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Citalopram

(sit-al-oh-pram)

Trade/other name(s): Celexa, citalopram hydrobromide

Why would this drug be used?

Citalopram is a type of antidepressant known as a selective serotonin reuptake inhibitor (SSRI). It is most often used to treat depression. Doctors may prescribe it for other reasons as well.

How does this drug work?

Citalopram works by raising levels of serotonin, a key chemical in the brain.

Before taking this medicine

Tell your doctor…

  • If you are allergic to anything, including medicines, dyes, additives, or foods.
  • If you have ever thought about or attempted suicide, or if other family members have had this problem. Treatment with an antidepressant may raise the risk of suicidal thoughts, especially during the first few months of treatment.
  • If you drink alcohol or are taking any type of sedative. This drug may increase their effects on the nervous system, which in some cases could be dangerous.
  • If you have ever had liver disease (including hepatitis or cirrhosis). This drug is cleared from the body mainly by the liver. Reduced liver function may result in more drug than expected staying in the body. This could lead to unwanted side effects. Your doctor will want to monitor you closely and may need to adjust your dose accordingly.
  • If you have ever had bleeding problems or are taking medicines that might raise your risk of bleeding, such as aspirin or aspirin-containing medicines, warfarin (Coumadin), vitamin E, ibuprofen, naproxen, etc. This drug may raise your risk of abnormal bleeding.
  • If you have taken monoamine oxidase inhibitors (MAOIs, such as isocarboxazid, phenelzine, selegiline, and tranylcypromine) within the past 2 weeks. Citalopram may cause serious side effects if taken with these drugs (see “Interactions with other drugs”).
  • If you have bipolar disorder (manic depressive illness), or if other family members have it. If you have it, citalopram could make this condition worse.
  • If you have an abnormal heart rhythm, slow heartbeat, heart block, heart failure, prolonged Q-T interval, or any problem with the heart or its electrical system. This drug can slow down the heart’s electrical impulses and make these problems worse.
  • If you have low potassium, sodium, or magnesium levels, or if you are taking medicines such as diuretics (“water pills”) that may affect levels of those minerals. These problems can affect the heart’s electrical system and the drug can make it worse.
  • If you have any other medical conditions such as congestive heart failure, lung disease, heart disease, kidney problems, high blood pressure, diabetes, seizures, gout, or infections. You may need closer monitoring of these conditions while being treated.
  • If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. This drug might cause problems if either the male or female is taking it at the time of conception or during pregnancy. It is important to check with your doctor about whether birth control should be used with this medicine. In some women who have taken this drug in the weeks before delivery, babies have required longer hospital stays due to problems that may have been related to the drug. Women who are pregnant should discuss this with their doctor before starting to take citalopram.
  • If you are breast-feeding. This drug passes into breast milk and may affect the baby. Talk with your doctor about the possible risks of breast-feeding while taking this drug.
  • About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

Citalopram may interact with other drugs and some dietary supplements.

Antidepressants known as monoamine oxidase inhibitors (MAOIs) such as phenelzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan), or selegiline (Emsam) may raise the risk of serious side effects, including high blood pressure and body temperature, seizures, coma, or even death, and should never be taken within 2 weeks of taking citalopram. The antibiotic linezolid (Zyvox) and the dye methylene blue, which are both given in the vein, also act as MAOIs and can interact in a harmful way with this drug. Pimozide (Orap) should never be taken with citalopram.

Citalopram may raise the risk of abnormal bleeding. This risk may be increased further if you are taking aspirin or aspirin-containing medicines, non-steroidal anti-inflammatory drugs such as ibuprofen or naproxen, or other drugs that can affect bleeding, such as warfarin (Coumadin), dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis), clopidogrel (Plavix), heparin injections, or vitamin E.

The dietary supplements tryptophan and St. John’s wort are not recommended for use while taking citalopram.

Drugs that are used to treat migraine or cluster headaches (triptans, such as those listed below) can cause an increased risk of serious side effects (see serotonin syndrome information in “Precautions” section) if taken with citalopram:

  • Sumatriptan (Imitrex)
  • Rizatriptan (Maxalt)
  • Naratriptan (Amerge)
  • Eletriptan (Relpax)
  • Frovatriptan (Frova)
  • Almotriptan (Axert)
  • Zolmitriptan (Zomig)

Other drugs that could interact with citalopram include:

  • Sedatives, anxiety medicines, antihistamines, or alcohol
  • Antipsychotic drugs such as haloperidol (Haldol), risperidone (Risperdal), chlorpromazine (Thorazine), thioridazine (Mellaril), and clozapine (Clozaril)
  • Tricyclic antidepressants (amitriptyline, amoxapine, clomipramine, desipramine, doxepin, imipramine, nortriptyline, protriptyline, trimipramine)
  • Heart rhythm drugs such as amiodorone (Cordarone, Pacerone), disopyramide (Norpace), dofetilide (Tikosyn), flecainide (Rhythmol), ibutilide (Corvert), procainamide (Procan, Pronestyl), propafenone (Tambocor), quinidine (Quinidex, Cardioquin), or sotalol (Betapace)
  • Pain medicines such as fentanyl (Duragesic, Actiq, Fentora, Lazanda, Onsolis, Abstral), Tramadol (Ultram), and methadone (Dolophine, Methadose)
  • Antifungal drugs such as ketoconazole (Nizoral) or itraconazole (Sporonox)
  • Antibiotics such as ciprofloxacin (Cipro), levofloxacin (Levaquin), sparfloxacin (Zagam), moxifloxacin (Avelox), erythromycin (E.E.S., E-Mycin, Erythrocin), clarithromycin (Biaxin), or pentamidine (Pentam, NebuPent)
  • Buspirone (Buspar), used for anxiety and depression
  • Carbamazepine (Tegretol)
  • Cimetidine (Tagamet)
  • Lithium (Eskalith, Lithobid)
  • Omeprazole (Losec, Omesec, Prilosec)
  • Metoprolol (Lopressor, Toprol XL)
  • Sibutramine (Meridia)

There may be other drug interactions not on the lists above. Check with your doctor, nurse, or pharmacist about all of your medicines, herbs, and supplements.

