Citalopram

Citalopram is an antidepressant medication that affects neurotransmitters, the chemicals that nerves within the brain use to communicate with each other. Neurotransmitters are manufactured and released by nerves and then travel and attach to nearby nerves. Thus, neurotransmitters can be thought of as the communication system of the brain. Many experts believe that an imbalance among neurotransmitters is the cause of depression.

Citalopram works by preventing the uptake of one neurotransmitter, serotonin, by nerve cells after it has been released. Since uptake is an important mechanism for removing released neurotransmitters and terminating their actions on adjacent nerves, the reduced uptake caused by citalopram results in more free serotonin in the brain to stimulate nerve cells.

Citalopram is in the class of drugs called selective serotonin reuptake inhibitors (SSRIs), a class that also contains fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft). Citalopram was approved by the FDA in July 1998.

Citalopram is approved for treating depression. It is also used off-label for treating:

• Alcoholism
• Binge-eating disorder
• Generalized anxiety disorder
• Panic disorder
• Hot flashes
• Obsessive-compulsive disorder (OCD)

Some patients may experience withdrawal reactions upon stopping citalopram. Symptoms of withdrawal include:

• dizziness,
• tingling sensations,
• tiredness,
• vivid dreams, and
• irritability or poor mood.

Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with depression and other psychiatric disorders.

Worsening behavior and suicidal tendencies may require discontinuation of therapy and should be reported to the health care provider.

Anyone considering the use of citalopram or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be closely observed for clinical worsening, suicidality, or unusual changes in behavior.

Contraindications

• Hypersensitivity
• Coadministration with pimozide
• Coadministration with serotonergic drugs

Side effects associated with citalopram are

• Dry mouth
• Nausea
• Drowsiness
• Insomnia
• Increased sweating
• Tremor
• Diarrhea
• Ejaculation disorder
• Runny nose
• Upper respiratory infection
• Indigestion
• Fatigue
• Vomiting
• Anxiety
• Loss of appetite
• Abdominal pain
• Agitation
• Impotence
• Sinusitis
• Painful menstrual periods
• Decreased sex drive
• Yawning
• Joint pain
• Muscle pain
• Absence of menstrual periods (amenorrhea)
• Confusion
• Cough
• Gas (flatulence)
• Increased saliva
• Migraine
• Dizziness upon standing
• Numbness and tingling
• Increased urination
• Itching
• Rash
• Fast heart rate
• Weight changes

Overall, between 1 in 6 and 1 in 5 persons experience a side effect. Citalopram is also associated with sexual dysfunction.

• The usual starting dose is 20 mg in the morning or evening. The dose may be increased to 40 mg daily after one week.
• A dose of 60 mg has not been shown to be more effective than 40 mg.
• As with all antidepressants, it may take several weeks of treatment before maximum effects are seen.
• Doses are often slowly adjusted upwards to find the most effective dose.

Inform your doctor of all medications you are currently taking, who can advise you on any possible drug interactions. Never begin taking, suddenly discontinue, or change the dosage of any medication without your doctor's recommendation.

MAOIs

All SSRIs, including citalopram, should not be taken with any of the mono-amine oxidase (MAO) inhibitor-class of antidepressants, for example, isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), selegiline (Eldepryl), and procarbazine (Matulane). Such combinations may lead to confusion, high blood pressure, tremor, and hyperactivity.

If treatment is to be changed from citalopram to an MAOI or vice-versa, there should be a 14 day period without either drug before the alternative drug is started. Tryptophan, a common dietary supplement, can cause headaches, nausea, sweating, and dizziness when taken with any SSRI. Linezolid and intravenous methylene blue are also MAO inhibitors and should not be combined with citalopram.

Pain Medications and NSAIDs

Use of an SSRI with aspirin, nonsteroidal anti-inflammatory drugs or other drugs that affect bleeding may increase the likelihood of upper gastrointestinal bleeding.

Severe interactions of citalopram include:

• dronedarone
• goserelin
• isocarboxazid
• leuprolide
• phenelzine
• pimozide
• procarbazine
• selegiline
• selegiline transdermal
• tranylcypromine
• ziprasidone

Citalopram has serious interactions with at least 79 different drugs.

Citalopram has moderate interactions with at least 208 different drugs.

Mild interactions of citalopram include:

• simeprevir

The drug interactions listed above are not all of the possible interactions or adverse effects. For more information on drug interactions, visit the RxList Drug Interaction Checker.

It is important to always tell your doctor, pharmacist, or health care provider of all prescription and over-the-counter medications you use, as well as the dosage for each, and keep a list of the information. Check with your doctor or health care provider if you have any questions about the medication. 

• Exposure of neonates to citalopram in the third trimester may cause complications.
• Citalopram is excreted in breast milk. Breastfeeding by a citalopram treated woman may cause adverse effects in the infant.

Do I need a prescription for citalopram?

Yes, a prescription is needed.

What preparations of citalopram are available?

Tablets: 10, 20, and 40 mg. Solution: 10 mg/5 ml

How should I keep citalopram stored?

Citalopram should be stored at room temperature, 15 to 30 C (59 to 86 F).