Citalopram

What is citalopram?

Citalopram is used to treat depression. It is one of a group of medicines known as selective serotonin reuptake inhibitors (SSRIs). It is believed that SSRIs work by increasing the activity of certain chemicals working in our brains called neurotransmitters. They pass signals from one brain cell to another. Although we don’t know for certain, the neurotransmitters that are most likely to be involved in depression are thought to be serotonin and noradrenaline. Selective serotonin reuptake inhibitors (SSRIs) are the most frequently prescribed antidepressants. SSRIs are called selective because they only affect serotonin. In New Zealand, citalopram is available as tablets (20 milligrams). 
Read more about antidepressants and SSRIs.

Dose

• The usual dose of citalopram is 20 milligrams once a day.
• Some people may need higher doses.
• Your doctor may start you on a low dose and if you need to, will increase your dose slowly after a few weeks. This allows your body to get used to the medicine and reduces side effects.
• Always take your citalopram exactly as your doctor has told you. The pharmacy label on your medicine will tell you how much citalopram to take, how often to take it, and any special instructions.

How to take citalopram

• Take citalopram at the same time each day, either in the morning OR in the evening. You can generally take it at a time to suit you, but try to take your doses at the same time of day, each day.
• You can take citalopram with or without food but if you think it is upsetting your stomach, try taking it with food.
• If you forget to take your dose, take it as soon as you remember that day. But, if it is nearly time for your next dose, just take the next dose at the right time. Do not take double the dose.
• Keep taking citalopram every day. It may take 4 to 6 weeks before you notice the full benefits of citalopram.
• If you think  citalopram is not working for you, do not stop taking it suddenly; speak to your doctor or nurse before stopping. It is usually best to stop taking citalopram very slowly to avoid side effects.

Read more about what to expect when starting SSRIs — see SSRIs and  frequently asked questions (FAQs) about SSRIs.

Precautions – before starting citalopram

• Do you have any heart problems such as irregular heartbeat?
• Have you had problems with mania or psychosis?
• Do you have problems with your kidneys or liver?
• Do you have epilepsy?
• Do you have diabetes? 
• Are you pregnant or breastfeeding?
• Do you have a bleeding disorder or stomach ulcer?
• Are you taking any other medicines, including medicines you can buy without a prescription, such as herbal and complementary medicines or pain relief medicines?

If so, it’s important that you tell your doctor or pharmacist before you start citalopram. Sometimes a medicine isn’t suitable for a person with certain conditions, or it can only be used with extra care.

Precautions – while taking citalopram

• Alcohol:  avoid alcohol while you are taking citalopram, especially when you first start treatment. Drinking alcohol while taking SSRIs can cause drowsiness and affect concentration, putting you at risk of falls and other accidents. It can also cause agitation, aggression and forgetfulness. If you do drink alcohol, drink only small amounts and see how you feel. Do not stop taking your medication.
• Diabetes: if you have diabetes, you may need to check your blood glucose more often because citalopram can affect the levels of glucose in your blood. 

Possible side effects

Like all medicines, citalopram can cause side effects, although not everyone gets them. Often side effects improve as your body gets used to the new medicine.

Suicidal behaviour

The use of antidepressants has been linked with an increase in suicidal thoughts and behaviour. Children, teenagers, young adults and people with a history of suicidal behaviour are particularly at risk. This is most likely during the first few weeks of starting an antidepressant or if the dose is changed. It is important to look for signs of suicidal behaviour such as agitation or aggression and ask about suicidal thoughts, self-harm, worsening of low mood, If you notice any of these signs, contact your doctor immediately.
It is ok and important to ask about suicidal thoughts and this will not increase risk. Note: citalopram is not recommended for people under 18 years of age. 

Risk of bleeding

SSRIs can increase your risk of bleeding especially if taken with NSAIDs (non-steroidal anti-inflammatory drugs) such as diclofenac and ibuprofen. Check with your doctor or pharmacist before you take pain relief.

Sexual side effects

SSRIs in both men and women can cause reduced sexual drive, lack of libido and problems keeping an erection, and reduce the intensity of orgasm. It’s important to talk to your healthcare provider if you get these effects, as they can be difficult to deal with and may not go away. Your healthcare provider may be able to suggest treatment or may reduce the dose of the SSRI or change to a different one. Read more about medicines and sexual problems. 

Other side effects

Interactions

Citalopram interacts with many other medications (including pain relief medicines) and herbal supplements (such as St. John's Wort) so check with your doctor or pharmacist before starting citalopram or before starting any new medicines.

Learn more

The following links provide further information on citalopram.

Medsafe Consumer Information Sheets: Arrow Citalopram; Celapram; Cipramil

New Zealand Formulary Patient Information: Citalopram

References

1. Citalopram New Zealand Formulary
2. Selective serotonin re-uptake inhibitors New Zealand Formulary
3. The role of medicines in the management of depression in primary care BPAC, 2017