Citalopram

Citalopram is a type of antidepressant known as a selective serotonin reuptake inhibitor (SSRI).

It's often used to treat depression and also sometimes for panic attacks.

Citalopram helps many people recover from depression, and has fewer unwanted side effects than older antidepressants.

Citalopram is available on prescription as tablets and liquid drops that you put in a drink of water.

• It usually takes 4 to 6 weeks for citalopram to work.
• Side effects such as tiredness, dry mouth and sweating are common. They're usually mild and go away after a couple of weeks.
• If you and your doctor decide to take you off citalopram, your doctor may recommend reducing your dose gradually to help prevent extra side effects.
• You can drink alcohol while taking citalopram, but it may make you feel sleepy.
• Do not take St John's wort while you're taking citalopram. It will increase your risk of side effects.

Citalopram can be taken by adults and children over the age of 12 years.

Check with your doctor before starting citalopram if you:

• have had an allergic reaction to citalopram or any other medicines in the past
• have a heart problem – citalopram can speed up or change your heartbeat
• have ever taken any other medicines for depression – some rarely used antidepressants can interact with citalopram to cause very high blood pressure, even when they have been stopped for a few weeks
• are trying to become pregnant, already pregnant or breastfeeding
• have an eye condition called glaucoma – citalopram can increase the pressure in your eye
• have epilepsy or are having electroconvulsive treatment – citalopram may increase your risk of having a seizure

If you have diabetes, citalopram can make it more difficult to keep your blood sugar stable.

Monitor your blood sugar more often for the first few weeks of treatment with citalopram and adjust your diabetes treatment if necessary.

Take citalopram once a day. You can take it with or without food.

You can take citalopram at any time of day, as long as you stick to the same time every day.

If you have trouble sleeping, it's best to take it in the morning.

Dosage

Citalopram tablets come in different strengths ranging from 10mg to 40mg.

The usual dose of citalopram is 20mg a day in adults. But it may be started at a lower dose and increased to a maximum dose of 40mg a day.

If you're over 65, or have liver problems, the maximum recommended dose is 20mg a day.

The usual dose of citalopram in children is 10mg a day, but this may be increased to 40mg a day.

With liquid drops of citalopram, 4 drops is equivalent to a 10mg tablet.

What if I forget to take it?

If you occasionally forget to take a dose, do not worry. Take your next dose the next day at the usual time. Never take 2 doses at the same time to make up for a forgotten one.

If you forget doses often, it may help to set an alarm to remind you.

You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

What if I take too much?

The amount of citalopram that can lead to an overdose varies from person to person.

Call your doctor straight away if:

If you need to go to A&E, do not drive yourself – get someone else to drive you or call for an ambulance.

Take the citalopram packet, or the leaflet inside it, plus any remaining medicine with you.

Like all medicines, citalopram can cause side effects in some people, but many people have no side effects or only minor ones.

Some of the common side effects of citalopram will gradually improve as your body gets used to it.

Some people who take citalopram for panic attacks find their anxiety gets worse during the first few weeks of treatment.

This usually wears off after a few weeks, but speak to your doctor if it bothers you. A lower dose may help reduce your symptoms.

Common side effects

Common side effects happen in more than 1 in 100 people. Keep taking the medicine, but talk to your doctor or pharmacist if these side effects bother you or do not go away:

• dry mouth
• sweating a lot
• being unable to sleep
• feeling sleepy
• feeling tired or weak

Serious side effects

Serious side effects are rare and happen in less than 1 in 1,000 people.

Go to A&E immediately if you get:

• chest pain or pressure or shortness of breath
• severe dizziness or passing out
• painful erections that last longer than 4 hours – this may happen even when you're not having sex
• any bleeding that's very bad or you cannot stop, such as cuts or nosebleeds that do not stop within 10 minutes

Call a doctor straight away if you get:

• thoughts about harming yourself or ending your life
• constant headaches, long-lasting confusion or weakness, or frequent muscle cramps – these can all be signs of low sodium levels in your blood (in severe cases low sodium can lead to fits or seizures)
• vomiting blood or dark vomit, coughing up blood, blood in your pee, black or red poo – these can be signs of bleeding from the gut
• bleeding from the gums or bruises that appear without a reason or that get bigger

Book an appointment with your doctor if you get:

• changes in your periods, such as heavy bleeding, spotting or bleeding between periods
• weight gain or weight loss without trying

Serious allergic reaction

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to citalopram.

These are not all the side effects of citalopram. For a full list, see the leaflet inside your medicines packet.

What to do about:

• dry mouth – chew sugar-free gum or sugar-free sweets
• sweating a lot – try wearing loose clothing, use a strong anti-perspirant and keep cool using a fan if possible. If this does not help, you may need to try a different type of antidepressant.
• being unable to sleep – take citalopram first thing in the morning
• feeling sleepy – take citalopram in the evening and cut down the amount of alcohol you drink. Do not drive or use tools or machinery if you're feeling sleepy. If this does not help, talk to your doctor.
• feeling tired or weak – do not drive or use tools or machinery if you're feeling tired. Cut down the amount of alcohol you drink as it can make you feel worse.

Citalopram and pregnancy

It's important for you and your baby that you stay well during your pregnancy.

If you become pregnant while taking citalopram, speak to your doctor. Do not stop taking your medicine unless your doctor tells you to.

Citalopram has been linked to a very small increased risk of problems for your unborn baby.

But if your depression is not treated during pregnancy, this can also increase the chance of problems.

You may need to take citalopram during pregnancy if you need it to remain well.

Your doctor can explain the risks and the benefits, and will help you decide which treatment is best for you and your baby.

Citalopram and breastfeeding

If your doctor or health visitor says your baby is healthy, citalopram can be used during breastfeeding.

Citalopram passes into breast milk in small amounts, and has been linked with side effects in very few breastfed babies.

It's important to continue taking citalopram to keep you well. Breastfeeding will also benefit both you and your baby.

If you notice that your baby is not feeding as well as usual or seems unusually sleepy, or you have any other concerns about your baby, talk to your health visitor or doctor as soon as possible.

For more information about how citalopram can affect you and your baby during pregnancy, read this leaflet on the Best Use of Medicines in Pregnancy (BUMPs) website.

Some medicines and citalopram can interfere with each other and increase the chances of you having side effects.

Tell your doctor if you're taking these medicines before you start citalopram:

• any medicines that affect your heartbeat – citalopram can speed up or change your heartbeat
• any other medicines for depression – some rarely used antidepressants can interact with citalopram to cause very high blood pressure even when they have been stopped for a few weeks

Mixing citalopram with herbal remedies and supplements

Do not take St John's wort, the herbal remedy for depression, while you're being treated with citalopram as this will increase your risk of side effects.