Citalopram Hbr

( Celexa )

Medically Reviewed by Harshi Dhingra, M.D.

Last Reviewed: Jun 21, 2022

Warnings

What are the risks of taking citalopram (Celexa)?

Citalopram can cause serious health problems, especially in certain high-risk patients.

Some of the risks of citalopram therapy include:

SUICIDE RISK: In a small number of people, especially young adults under the age of 24 years, citalopram and other drugs used to treat depression can increase the risk of suicidal thoughts and behaviors. The risk is highest when treatment is first started and after changes in citalopram dose. Tell your doctor right away if you notice any unusual changes in mood or behaviors. Family members and caregivers should be aware of this risk and the need for close observation of any person under treatment with citalopram.
SEROTONIN SYNDROME: This is a rare but potentially life-threatening syndrome caused by dangerously high serotonin levels in the brain. The risk of serotonin syndrome is greater in people who take other drugs that can increase serotonin levels, such as lithium, triptans (used to treat cluster headaches and migraines), and St John’s Wort. Symptoms of serotonin syndrome include fever, confusion, muscle stiffness or spasms, sweating, and a fast or pounding heartbeat. Please seek immediate medical attention if you experience these symptoms.
INCREASED BLEEDING RISK: An increased risk of bleeding and bruising is present in people on citalopram and taking medications like blood thinners (warfarin) or NSAIDs (aspirin, ibuprofen, naproxen). Tell your doctor immediately if you notice any unexplained bruises, unusual bleeding, pink or red urine, or dark-colored stools.
LOW SODIUM LEVELS: In a small number of people, citalopram can cause a drop in blood sodium levels. The risk is higher in older adults, people who are dehydrated, and those who are also taking diuretics (water pills). You may need to have regular blood tests to ensure your sodium level stays normal while on citalopram. Call your doctor immediately if you experience headaches, confusion, problems concentrating, memory difficulties, or weakness.
MANIA: Depression is often the first symptom of bipolar disorder (a condition in which there are alternating episodes of depression and mania). If an individual with bipolar disorder presents with depression and is treated with an antidepressant such as citalopram, it can bring on a manic episode. Contact your doctor right away if you notice abnormal excitement, delusions, euphoria, overactivity, or any unusual behaviors or moods.
WITHDRAWAL SYMPTOMS: Suddenly stopping citalopram can cause withdrawal symptoms such as anxiety, agitation, flu-like symptoms, nausea, dizziness, and sleep problems. Do not attempt dose reduction or stop taking citalopram without talking to your doctor. Your doctor will decrease the dose gradually.
QT PROLONGATION: Citalopram can affect the heart's normal rhythm and cause it to beat abnormally. This is known as QT prolongation. The risk of QT prolongation is higher in people who have existing heart rhythm problems, have had a heart attack, have low blood potassium or blood magnesium levels, take other drugs that can affect the heart rhythm, have liver problems, or are on high doses of citalopram. Go to the emergency room immediately if you experience chest pain, difficulty breathing, or abnormal heart rate.
SEIZURES: Rarely, citalopram can cause a seizure. This risk is higher in people who have had seizures before. This medicine should be used with caution in people with a history of seizures.
GLAUCOMA: Citalopram can cause closed-angle glaucoma (increased eye pressure). Your doctor may request an eye examination before starting you on citalopram. Call your doctor right away if you experience symptoms such as nausea, eye pain, swelling around the eyes, or vision problems during citalopram treatment.

If you are at a high risk of complications from citalopram use, your doctor or pharmacist can help you find other treatments for your condition.

What should I tell my doctor before starting citalopram (Celexa)?

Tell your healthcare provider if you have ever had an allergic reaction to citalopram, any active or inactive ingredients in citalopram preparations, other SSRIs, or other drugs. Your pharmacy can give you a list of ingredients.

Give your healthcare provider a complete medical history. Citalopram may not be suitable for people with certain medical conditions such as congenital long QT syndrome, low sodium levels, low magnesium levels, low potassium levels, seizures, high blood pressure, heart disease, heart attack, heart failure, bleeding problems, severe renal impairment (kidney disease), or liver disease. Tell your doctor if you or anyone in your family has a history of suicide attempts or bipolar disorder.

