Citalopram

A small number of children, teenagers, and young adults (up to 24 years of age) who took antidepressants ('mood elevators') such as citalopram during clinical studies became suicidal (thinking about harming or killing oneself or planning or trying to do so). Children, teenagers, and young adults who take antidepressants to treat depression or other mental illnesses may be more likely to become suicidal than children, teenagers, and young adults who do not take antidepressants to treat these conditions. However, experts are not sure about how great this risk is and how much it should be considered in deciding whether a child or teenager should take an antidepressant. Children younger than 18 years of age should not normally take citalopram, but in some cases, a doctor may decide that citalopram is the best medication to treat a child's condition.

You should know that your mental health may change in unexpected ways when you take citalopram or other antidepressants even if you are an adult over 24 years of age. You may become suicidal, especially at the beginning of your treatment and any time that your dose is increased or decreased. You, your family, or your caregiver should call your doctor right away if you experience any of the following symptoms: new or worsening depression; thinking about harming or killing yourself, or planning or trying to do so; extreme worry; agitation; panic attacks; difficulty falling asleep or staying asleep; aggressive behavior; irritability; acting without thinking; severe restlessness; and frenzied abnormal excitement. Be sure that your family or caregiver knows which symptoms may be serious so they can call the doctor if you are unable to seek treatment on your own.

Your healthcare provider will want to see you often while you are taking citalopram, especially at the beginning of your treatment. Be sure to keep all appointments for office visits with your doctor.

The doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with citalopram. Read the information carefully and ask your doctor or pharmacist if you have any questions. You also can obtain the Medication Guide from the FDA website: https://www.fda.gov/Drugs/DrugSafety/ucm085729.htm.

No matter your age, before you take an antidepressant, you, your parent, or your caregiver should talk to your doctor about the risks and benefits of treating your condition with an antidepressant or with other treatments. You should also talk about the risks and benefits of not treating your condition. You should know that having depression or another mental illness greatly increases the risk that you will become suicidal. This risk is higher if you or anyone in your family has or has ever had bipolar disorder (mood that changes from depressed to abnormally excited) or mania (frenzied, abnormally excited mood), or has thought about or attempted suicide. Talk to your doctor about your condition, symptoms, and personal and family medical history. You and your doctor will decide what type of treatment is right for you.

Citalopram is used to treat depression. Citalopram is in a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs). It works by increasing the amount of serotonin, a natural substance in the brain that helps maintain mental balance.

Citalopram comes as a tablet and a solution (liquid) to take by mouth. It is usually taken once a day, in the morning or in the evening, with or without food. Take citalopram at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take citalopram exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Your doctor may start you on a low dose of citalopram and gradually increase your dose, not more often than once a week.

It may take 1 to 4 weeks before you notice the full benefit of citalopram. Continue to take citalopram even if you feel well. Do not stop taking citalopram without talking to your doctor. Your doctor will probably decrease your dose gradually. If you suddenly stop taking citalopram, you may experience withdrawal symptoms such as mood changes, irritability, agitation, dizziness, numbness, tingling or electric shock-like sensations in the hands or feet, anxiety, confusion, headache, tiredness, nausea, sweating, shaking, frenzied or abnormally excited mood, and difficulty falling asleep or staying asleep. Tell your doctor if you experience any of these symptoms while you are decreasing your dose of citalopram or soon after you stop taking citalopram.

Citalopram is also sometimes used to treat obsessive-compulsive disorder (bothersome thoughts that won't go away and the need to perform certain actions over and over), eating disorders, alcoholism, panic disorder (condition that causes sudden attacks of extreme fear with no apparent cause), premenstrual dysphoric disorder (a group of physical and emotional symptoms that occur before the menstrual period each month), social anxiety disorder (extreme fear of interacting with others or performing in front of others that interferes with normal life), posttraumatic stress disorder, tingling in the hands and feet caused by diabetes, and certain male sexual problems. Talk to your doctor about the possible risks of using this medication for your condition.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Before taking citalopram,

