alcohol should be avoided.
- May increase the risk of bleeding, especially if used with other drugs that also increase bleeding risk.
- May precipitate a manic episode in people with undiagnosed bipolar disorder.
- May cause lowering of total body sodium (called hyponatremia); elderly people or people taking diuretics or already dehydrated may be more at risk.
- May interact with a number of other drugs including those metabolized by hepatic enzymes CYP 3A4 and 2C19, other antidepressants and medicines that also cause serotonin release (such as tramadol, St John's wort, and opioids).
- Rarely causes seizures.
Notes: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. For a complete list of all side effects, click here.
- May be taken with or without food.
- Blood tests may need to be taken before treatment to check electrolyte levels (for example potassium, magnesium) and these corrected if necessary before treatment begins.
- Dosages greater than 40mg/day are not recommended.
- Report to your doctor any signs of worsening of depression or suicidal thoughts particularly during the first few months of therapy.
- Do not stop suddenly as withdrawal symptoms may occur; taper off slowly under medical supervision.
- Do not drive or operate machinery until the full effects of citalopram are known as it may impair your judgment and affect your ability to drive or operate machinery.
- Report any problems with bleeding or bruising to your doctor, also report any unexplained skin changes (such as blisters or rashes), problems with urination, eye pain or swelling and vision changes to your doctor.
- Seek urgent medical advice if symptoms consistent with serotonin syndrome (such as agitation, hallucinations, fast heart rate, dizziness, flushing, nausea, diarrhea) develop.
6. Response and Effectiveness
- Peak blood levels of citalopram occur within 4 hours; however, it may take up to 4-6 weeks of regular dosing before its maximum antidepressant effects are seen.
Medicines that interact with citalopram may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with citalopram. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.
Common medications that may interact with citalopram include:
- anticoagulants (blood thinners), such as warfarin, or other drugs that have blood-thinning effects such as aspirin or NSAIDs
- anticonvulsants, such as phenytoin, phenobarbital, or primidone
- antipsychotics (such as butyrophenones, phenothiazines, or thioxanthenes) and atypical antipsychotics (eg, olanzapine, quetiapine, ziprasidone)
- any medication that may cause drowsiness, such as benzodiazepines (eg, diazepam, lorazepam), first-generation antihistamines (such as doxylamine or promethazine), metoclopramide, or opioids (such as codeine, morphine)
- medications that may affect the heartbeat by prolonging the QT interval, such as amiodarone, encainide, or flecainide
- other antidepressants, such as tricyclic antidepressants (eg, amitriptyline), monoamine oxidase inhibitors (eg, isocarboxazid, phenelzine, and tranylcypromine), and SSRIs (eg, paroxetine, sertraline)
- other medications that affect serotonin, such as amphetamines, fentanyl, lithium, tramadol, triptans (eg, almotriptan, eletriptan, or sumatriptan), or St. John's Wort
- other medications that are metabolized by the same enzymes (CYP2C19 or CYP3A4)
- others, such as HIV medications (fosamprenavir, ritonavir)
Avoid drinking alcohol or taking illegal or recreational drugs while taking citalopram.
Note that this list is not all-inclusive and includes only common medications that may interact with citalopram. You should refer to the prescribing information for citalopram for a complete list of interactions.
Citalopram. Revised 08/2019 Drugs.com https://www.drugs.com/ppa/citalopram.html
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use citalopram only for the indication prescribed.
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- Drug class: selective serotonin reuptake inhibitors
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Other brands: Celexa