Citalopram (Oral)

Otherwise known by its trade name, Celexa, Citalopram is classed into the SSRI (selective serotonin reuptake inhibitor) group of medications which work by expanding the activity of a chemical in the brain called serotonin. It is taken orally in the form of tablets, or as a solution, and is used to treat depression.

Overview

This medicine is usually prescribed as part of a regular and long-term treatment plan as directed by your doctor. Used to help treat mental health conditions, predominantly depression, it is categorized as an SSRI (selective serotonin reuptake inhibitor) medication and must be administered orally in the form of tablets of a solution.

The SSRI categorization is used for a group of medications that inhibit the reabsorption of serotonin in the brain, consequently increasing serotonin activity and its effects. Serotonin is hugely important to physical and mental health as it contributes towards social behaviour, mood, digestion, appetite, sleep, memory and sexual function amongst other things. For patients who are deficient in serotonin, it is likely that they will have severe problems with mood and certain behaviours. SSRI's are selective medicines as they are thought to mostly affect serotonin without impacting other neurotransmitters.

Depression (also known as major depressive disorder) affects over 16.1 million American adults each year. It is a common and serious medical illness that has a huge impact on a patient's life, negatively affecting mood, thought processes and actions. Weight loss, difficulty in sleeping, a continuous low mood, suicidal thoughts and the neglect of previously enjoyed hobbies and activities are just a few of the effects that depression can cause. It is often the result of a chemical or serotonin imbalance in the brain.

Once diagnosed, depression can be easily and effectively managed through the use of medication and care plans. Citalopram is a commonly used medication to treat depression, benefitting from the lack of certain restrictions that other medicines may have such as the effect on contraceptives and menstruation. It is also not a banned substance in sports.

Citalopram does have the potential to cause side effects, with the most common ones being mild and likely to disappear once the body has adjusted and in long-term use. The citalopram dosage is commonly taken in tablet form, but it can also be taken as oral drops that are diluted with water.

Effective treatment of citalopram will result in the improvement of energy levels, mood and any physical effects of depression that a patient may experience. It works to rebalance the levels of serotonin in the brain. In all cases of using this medication, it must be prescribed and managed by your doctor.

Conditions treated

Type of medicine

  • Selective serotonin reuptake inhibitor

Side effects

It is likely that patients will experience some side effects to this medication, especially within the first few days or week of its administration. Due to the long-term use of citalopram, for most patients, these side effects will usually go away once the body has adjusted to the medicine. It is also likely that some of these side effects will not need medical attention.

Typical reactions that are common when initially taking citalopram include:

  • A loss of appetite
  • Tiredness
  • Drowsiness
  • Sweating
  • Nausea
  • A decrease in libido
  • Excessive yawning
  • Grinding teeth
  • Change in the sense of taste
  • Weight loss due to the loss of appetite

If you find that any of these side effects are persistent or cause concern, make sure to discuss them with your doctor.

There is also the possibility that citalopram may cause certain behavioural changes in young adults and teenagers.

Behavioural changes may include:

  • Agitation
  • Being irritable
  • Recklessness
  • The display of other irregular behaviours
  • Suicidal thoughts
  • Self-harm
  • Temporarily becoming more depressed

If you suspect that you are experiencing any of these effects, please discuss them with your doctor immediately. Because of this, it is also essential that you tell your doctor know if you or any of your relatives have bipolar disorder, or have had suicidal behaviours in the past before you begin your treatment.

Less common side effects that should be checked by a doctor include:

  • Blurred vision
  • Confusion
  • Agitation
  • Uncontrolled eye movements
  • The increase in needing to urinate
  • The amount of urine produced
  • Menstrual changes

If you experience swelling of the face, a skin rash, itching or any trouble breathing, you should also seek medical advice when possible as these could be signs of an allergic reaction.

Citalopram has the potential to cause a condition called hyponatremia, which is also known as low sodium in the blood. It is an uncommon reaction that is more likely to happen in elderly patients, patients who are also taking diuretic medicines to treat high blood pressure, or patients who have lower amounts of fluid in the body as a consequence of diarrhea or vomiting. If you experience any confusion, headache, memory problems, difficulty in concentration, weakness or the feeling of unsteadiness when standing, contact your doctor immediately.

Rare reactions to this medication that will need to be alerted to a medical professional include:

  • Bleeding gums
  • Breast tenderness
  • Enlargement of an abnormal secretion of milk in women
  • Seizures
  • Nosebleeds
  • Painful urination
  • Rapid weight gain
  • Redness
  • Tenderness
  • Itching, burning or peeling of the skin
  • Trembling, shaking or twitching and unusual movements of the body

In very rare circumstances, a patient may experience:

  • Abdominal, stomach, back or leg pain
  • Black tarry or bloody stools
  • Constipation
  • darkened urine
  • Bloating
  • General body swelling
  • The loss of bladder control
  • Muscle tightness, cramps or spasms
  • A cough
  • Impaired consciousness
  • Drooling and difficulty with swallowing
  • Severe confusion
  • Unusual excitement
  • Holding false beliefs that cannot be altered by fact and seeing
  • Hearing or feeling things that aren't there

These are signs of serious reactions that require medical attention and should be alerted to a doctor immediately.