Give your doctor a complete list of all your medications, including prescription drugs, over-the-counter medications, vitamins, dietary supplements, and herbal products, especially St. John’s Wort or tryptophan. This can help avoid serious drug interactions.

Tell your doctor if you are pregnant, could be pregnant, plan to get pregnant, or are breastfeeding. Citalopram can cause problems in a newborn baby if taken during the last few months of pregnancy.

What precautions should I take while on citalopram (Celexa)?

Keep all appointments with healthcare professionals while on citalopram. Your doctor may want to see you often, especially when you start treatment, to evaluate your response to the medication and for dosage adjustment.

Citalopram is very similar to escitalopram (Lexapro), also an SSRI. You should not take these two medications together.

Watch out for any unusual mood or behavioral changes or new or worse depression. A small number of people, especially those under the age of 24, can experience unexpected mental health changes and suicidality while on citalopram. Call your doctor immediately if you notice any unusual behaviors or moods.

Citalopram can make you drowsy and dizzy. Do not drive, operate heavy machinery, or do anything that requires focus before knowing how this medicine affects you. Remember that alcohol can make the drowsiness caused by citalopram worse.

Tell your doctor if you become pregnant while on citalopram. This medicine can be harmful to the baby.

Citalopram can cause closed-angle glaucoma (increased eye pressure). Call your doctor immediately if you develop symptoms such as eye pain, vision changes, redness and swelling around the eyes, or nausea.

Tell your healthcare professionals you are taking citalopram before undergoing any surgery, including dental surgery.

What are citalopram (Celexa) interactions?

Taking citalopram with some other medications can affect how the medications work. Drug interactions can also increase the risk of serious adverse effects. Your physician may choose a different antidepressant for you, change the dose or frequency of one or both medicines, and/or closely monitor you for side effects if there are known interactions between citalopram and your other medications.

You should not take citalopram if you are taking or have taken within the last 14 days any monoamine oxidase (MAO) inhibitors. Examples of MAO-inhibitors include linezolid (Zyvox), isocarboxazid (Marplan), methylene blue, selegiline (Eldepryl, Emsam, Zelapar), phenelzine (Nardil), and tranylcypromine (Parnate).

Taking citalopram with the following medications is not recommended:

Pimozide (Orap)
Escitalopram (Lexapro)

There can be drug interactions between citalopram and the following medications:

Anti-seizure medications like carbamazepine (Tegretol)
Cimetidine (Tagamet)
Cisapride (Propulsid)
Water pills (diuretics)
Antibiotics like erythromycin (E.E.S. E-Mycin, Erythrocin)
Tricyclic antidepressants such as amitriptyline (Elavil), desipramine (Norpramin), imipramine (Tofranil), nortriptyline (Aventyl, Pamelor)
Heparin
Lithium (Eskalith, Lithobid)
Quinidine (Quinidex)
Sibutramine (Meridia)

Medications used for abnormal heart rhythm, such as amiodarone (Cordarone), disopyramide (Norpace), dofetilide (Tikosyn), sotalol (Betapace)
Anticoagulants or blood thinners like warfarin (Coumadin, Jantoven)
NSAIDs (nonsteroidal anti-inflammatory drugs) such as aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn)
Medications used to treat anxiety, mental illness, chronic pain, seizures, Parkinson's disease
Triptan medications used to treat migraine headaches
Metoprolol (Lopressor, Toprol XL)
Thioridazine (Mellaril)
Tramadol (Ultram)

Other selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs)
Tricyclic antidepressants such as amitriptyline (Elavil), desipramine (Norpramin), imipramine (Tofranil), nortriptyline (Aventyl, Pamelor)
Heparin
Other selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs)
Moxifloxacin (Avelox)
Omeprazole (Prilosec, Zegerid)
Procainamide (Procanbid, Pronestyl)
Sedatives, sleeping pills, tranquilizers
Sparfloxacin (Zagam)

This list does not describe all possible citalopram interactions. Give your healthcare professionals a complete list of your medications, including prescription and non-prescription drugs, vitamins and dietary supplements, and herbal products. Also, tell your health care provider if you smoke, drink alcohol, or use illegal drugs because some of these substances can cause serious health complications when used with prescription drugs.

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