What is the most important information I should know about citalopram?

Do not take citalopram together with pimozide (Orap), linezolid (Zyvox), or a monoamine oxidase inhibitor (MAOI) such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate).

Before you take citalopram, tell your doctor if you have seizures or epilepsy, a bleeding disorder, liver or kidney disease, bipolar disorder, heart disease, a heart rhythm disorder, recent history of heart attack, or a history of drug abuse or suicidal thoughts.

You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

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.

Tell your doctor right away if you become pregnant while taking this medication. Citalopram may cause heart defects or serious lung problems in a newborn if you take the medication during pregnancy. However, you may have a relapse of depression if you stop taking your antidepressant. Do not start or stop taking citalopram during pregnancy without your doctor's advice.

What is citalopram?

Citalopram is an antidepressant in a group of drugs called selective serotonin reuptake inhibitors (SSRIs).

Citalopram is used to treat depression.

Citalopram may also be used for purposes not listed in this medication guide.

What should I discuss with my healthcare provider before taking citalopram?

Do not take citalopram together with pimozide (Orap), linezolid (Zyvox), or a monoamine oxidase inhibitor (MAOI) such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate). A dangerous drug interaction could occur, leading to serious side effects.

You should not take citalopram if you are allergic to it.

Tell your doctor about all other antidepressants you take, especially Cymbalta, Desyrel, Effexor, Lexapro, Luvox, Oleptro, Prozac, Sarafem, Symbyax, Paxil, Pexeva, Viibryd, or Zoloft.

To make sure you can safely take citalopram, tell your doctor if you have any of these other conditions:

• a bleeding or blood clotting disorder;
• liver or kidney disease;
• seizures or epilepsy;
• heart disease, a heart rhythm disorder, or recent history of heart attack;
• bipolar disorder (manic depression); or
• a history of drug abuse or suicidal thoughts.

You may have thoughts about suicide while taking an antidepressant, especially if you are younger than 24 years old. Tell your doctor if you have worsening depression or suicidal thoughts during the first several weeks of treatment, or whenever your dose is changed.

Your family or other caregivers should also be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

FDA pregnancy category C. Tell your doctor right away if you become pregnant while taking this medication. Citalopram may cause heart defects or serious lung problems in a newborn if you take the medication during pregnancy. However, you may have a relapse of depression if you stop taking your antidepressant. Do not start or stop taking citalopram during pregnancy without your doctor's advice.

Citalopram can pass into breast milk and may harm a nursing baby. You should not breast-feed while you are using citalopram.

Do not give this medication to anyone under 18 years old without medical advice.

How should I take citalopram?

Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results.

Measure liquid medicine with a special dose-measuring spoon or medicine cup, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.

It may take 4 weeks or longer before your symptoms improve. Keep using the medication as directed and tell your doctor if your symptoms do not improve after 4 weeks of treatment.

Do not stop using citalopram suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to avoid withdrawal symptoms when you stop using citalopram.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Overdose symptoms may include nausea, vomiting, tremor, sweating, rapid heartbeat, confusion, fainting, seizures, and coma.

What should I avoid while taking citalopram?

Avoid taking tryptophan while you are taking citalopram.

Drinking alcohol can increase certain side effects of citalopram.

Citalopram may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

What are the possible side effects of citalopram?

Get emergency medical help if you have any of these signs of an allergic reaction: skin rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

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.

Call your doctor at once if you have a serious side effect such as:

• very stiff (rigid) muscles, high fever, sweating, fast or uneven heartbeats, tremors, overactive reflexes;
• severe dizziness, feeling short of breath, fainting, fast or pounding heartbeats;
• nausea, vomiting, diarrhea, loss of appetite, feeling unsteady, loss of coordination; or
• headache, trouble concentrating, memory problems, weakness, confusion, hallucinations, fainting, seizure, shallow breathing or breathing that stops.

Less serious side effects may include:

• drowsiness, tired feeling, memory problems, trouble concentrating;
• sleep problems (insomnia);
• mild nausea, diarrhea, upset stomach, dry mouth;
• increased sweating or urination;
• cold symptoms such as stuffy nose, sneezing, sore throat, cough;
• weight changes; or
• decreased sex drive, impotence, or difficulty having an orgasm.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect citalopram?

Cold or allergy medicine, sedatives, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures or anxiety can add to sleepiness caused by citalopram. Tell your doctor if you regularly use any of these medicines.

Ask your doctor before taking a nonsteroidal anti-inflammatory drug (NSAID) for pain, arthritis, fever, or swelling. This includes aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn, Naprelan, Treximet), celecoxib (Celebrex), diclofenac (Arthrotec, Cambia, Cataflam, Voltaren, Flector Patch, Pennsaid, Solareze), indomethacin (Indocin), meloxicam (Mobic), and others. Using an NSAID with citalopram may cause you to bruise or bleed easily.

Many drugs can interact with citalopram. Below is just a partial list. Tell your doctor if you are using:

• any other antidepressants, such as amitriptylline (Elavil, Vanatrip, Limbitrol), clomipramine (Anafranil), or desipramine (Norpramin);
• lithium (Lithobid, Eskalith);
• isoniazid (Rifamate, Rifater);
• St. John's wort;
• an antibiotic such as clarithromycin (Biaxin), erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin, Pediazole), levofloxacin (Levaquin), moxifloxacin (Avelox), or pentamidine (NebuPent, Pentam);
• a blood thinner such as warfarin (Coumadin, Jantoven) or ticlopidine (Ticlid);
• anti-malaria medication such as chloroquine (Aralen) or mefloquine (Lariam);
• heart medication such as amiodarone (Cordarone, Pacerone), digoxin (Lanoxin), dofetilide (Tikosyn), disopyramide (Norpace), dronedarone (Multaq), ibutilide (Corvert), procainamide (Procan, Pronestyl), propafenone (Rythmol), quinidine (Quin-G), or sotalol (Betapace);
• HIV or AIDS medication such as delavirdine (Rescriptor, efavirenz (Sustiva, Atripla), or etravirine (Intelence);
• medicine to prevent or treat nausea and vomiting such as dolasetron (Anzemet), droperidol (Inapsine), or ondansetron (Zofran);
• medicines to treat psychiatric disorders, such as chlorpromazine (Thorazine), clozapine (FazaClo, Clozaril), haloperidol (Haldol), pimozide (Orap), thioridazine (Mellaril), or ziprasidone (Geodon); or
• migraine headache medicine such as almotriptan (Axert), frovatriptan (Frova), sumatriptan (Imitrex, Treximet), naratriptan (Amerge), rizatriptan (Maxalt), or zolmitriptan (Zomig).
• seizure medicine such as carbamazepine (Carbatrol, Equetro, Tegretol), felbamate (Felbatol), or oxcarbazepine (Trileptal); or
• stomach acid reducers such as cimetidine (Tagamet), lansoprazole (Prevacid), or omeprazole (Prilosec).

This list is not complete and there are many other drugs that can interact with citalopram. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor. Keep a list of all your medicines and show it to any healthcare provider who treats you.

Where can I get more information?

Your pharmacist can provide more information about citalopram.