Citalopram belongs to a group of medications called selective serotonin reuptake inhibitors (SSRIs) that are used for the treatment of depression. SSRIs improve depression by increasing the amount of serotonin (a neurotransmitter) in certain areas of the brain. This improves the ability of the brain to transmit messages from one nerve cell to another. Although you may start feeling better within a few weeks of treatment, the full effects of the medication may not be evident until several weeks of treatment have passed.

Your doctor may have suggested this medication for conditions other than the ones listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Citalopram should be taken once daily in the morning or evening, with or without food. The dose is usually started at 20 mg daily and increased by the doctor as appropriate.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important that this medication be taken exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue on with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue on with your regular dosing schedule. Do not take a double dose to make up for a missed one.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

Celexa® is available in strengths of 20 mg and 40 mg.

20 mg: Each film-coated, white, oval, scored tablet, marked "C" to the left of the score and "N" to the right, contains 20 mg of citalopram.

40 mg: Each film-coated, white, oval, scored tablet, marked "C" to the left of the score and "R" to the right, contains 40 mg of citalopram.

Nonmedicinal ingredients: copolyvidone, cornstarch, croscarmellose sodium, glycerin, lactose monohydrate, magnesium stearate, methylhydroxypropyl cellulose, microcrystalline cellulose, polyethylene glycol, and titanium dioxide.

Citalopram should not be used by anyone who:

• is allergic to citalopram or any of the ingredients of the medication
• has taken a type of medication known as an MAO inhibitor (e.g., phenelzine, tranylcypromine, moclobemide) within the past two weeks.

Do not start treatment with an MAO inhibitor until at least two weeks after discontinuing citalopram treatment.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor. Your health professional may be able to help you deal with some of the effects.

The following side effects may go away as your body becomes used to the medication; check with your doctor if they continue or become bothersome.

More common
• drowsiness
• dry mouth
• increased sweating
• nausea

Less common
• abdominal pain
• anxiety
• fever
• heartburn
• increased yawning
• loss of appetite
• nervousness
• painful periods
• sexual difficulties
• sore throat
• stuffy or runny nose
• trembling or shaking
• trouble sleeping
• unusual tiredness
• urinary difficulties
• vomiting

Check with your doctor as soon as possible if any of the following side effects occur:

Less common
• blurred vision
• confusion
• increase in frequency of urination or amount of urine produced
• lack of emotion
• loss of memory
• menstrual changes
• severe agitation
• skin rash or itching
• trouble breathing

Rare
• behaviour similar to drunkenness
• bleeding gums
• dizziness or fainting
• irregular heartbeat
• mood or mental changes
• nervousness
• nosebleed
• purple or red spots on skin
• seizure or convulsions
• serotonin syndrome (signs include: agitation, confusion, diarrhea, fever, overactive reflexes, poor coordination, restlessness, shivering, sweating, talking or acting with excitement you cannot control, trembling or shaking, twitching)
• severe migraine
• slow or irregular heartbeat (less than 50 beats per minute)
• sore throat, fever, and chills
• trouble holding or releasing urine
• unusual or sudden body or facial movements or postures

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Diabetes: People with diabetes should be cautious while taking citalopram, as it may infrequently lower blood sugar levels (hypoglycemia).

Drowsiness/reduced alertness: Citalopram may cause drowsiness for some who take it. Avoid activities that require mental alertness, judgement, and physical coordination (such as driving a car or performing hazardous tasks) until you establish that citalopram does not affect you in this way.

Liver function: People with reduced liver function should use citalopram with caution and take a lower-than-usual dose as prescribed by their doctor.

Mania: Citalopram may cause activation of mania and should therefore be used with caution by people with a history of mania or bipolar disorder.

Seizures: People with a history of seizures should use caution when taking citalopram. If you develop seizures, stop taking the medication and contact your doctor.

Stopping the medication: Stopping this medication suddenly may lead to side effects. If you are thinking of stopping the medication, check with your doctor first.

Suicidal or agitated behaviour: Adults and children taking this medication may feel agitated (restless, anxious, aggressive, emotional, and feeling not like themselves), or they may want to hurt themselves or others. These symptoms may occur within several weeks after people start taking this medication. People should be closely monitored by their doctor for emotional and behavioural changes.

Pregnancy: The safe use of citalopram during pregnancy has not been established. It has been reported that babies born to pregnant women who have taken citalopram during the last trimester of pregnancy may be adversely affected, resulting in complications at birth requiring prolonged hospitalization, breathing support, and tube feeding. Reported symptoms include feeding and/or breathing problems, seizures, muscle rigidity, jitteriness, and constant crying. Physicians and pregnant women should carefully consider the benefits and the risks of all treatment options.

Breast-feeding: Like other antidepressants, citalopram passes into breast milk. It should not be taken by nursing women unless, in the opinion of the doctor, the expected benefits outweigh the risks.

Children: The safety and efficacy of this medication for children and adolescents under 18 years of age have not been established. The use of this medication in children below the age of 18 may cause behavioural and emotional changes, such as suicidal thoughts and behaviour.

The following medications may affect how citalopram works or increase the risk of side effects:

• alcohol
• bromocriptine
• cimetidine
• fluconazole
• itraconazole
• ketoconazole
• levodopa
• lithium
• l-tryptophan
• macrolide antibiotics (e.g., clarithromycin, erythromycin)
• MAO inhibitors (e.g., selegiline, phenelzine, tranylcypromine)
• omeprazole
• pentazocine
• St. John's wort
• sumatriptan

The following medications may be affected by citalopram:

• beta-blockers (e.g., propranolol, metoprolol)
• desipramine
• imipramine
• trazodone

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. In many cases, interactions are intended or are managed by close monitoring. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.