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US Brand Names

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Description

Citalopram is used to treat mental depression .

Citalopram 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 .

This medicine is available only with your doctor's prescription .

This product is available in the following dosage forms:

• Tablet
• Solution

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Before Using

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 this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine 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.

Pediatric

Appropriate studies performed to date have not demonstrated any benefit to using citalopram in children with depression. Studies have shown that some children, teenagers, and young adults think about suicide or attempt suicide when taking the medicine. Because of this toxicity, use in children is not recommended .

Geriatric

Appropriate studies performed to date have not demonstrated geriatrics-specific problems that would limit the usefulness of citalopram in the elderly. However, elderly patients are more likely to have age-related liver problems, which may require an adjustment in the dose for patients receiving citalopram .

Pregnancy

Breastfeeding

Studies in women breastfeeding have demonstrated harmful infant effects. An alternative to this medication should be prescribed or you should stop breastfeeding while using this medicine.

Drug Interactions

Using this medicine 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.

• Clorgyline
• Furazolidone
• Iproniazid
• Isocarboxazid
• Levomethadyl
• Linezolid
• Moclobemide
• Nialamide
• Pargyline
• Phenelzine
• Procarbazine
• Selegiline
• Toloxatone
• Tranylcypromine

Other Interactions

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. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

• Bipolar disorder (mental disease with cycles of elation and depression), history of, or
• Hyponatremia (low sodium in the blood) or
• Seizures (convulsions), history of—May make these conditions worse .

• Kidney disease, severe or
• Liver disease—Use with caution. The effects may be increased because of slower removal of the medicine from the body .

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Proper Use

Take this medicine 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 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 form of citalopram, shake the bottle well before measuring each dose. Use a marked measuring spoon, oral syringe or medicine cup to measure each dose .

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 .

Do not stop taking this medication without checking with your doctor. Your doctor may want you to gradually reduce the amount you are taking before stopping it completely to prevent side effects .

Dosing

The dose of this medicine 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 this medicine. 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 form (solution and tablets):
  • For depression:
    • Adults and adolescents—At first, 20 milligrams (mg) once a day, taken either in the morning or evening. Your doctor may increase your dose gradually if needed. However, the dose usually is not more than 60 mg a day.
    • Children—Use and dose must be determined by your doctor.
    • Older adults—At first, 20 milligrams (mg) once a day, taken either in the morning or evening. Your doctor may increase your dose gradually if needed. However, the dose usually is not more than 40 mg a day .

Missed Dose

If you miss a dose of this medicine, 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.

Storage

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.

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Precautions

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 .

Do not take citalopram with or within 14 days of taking an MAO inhibitor (e.g., isocarboxazid [Marplan®], phenelzine [Nardil®], procarbazine [Matulane®], selegiline [Eldepryl®], 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) .

Make sure your doctor knows about all the other medicines you are using. Citalopram may cause a serious condition called serotonin syndrome when taken with some medicines. Do not use citalopram with linezolid (e.g., Zyvox®), lithium, tryptophan, St. John's Wort, or some pain or migraine medicines (e.g., tramadol [Ultram®], sumatriptan [Imitrex®], zolmitriptan [Zomig®], or rizatriptan [Maxalt®]). Check with your doctor first before taking any other medicines, including pimozide (Orap®) .

Citalopram may cause some people to be agitated, irritable, or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. If you, your child, or your caregiver notice any of these side effects, tell your doctor or your child's doctor right away .

Avoid drinking alcoholic beverages while you are taking citalopram .

This medicine 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 .

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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:

• Decrease in sexual desire or ability

• Agitation
• Blurred vision
• Confusion
• Fever
• Increase in frequency of urination or amount of urine produced
• Lack of emotion
• Loss of memory
• Menstrual changes
• Skin rash or itching
• Trouble in breathing

• Anxiety
• Behavior change similar to drunkenness
• Bleeding gums
• Breast tenderness or enlargement or unusual secretion of milk (in females)
• Difficulty with concentrating
• Dizziness or fainting
• Increased hunger
• Irregular heartbeat
• Irritability
• Lethargy
• Low blood sodium (confusion, convulsions [seizures], drowsiness, dryness of mouth, increased thirst, or lack of energy)
• Mood or mental changes
• Nervousness
• Nose bleed
• Painful urination
• Purple or red spots on skin
• Sore throat, fever, and chills
• Rapid weight gain
• Red or irritated eyes
• Redness, tenderness, itching, burning, or peeling of skin
• Seizures
• Serotonin syndrome (agitation, confusion, diarrhea, fever, overactive reflexes, poor coordination, restlessness, shivering, sweating, talking or acting with excitement you cannot control, trembling or shaking, or twitching)
• Shakiness
• Slow or irregular heartbeat (less than 50 beats per minute)
• Stupor
• Swelling of the face, ankles, or hands
• 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
• Bloating
• Bloody stools
• Chest pain
• Confusion as to time, place, or person
• Constipation
• Cough
• Darkened urine
• Difficult or fast breathing
• Difficulty swallowing
• Drooling
• Fast, slow, or irregular heartbeat
• Fatigue
• General body swelling
• Hallucinations
• 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
• Nervousness
• Nosebleeds
• Pale skin
• Penile erections, frequent or continuing
• Recurrent fainting
• Redness, tenderness, itching, burning, or peeling of skin
• Restlessness or agitation
• Rhythmic movement of muscles
• Shortness of breath
• Skin rash
• Swelling of breasts or unusual milk production
• Tenderness, pain, swelling, warmth, skin discoloration, and prominent superficial veins over affected area
• Tightness in chest
• Total body jerking
• Twitching, twisting, uncontrolled repetitive movements of tongue, lips, face, arms, or legs
• Uncontrolled jerking or twisting movements
• Unusual excitement
• Vomiting of blood or material that looks like coffee grounds
• Wheezing
• Yellowing of the eyes or skin

• Bluish colored skin or lips
• Confusion
• Convulsions (seizures)
• Coma
• Deep or fast breathing with dizziness
• Dizziness
• Drowsiness
• Fainting
• Fast heartbeat
• General feeling of discomfort or illness
• Loss of memory
• Muscle pain
• Nausea
• Sleepiness
• Slow or irregular heartbeat
• Sweating
• Trembling or shaking
• Vomiting
• Weakness

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:

• Drowsiness
• Dry mouth
• Nausea
• Sleepiness or unusual drowsiness
• Trouble in sleeping

• Abdominal pain
• Anxiety
• Body aches or pain
• Change in sense of taste
• Chills
• Diarrhea
• Difficulty with breathing
• Gas
• Headache
• Headache (severe and throbbing)
• Heartburn
• Increased sweating
• Increased yawning
• Loss of appetite
• Loss of voice
• Nasal congestion
• Pain in muscles or joints
• Sneezing
• Sore throat
• Stuffy or runny nose
• Tingling, burning, or prickly feelings on skin
• Tooth grinding
• Trembling or shaking
• Unusual increase or decrease in weight
• Unusual tiredness or weakness
• Vomiting
• Watering of mouth

• Bruising
• Inability to sit still
• Large, flat, blue or purplish patches in the skin
• Need to keep moving
• Restlessness
• Uncontrolled eye movements

After you stop using this medicine, it may still produce some side effects that need attention. During this period of time, check with your doctor immediately if you notice the following side effects:

• Anxiety
• Dizziness
• Nervousness
• Trembling or shaking

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

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