Citalopram

Medicines can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of citalopram there are no specific foods that you must exclude from your diet when receiving citalopram.

Tell your healthcare provider if you are pregnant or plan to become pregnant.It is not known if citalopram will harm your unborn baby. Talk to your healthcare provider about the benefits and risks of treating depression during pregnancy.

• Your doctor will tell you how much of this medicine to take and how often. The typical dose for adults is 20-40 mg daily. A lower dose may need to be used if you are elderly or if you have liver problems.
• You may take this medicine with or without food.
• Your dose may need to be changed several times in order to find out what works best for you. Do not take more medicine or take it more often than your doctor tells you to.
• You may need to take this medicine for several weeks before you feel better. Keep taking the medicine as your doctor prescribes.

In the U.S.

• CeleXA

Available Dosage Forms:

• Tablet
• Solution

Therapeutic Class: Antidepressant

Pharmacologic Class: Serotonin Reuptake Inhibitor

Take citalopram 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 should come with a Medication Guide. Read and follow these instructions carefully. Ask your doctor or pharmacist if you have any questions.

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, shake the bottle well before measuring each dose. Use a marked measuring spoon, oral syringe or medicine cup to measure each dose. The average household teaspoon may not hold the right amount of liquid.

You may have to take citalopram for a month or longer before you begin to feel better.

Dosing

The dose of citalopram 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 citalopram. 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 forms (solution or tablets):
  • For depression:
    • Adults—At first, 20 milligrams (mg) once a day, taken either in the morning or evening. Your doctor may adjust your dose as needed. However, the dose is usually not more than 40 mg per day.
    • Older adults—20 mg once a day, taken either in the morning or evening.
    • Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of citalopram, 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.

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. Blood tests may be needed to check for unwanted effects.

Do not take citalopram with a monoamine oxidase (MAO) inhibitor (eg, isocarboxazid [Marplan®], linezolid (Zyvox®), methylene blue injection, phenelzine [Nardil®], selegiline [Eldepryl®], tranylcypromine [Parnate®]). Do not start taking citalopram during the 2 weeks after you stop a MAO inhibitor and wait 2 weeks after stopping citalopram before you start taking a MAO inhibitor. If you take them together or do not wait 2 weeks, you may develop confusion, agitation, restlessness, stomach or intestinal symptoms, a sudden high body temperature, an extremely high blood pressure, or severe convulsions.

Do not take pimozide (Orap®) while you are taking citalopram. Using these medicines together can cause very serious heart problems.

Citalopram may cause a serious condition called serotonin syndrome if taken together with some medicines. Do not use citalopram with buspirone (Buspar®), fentanyl (Abstral®, Duragesic®), lithium (Eskalith®, Lithobid®), methylene blue injection, tryptophan, St. John's wort, amphetamines, or some pain or migraine medicines (eg, rizatriptan, sumatriptan, tramadol, Frova®, Imitrex®, Maxalt®, Relpax®, Ultram®, Zomig®). Check with your doctor first before taking any other medicines with citalopram.

Citalopram may cause some teenagers and young adults 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. Some people may have trouble sleeping, get upset easily, have a big increase in energy, or start to act reckless. If you or your caregiver notice any of these unwanted effects, tell your doctor right away. Let the doctor know if you or anyone in your family has bipolar disorder (manic-depressive) or has tried to commit suicide.

Contact your doctor right away if you have any changes to your heart rhythm. You might feel dizzy or faint, or you might have a fast, pounding, or irregular heartbeat. Make sure your doctor knows if you or anyone in your family has ever had a heart rhythm problem such as QT prolongation or slow heartbeat.

