CITALOPRAM
Generic Name: citalopram (oral) (sih TAL oh pram)
Brand Names: Celexa

What is the most important information I should know about citalopram?
• While you are taking citalopram you may need to be monitored for worsening symptoms of depression and/ or suicidal thoughts at the start of therapy or when doses are changed. This concern about the increased risk of suicidal thoughts or behaviors may be greater if you are 18 years of age or younger and are taking citalopram. In patients younger than 18 years, the period of risk may extend beyond start of therapy or when doses are changed. Your doctor may want you to monitor for the following symptoms: anxiety, panic attacks, difficulty sleeping, irritability, hostility, impulsivity, severe restlessness, and mania (mental and/ or physical hyperactivity). These symptoms may be associated with the development of worsening symptoms of depression and/ or suicidal thoughts or actions. Contact your healthcare provider if you develop any new or worsening mental health symptoms during treatment with citalopram. Do not stop taking citalopram.
• Do not stop taking without first talking to your doctor. It may take several weeks for you to start feeling better.
• Use caution when driving, operating machinery, or performing other hazardous activities. Citalopram may cause dizziness. If you experience dizziness, avoid these activities.
• Use alcohol cautiously. Alcohol may increase drowsiness and dizziness while taking citalopram or affect your condition.

What is citalopram?
• Citalopram is in a class of drugs called selective serotonin reuptake inhibitors. Citalopram affects chemicals in the brain that may become unbalanced and cause depression.
• Citalopram is used to treat depression.
• Citalopram may also be used for purposes other than those listed in this medication guide.

What should I discuss with my healthcare provider before taking citalopram?
• While you are taking citalopram you may need to be monitored for worsening symptoms of depression and/ or suicidal thoughts at the start of therapy or when doses are changed. This concern about the increased risk of suicidal thoughts or behaviors may be greater if you are 18 years of age or younger and are taking citalopram. In patients younger than 18 years, the period of risk may extend beyond start of therapy or when doses are changed. Your doctor may want you to monitor for the following symptoms: anxiety, panic attacks, difficulty sleeping, irritability, hostility, impulsivity, severe restlessness, and mania (mental and/ or physical hyperactivity). These symptoms may be associated with the development of worsening symptoms of depression and/ or suicidal thoughts or actions. Contact your healthcare provider if you develop any new or worsening mental health symptoms during treatment with citalopram. Do not stop taking citalopram.
• You cannot take citalopram if you have taken a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate) during the last 2 weeks. A dangerous drug interaction can occur if citalopram is combined with any of these medications.
• Before taking citalopram, tell your doctor if you
· have liver disease,
· have kidney disease,
· suffer from seizures, or
· suffer from mania or have suicidal thoughts.
• You may not be able to take citalopram, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.
• Citalopram should not be taken during treatment with escitalopram (Lexapro). Also, if you have had an allergic reaction to escitalopram (Lexapro), you may also have an allergic reaction to citalopram. Do not take citalopram without first talking to your doctor if you have had an allergic reaction to either medication in the past.
• Citalopram is in the FDA pregnancy category C. This means that it is not known whether citalopram will be harmful to an unborn baby. Do not take citalopram without first talking to your doctor if you are pregnant or could become pregnant during treatment.
• Citalopram passes into breast milk and may affect a nursing infant. Do not take citalopram without first talking to your doctor if you are breast-feeding a baby.

How should I take citalopram?
• Take citalopram exactly as directed by your doctor. If you do not understand these instructions, ask your pharmacist, nurse, or doctor to explain them to you.
• Take each dose with a full glass (8 ounces) of water.
• Citalopram may be taken with or without food.
• To ensure that you get the correct dose, measure the citalopram solution with a dose-measuring spoon or cup, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist where you can get one.
• Citalopram is usually taken once a day. Follow your doctor's instructions. Take the dose at the same time each day.
• It is important to take citalopram regularly to get the most benefit.
• Do not stop taking citalopram without first talking to your doctor. It may take several weeks for you to start feeling better.
• Store citalopram at room temperature away from moisture and heat.

What happens if I miss a dose?
• Take the missed dose as soon as you remember. However, if it is almost time for the next regularly scheduled dose, skip the missed dose and take the next one as directed. Do not take a double dose of this medication unless otherwise directed by your doctor.

What happens if I overdose?
• Seek emergency medical attention if an overdose is suspected.
• Symptoms of a citalopram overdose include nausea, vomiting, tremor, drowsiness, dizziness, sweating, and a fast heartbeat.

What should I avoid while taking citalopram?
• Use caution when driving, operating machinery, or performing other hazardous activities. Citalopram may cause dizziness. If you experience dizziness, avoid these activities.
• Use alcohol cautiously. Alcohol may increase drowsiness and dizziness while taking citalopram or affect your condition.

What are the possible side effects of citalopram?
• If you experience any of the following serious side effects, stop taking citalopram and call your doctor immediately or seek emergency medical treatment:
· an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives);
· an irregular heartbeat or pulse;
· low blood pressure (dizziness, weakness);
· high blood pressure (severe headache, blurred vision); or
· chills or fever.
• If you experience any of the following less serious side effects, continue taking citalopram and talk to your doctor:
· headache, tremor, nervousness, or anxiety;
· nausea, diarrhea, dry mouth, or changes in appetite or weight;
· sleepiness or insomnia; or
· decreased sex drive, impotence, or difficulty having an orgasm.
• Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect citalopram?
• You cannot take citalopram if you have taken a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate) during the last 2 weeks. A dangerous drug interaction can occur when citalopram is combined with any of these medications.
• Before taking citalopram, tell your doctor if you are taking any of the following medicines:
· another antidepressant such as fluoxetine (Prozac), fluvoxamine (Luvox), sertraline (Zoloft), paroxetine (Paxil), trazodone (Desyrel), or nefazodone (Serzone);
· a tricyclic antidepressant such as amitriptyline (Elavil), imipramine (Tofranil), doxepin (Sinequan), nortriptyline (Pamelor), and others;
· a seizure medication including carbamazepine (Tegretol) or felbamate (Felbatol);
· a stomach medicine such as cimetidine (Tagamet, Tagamet HB), ranitidine (Zantac, Zantac 75), or omeprazole (Prilosec);
· an antibiotic such as erythromycin (Eryc-Tab, E-Mycin, E.E.S., Erythrocin, P.C.E., others), linezolid (Zyvox) or clarithromycin (Biaxin);
· an antifungal medication such as fluconazole (Diflucan), itraconazole (Sporanox), or ketoconazole (Nizoral);
· a migraine medication such as almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex), or zolmitriptan (Zomig);
· the asthma medication zafirlukast (Accolate); or
· lithium (Eskalith, Lithobid, Lithonate, Lithotabs).
• You may not be able to take citalopram, or you may require a dosage adjustment or special monitoring during treatment if you are taking any of the medicines listed above.
• Drugs other than those listed here may also interact with citalopram. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including vitamins, minerals, and herbal products.

Where can I get more information?
• Your pharmacist has additional information about citalopram written for health professionals that you may read.