Interactions with foods

Alcohol may have more potent effects on the nervous system while taking citalopram. Its use should be minimized or avoided while taking this drug. No other serious interactions with foods are known at this time. Check with your doctor, nurse, or pharmacist about whether some foods may be a problem.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Citalopram is taken by mouth as a tablet or as a liquid, once a day in the morning or evening. It should be taken at the same time each day. It can be taken with or without food.

The usual starting dose is 20 milligrams (mg) per day. For some people, the dose may be increased to 40 mg if needed after waiting at least a week. Lower doses may be recommended in patients older than 60 and in those with liver problems. Do not change the dose or stop taking this drug without first speaking to your doctor or nurse. Talk to your doctor before starting any new medicines.

Store the medicine in a tightly closed container and away from children or pets.

Precautions

This drug may make you feel drowsy when you first start taking it or if the dose is increased. Do not drive or operate heavy machinery until you know how the drug affects you. Use caution if taking cold or allergy medicines, sedatives, anxiety medicines, or sleeping pills or if consuming alcohol while taking this medicine. Talk to your doctor or nurse if you feel too drowsy or it does not go away.

The antidepressant effects of this medicine may take 2 weeks or longer to start. Do not stop taking this drug without first speaking to your doctor or nurse. If you are going to stop taking this drug, it should usually be tapered down over the course of several weeks, as directed by your doctor. Suddenly stopping the drug can cause anxiety, dizziness, irritability, sweating, shaking, headache, mood changes, insomnia, and confusion in some people.

This drug should be used with caution if you have ever had liver disease (including hepatitis or cirrhosis). This drug is cleared from the body mainly by the liver. Reduced liver function may result in more drug than expected staying in the body, which could lead to unwanted side effects. Your doctor will want to monitor you closely and may need to adjust your dose accordingly.

As with other antidepressants, this drug may raise the risk of suicidal thoughts and actions, mostly in people under age 25. This is more common during the first few months of treatment.

If you notice any strange or unusual thoughts or behavior, such as irritability, sleep problems, aggressiveness, restlessness, panic attacks, or thoughts of suicide while on this medicine, call your doctor. Tell family members, loved ones, and caregivers that you are taking this drug, so that they can help you if they notice behavior changes.

This drug may lessen saliva production, which can lead to dry mouth and an increased risk of dental cavities or gum disease, especially in older people. Your doctor or nurse should be able to offer suggestions on how to deal with this if needed.

Older people may have low levels of sodium in the blood while on this drug. This is usually found only on blood tests, but if severe, may cause sluggishness, unsteadiness, confusion, muscle twitching, seizures, and coma.

Rarely, this drug can change the heart’s rhythm, especially in higher doses. It can cause dizziness, chest pain, fainting, seizures, or even death. Call your doctor right away if you have any of these symptoms, or you notice a slow or irregular heartbeat. Your doctor may also check your heart rhythm using an EKG.

This drug can rarely cause a problem called serotonin syndrome, with symptoms such as nausea, vomiting, diarrhea, headache, restlessness, muscle twitching, and confusion. Rarely it can progress to worse symptoms like agitation, rigid muscles, high or low blood pressure, hallucinations, fever, and even coma, It can also cause bleeding, easy bruising, and trouble walking. These kinds of problems can become life-threatening if not treated quickly. If you have symptoms like these, call your doctor right away.

Allergic reactions to this medicine may cause trouble breathing; swelling of the face, tongue, eyes, or mouth; rash, itchy welts (hives) or blisters; fever, or joint pain. Get help right away if you have any of these.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common

  • Problems with ejaculation (men)
  • Dry mouth*
  • Feeling drowsy*
  • Nausea

Less common

  • Trouble sleeping
  • Sweating
  • Trembling*
  • Change in heart rate*
  • Diarrhea
  • Upset stomach
  • Feeling tired or weak
  • Feeling restless
  • Runny or stuffy nose
  • Blurred vision
  • Less interest in sex
  • Impotence (men)
  • Prolonged painful erection (men)
  • Menstrual changes (women)

Rare

  • Muscle or joint pain
  • Trouble reaching orgasm (women)
  • Fever*
  • Easy bleeding or bruising*
  • Changes in urination
  • Low blood sodium levels*
  • Suicidal thoughts or actions*
  • Changes in mood or behavior*
  • Changes in the heart’s electrical conduction (prolonged QT interval)*
  • Death due to allergic reaction or changes in heart rhythm

*See “Precautions” section for more detailed information.

There are other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes – first approved in 1998

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.


Last Medical Review: 04/20/2012
Last Revised: 01/25/2013