If you experience dizzy spells, feeling faint, a fast or irregular heartbeat, make sure to let your doctor know immediately. This medication has the potential to cause heart problems, particularly in patients who may have already had heart conditions or problems in the past. Because of this, it is important that your doctor is aware whether you or your close relatives have had a heart rhythm problem in the past.

This is not a complete list of side effects that may occur when taking citalopram. In advance of your treatment, make sure to read all the documentation that you are provided with to find a complete list effects.

Dosage

The dose strength that a doctor will prescribe for citalopram may differ from patient to patient. As well as other any other medications that a patient may be taking, factors such as a patient's current state of health, age, weight, the number of doses that will be taken per day and the time that will be allowed between each dose must all be taken into account.
When taking this medication, it is vital that you follow your doctor's instructions or those that are on the label. To do otherwise may result in serious reactions of increased side effects.
The standard dose of citalopram in adults who have depression is initially 20 mg taken once a day, either in the form of tablets or a solution. It can be taken in the morning or the evening and the dose may be increased in the weeks or months following the treatment start date. This dose should not be more than 40 mg a day. In the elderly and older adults, 20 mg should be taken once a day in the morning or evening. A child's use and their dose of citalopram must be decided by a doctor.

Citalopram can be taken either with or without food, however, if your doctor instructs you to take it at a specific time, it is important to follow their directions. This may be to reduce certain side effects that you are likely to experience. It is also important to remember that for some patients, the positive effects of citalopram may take up to a month or longer to become noticeable. For this reason, it is important that you continue to take your medicine, even if you don't feel as if it's working.

For patients who will be administering citalopram by oral liquid, make sure to shake the bottle before measuring each dose. You should also use a medically approved measuring spoon, oral syringe or cup to determine each dose to ensure that you are given the right amount of liquid.

If you happen to miss a dose of citalopram, it is important that you take it as soon as possible. However, if such a long period of time has passed that it is near your next dosage, it is important that you do not double dose. Instead, make sure to skip the missed dose and return to your regular dosing schedule.

Interactions

Before starting your treatment with citalopram, it is essential that you let your doctor know of any other medications that you may be taking. This should include any herbal remedies, supplements or over-the-counter medicines that you are taking, as these can have unwanted interactions with citalopram. St John's Wort is a particular herbal remedy that should be stated as it can interact with citalopram and cause a serious condition known as serotonin syndrome.

Other vitamins that should be alerted to your doctor include:

  • Calcium combined with Vitamin D
  • Omega 3 fish oil
  • Vitamin B12
  • Vitamin C
  • Vitamin D3

There are a number of other medicines that may cause serotonin syndrome when used in combination with citalopram. These medicines should not be taken and include any forms of:

  • Buspirone
  • Fentanyl
  • Lithium
  • Methylene blue injection
  • Tryptophan
  • Rizatriptan
  • Sumatriptan
  • Tramadol

If you are unsure about any medications make sure to discuss them with your doctor first.

A monoamine oxidase inhibitor (MAO) is of particular harm when combined with citalopram and can cause severe reactions that include confusion, restlessness, intestinal problems, a high body temperature, seriously high blood pressure, or extreme convulsions.

Monoamine oxidase inhibitors include:

  • IsocarboxazidLinezolid
  • Methylene blue injection
  • Phenelzine
  • Selegiline
  • Tranylcypromine

If you have been taking an MAO inhibitor, your doctor will advise that you wait for two weeks before taking citalopram, or wait two weeks after taking citalopram to begin MAO inhibitor treatment.

An increase in the risk of bleeding problems can happen when taking citalopram, so it is important to discuss any blood-thinning medication that you are currently taking or are likely to take. This includes any forms of aspirin, nonsteroidal anti-inflammatory agents (NSAIDs) and or warfarin.

Finally, it is important that patients do not take pimozide alongside this medicine. This is because the two medications combined can cause severe heart problems.

Alongside medicines that may interact with citalopram, factors such as lifestyle and diet should also be factored into your treatment. Alcohol is known to emphasise certain side effects of citalopram whilst smoking tobacco may also have a negative impact. It is important to discuss the impact of food, alcohol and tobacco to your treatment plan with your doctor so that you can have the best possible experience of citalopram.

Warnings

Before beginning your course of citalopram, it is essential that your doctor is aware of your medical history and of any medicines that you are taking. It is of particular importance if you or your family have a history of bipolar disorder, suicidal behaviour, liver disease, seizures, low sodium levels in your blood, intestinal ulcers or bleeding, bleeding issues or a personal or family history of com/health/coma/">glaucoma. This is because citalopram may interact with these conditions and result in serious side effects that may need urgent medical attention. Make sure to consult your doctor before taking any new over-the-counter medications in combination with citalopram as these may also cause serious adverse reactions.