Do not suddenly stop taking citalopram without checking first with your doctor. Your doctor may want you to gradually reduce the amount you are using before stopping it completely. This will decrease the chance of having withdrawal symptoms such as agitation, breathing problems, chest pain, confusion, diarrhea, dizziness or lightheadedness, fast heartbeat, headache, increased sweating, muscle pain, nausea, restlessness, runny nose, trouble in sleeping, trembling or shaking, unusual tiredness or weakness, vision changes, or vomiting.

citalopram may increase your risk for bleeding problems. Make sure your doctor knows if you are also taking other medicines that thin the blood, such as aspirin, nonsteroidal antiinflammatory agents, also called NSAIDs (eg, diclofenac, ibuprofen, naproxen, Advil®, Aleve®, Celebrex®, Voltaren®), or warfarin (Coumadin®, Jantoven®).

citalopram may cause hyponatremia (low sodium in the blood). This is more common in elderly patients, those who are taking diuretic medicines for high blood pressure, or those who have decreased amounts of fluid in the body due to severe diarrhea or vomiting. Check with your doctor right away if you have confusion, headache, memory problems, trouble concentrating, weakness, or feel unsteady when standing.

The use of alcohol is not recommended in patients who are taking citalopram.

citalopram 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.

Your doctor may want to monitor your child's weight and height, because citalopram may cause decreased appetite and weight loss in children.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Oral clearance decreased 17% in mild to moderate renal impairment.

Depression: Elderly ≥60 years: Oral: Initial: 20 mg once daily; maximum dose in adults ≥60 years: 20 mg daily due to increased exposure and the risk of QT prolongation. Refer to adult dosing.

Discontinuation of therapy: Refer to adult dosing.

MAO inhibitor recommendations: Refer to adult dosing.

Mild-to-moderate impairment: No dosage adjustment necessary.

Severe impairment: CrCl <20 mL/minute: No dosage adjustment provided in manufacturer's labeling (has not been studied); use caution.

Initial: 20 mg once daily; maximum recommended dose: 20 mg daily due to decreased clearance and the risk of QT prolongation

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience nausea, fatigue, dry mouth, lack of appetite, loss of strength and energy, insomnia, tremors, diarrhea, sweating a lot, or yawning. Have patient report immediately to prescriber signs of low sodium (headache, difficulty focusing, memory impairment, confusion, weakness, seizures, or change in balance), signs of depression (suicidal ideation, anxiety, emotional instability, or confusion), signs of bleeding (vomiting blood or vomit that looks like coffee grounds; coughing up blood; hematuria; black, red, or tarry stools; bleeding from the gums; abnormal vaginal bleeding; bruises without a reason or that get bigger; or any severe or persistent bleeding), agitation, panic attacks, mood changes, angina, tachycardia, abnormal heartbeat, shortness of breath, severe dizziness, passing out, sexual dysfunction, weight gain, weight loss, menstrual changes, vision changes, eye pain, eye irritation, signs of serotonin syndrome (dizziness, severe headache, agitation, hallucinations, tachycardia, abnormal heartbeat, flushing, tremors, sweating a lot, change in balance, severe nausea, or severe diarrhea), or priapism (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.

You should not use citalopram if you also take pimozide, or if you are being treated with methylene blue injection.

Do not use citalopram if you have used an MAO inhibitor in the past 14 days, such as isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, or tranylcypromine.

Some young people have thoughts about suicide when first taking an antidepressant. Stay alert to changes in your mood or symptoms. Report any new or worsening symptoms to your doctor.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Do not give citalopram to anyone younger than 18 years old without the advice of a doctor. This medicine is not approved for use in children.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Usual Adult Dose for Depression:

Initial dose: 20 mg orally once a day
Maintenance dose: 20 to 40 mg orally once a day
Maximum dose: 40 mg orally per day

Comments:
-The initial dose may be increased if necessary to 40 mg once a day after at least 1 week of therapy.
-Doses of 60 mg/day did not demonstrate an advantage in efficacy over 40 mg/day doses.
-Acute episodes of depression may require several months or more of sustained pharmacologic therapy

Use: Treatment of depression

Usual Geriatric Dose for Depression:

Over 60 years of age:
Recommended dose: 20 mg orally once a day

Comments:
-Doses of 60 mg/day did not demonstrate an advantage in efficacy over 40 mg/day doses.
-Acute episodes of depression may require several months or more of sustained pharmacologic therapy.

Use: Treatment of depression

Data not available