• tell your doctor and pharmacist if you are allergic to citalopram, escitalopram (Lexapro), any other medications, or any of the ingredients in the citalopram product you are taking. Talk to your pharmacist or check the Medication Guide for a list of the ingredients.
• tell your doctor or pharmacist if you are taking the following medications or have stopped taking them within the past two weeks: pimozide (Orap) or a monoamine oxidase (MAO) inhibitor such as isocarboxazid (Marplan), linezolid (Zyvox), methylene blue, phenelzine (Nardil), selegiline (Emsam, Zelapar), or tranylcypromine (Parnate).
• you should know that citalopram is very similar to another SSRI, escitalopram (Lexapro). You should not take these two medications together.
• the following nonprescription or herbal products may interact with citalopram: St. John's wort; tryptophan; cimetidine (Tagamet); aspirin and nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve). Be sure to let your doctor and pharmacist know that you are taking these medications before you start taking citalopram. Do not start any of these medications while taking citalopram without discussing with your healthcare provider.
• tell your doctor if you drink or have ever drunk large amounts of alcohol or use or have ever used street drugs or have ever overused prescription medications. Also tell your doctor if you or anyone in your family has or has ever had long QT syndrome (a rare heart problem that may cause irregular heartbeat, fainting, or sudden death),if you have recently had a heart attack, or if you have or have ever had a slow or irregular heartbeat, heart failure (condition in which the heart cannot pump enough blood to other parts of the body) or other heart conditions; high blood pressure; bleeding problems; stroke; low levels of magnesium, potassium, or sodium in your blood; seizures; or kidney or liver disease.
• tell your doctor if you are pregnant, especially if you are in the last few months of your pregnancy, or if you plan to become pregnant or are breast-feeding. If you become pregnant while taking citalopram, call your doctor. Citalopram may cause problems in newborns following delivery if it is taken during the last months of pregnancy.
• you should know that citalopram may make you drowsy and may affect your judgment, thinking, and movements. Do not drive a car or operate machinery until you know how this medication affects you.
• talk to your doctor about the safe use of alcoholic beverages during your treatment with citalopram. Alcohol can make the side effects of citalopram worse.
• you should know that citalopram may cause angle-closure glaucoma (a condition where the fluid is suddenly blocked and unable to flow out of the eye causing a quick, severe increase in eye pressure which may lead to a loss of vision). Talk to your doctor about having an eye examination before you start taking this medication. If you have nausea, eye pain, changes in vision, such as seeing colored rings around lights, and swelling or redness in or around the eye, call your doctor or get emergency medical treatment right away.

Unless your doctor tells you otherwise, continue your normal diet.

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

Citalopram may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• nausea
• diarrhea
• constipation
• vomiting
• stomach pain
• heartburn
• decreased appetite
• weight loss
• increased sweating
• increased thirst
• frequent urination
• difficulty falling asleep or staying asleep
• drowsiness
• excessive tiredness
• yawning
• weakness
• uncontrollable shaking of a part of the body
• muscle or joint pain
• dry mouth
• sexual problems in males; decreased sex drive, inability to get or keep an erection, or delayed or absent ejaculation
• sexual problems in females; decreased sex drive, or delayed orgasm or inability to have an orgasm
• heavy menstrual periods
• runny nose

Some side effects can be serious. If you experience any of the following symptoms, or those listed in the IMPORTANT WARNING or SPECIAL PRECAUTIONS sections, call your doctor immediately or get emergency medical treatment:

• chest pain
• shortness of breath
• dizziness
• fainting
• fever, sweating, confusion, fast or irregular heartbeat, severe muscle stiffness or twitching, agitation, hallucinations, loss of coordination, nausea, vomiting, or diarrhea
• coma (loss of consciousness)
• hives or blisters
• rash
• itching
• difficulty breathing or swallowing
• swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
• hoarseness
• unusual bleeding or bruising
• nose bleeding
• headache
• unsteadiness
• problems with thinking, concentration, or memory
• seizures

Citalopram may decrease appetite and cause weight loss in children. Your child's doctor will watch his or her growth carefully. Talk to your child's doctor if you have concerns about your child's growth or weight while he or she is taking this medication. Talk to your child's doctor about the risks of giving citalopram to your child.

Citalopram may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (https://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. https://www.upandaway.org

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (https://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include the following:

• dizziness
• sweating
• nausea
• vomiting
• uncontrollable shaking of a part of the body
• drowsiness
• fast, irregular, or pounding heartbeat
• memory loss
• confusion
• seizures
• coma (loss of consciousness)
• fast breathing
• bluish color around mouth, fingers, or fingernails
• muscle pain
• dark-colored urine

Keep all appointments with your doctor and the laboratory. Your doctor may order certain laboratory tests and electrocardiograms (EKG; a test to monitor your heart rate and rhythm) before you start taking citalopram and during your treatment with this medication.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

• Celexa^®