Citalopram can also cause a decreased appetite in both children and adults, although the effects can be more damaging to children. Because of this, your doctor is likely to monitor your child's height and weight throughout the duration of their treatment plan. Regular visits to the doctor will be made for both children, the elderly and adults when taking citalopram as it is important that your doctor is able to track any side effects and the effectiveness of the medicine. It is likely that they will perform regular blood tests and these visits may result in the alteration of your dose to ensure the best possible treatment.

When taking this medication, it can cause some patients to become drowsy, have difficulty thinking, or to have problems with movement. This is especially common in the first few days or weeks of taking it. Consequently, you should be aware of how you respond to citalopram before driving, operating machinery or any other activities that require alertness and coordination. If you find that you are affected by these problems and it is impacting your life, your doctor may alter your dose or advise a different time of administration. The levels of citalopram in your blood are likely to be highest four to six hours after administration, something that should be kept in mind when it comes to your treatment plan.

It is vital that patients do not suddenly discontinue the administration of this medication without speaking to your doctor first. In most cases, you will be advised to gradually reduce the amount of citalopram that you are taking with smaller doses, before stopping its use entirely. This will lower the chance of experiencing unpleasant withdrawal symptoms such as agitation, confusion, diarrhea, dizziness, feeling light-headed, muscle pain, sickness, insomnia and unusual tiredness or weakness. More serious symptoms may include breathing problems, chest pain, a fast or irregular heartbeat, muscle pain, trembling or shaking and vision changes.

For mothers, it is advised that you do not breastfeed when taking citalopram. This is because it has been shown to transfer through milk and cause harmful effects of infants. If you plan to breastfeed whilst taking this medication, your doctor will prescribe you an alternative treatment.

The impact of citalopram on pregnancy is unknown, with studies having been unable to find clear links between citalopram and birth defects in babies. For anyone taking this medication who may be pregnant or who are planning to have a child, please discuss it with your doctor as the benefits of taking citalopram may outweigh the risks.

It has been recorded to have a negative impact on certain contraceptives and for sexually active partners, this should be discussed in advance to treatment.

Storage

For both tablet and solution forms of citalopram, it is essential that you keep it in a safe, secure place that is out of reach of children, pets and vulnerable adults.The medicine should be stored in a sealed container away from direct light, heat and moisture and it should never be frozen. It should be kept at room temperature.

As with all medications, you must dispose of citalopram if it has reached its label expiry date or appears to be damaged. Seek advice from your doctor or a pharmacist about the best way to dispose of unused medication.

Summary

Taken as part of a long-term treatment plan for mental health conditions such a depression or anxiety, citalopram can have a hugely positive impact on a patient's health and wellbeing. Effectively working to rebalance the serotonin chemical in our brain, citalopram selectively targets serotonin without impacting other neurotransmitters, increasing its activity in the brain and inhibiting its reabsorption.

It is a medication that will be taken long-term for most patients, and it can take a while for the body to adjust to. Side effects are common in many patients, being most noticeable within the first few days or week. Many of these side effects are mild enough to not need any medical intervention and will disappear once the body has adjusted. A decrease in libido, the loss of appetite, tiredness, drowsiness and nausea are all common reactions that patients can experience, however, if they remain persistent or worsen, they should be discussed with a doctor. In addition to these mild side effects, there is a possibility of experiencing very serious ones that will need fast medical attention. For patients with previous heart problems, low blood sodium, glaucoma, liver disease or bleeding problems, it is especially important that you keep track of any side effects that you experience. It is also important for patients to be mindful of the fact that it can take weeks or a month for the positive effects of citalopram to become apparent, and that even if you don't feel better, you must continue taking your medication.

Because citalopram needs to be taken orally, it can be off-putting to some people as this requires a degree of responsibility and organisation that may be unfamiliar. The fact that it can be taken with or without meals, at morning or at night can alleviate these concerns, however, as this gives it the ability to be taken before bed or on waking up. Many people tend to find this an easier way to adhere to a dosage schedule. To create effective dosage schedules of for advice on taking your medicine, make sure to discuss it with your doctor or pharmacist as it is likely that they have effective tips on how to manage it.

Successful treatment of citalopram can result in a person being able to take up activities and hobbies that they could no longer enjoy, work and make positive changes to their lifestyle. It requires commitment from patients, with the need for them to make sure that they are able to visit their doctor regularly. These visits are essential for your treatment as they will give your doctor the ability to track progress and help manage any side effects. They may also result in your doctor increasing or decreasing your dosage, depending on your reactions and its effectiveness. It is also important that before beginning treatment, a patient is as transparent as possible in regards to current medications and illnesses, as this will help to contribute to the most beneficial and side effect-free treatment plan as possible.