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pms-Citalopram

Common Name

citalopram

How does this medication work? What will it do for me?

Citalopram belongs to a group of medications called selective serotonin reuptake inhibitors (SSRIs). It is used to treat depression. SSRIs improve depression by increasing the amount of serotonin (a neurotransmitter) in certain areas of the brain, which in turn improves the ability of the brain to transmit messages from one nerve cell to another.

Although you may start feeling better within a few weeks of treatment, the full effects of the medication may not be evident until several weeks of treatment have passed.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. As well, some forms of this medication may not be used for all of the conditions discussed here. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

10 mg
Each white, oval, coated tablet, debossed with "10" on one side and plain on the other side, contains citalopram 10 mg as citalopram HBr. Nonmedicinal ingredients: colloidal silicon dioxide, hydroxypropyl cellulose, hydroxypropyl methylcellulose, lactose monohydrate, magnesium stearate, microcrystalline cellulose, polyethylene glycol, sodium starch glycolate, and titanium dioxide.

20 mg
Each white to off-white, oval, film-coated tablet, imprinted "20" on one side and scored on the other, contains citalopram 20 mg as citalopram HBr. Nonmedicinal ingredients: colloidal silicon dioxide, hydroxypropyl cellulose, hydroxypropyl methylcellulose, lactose monohydrate, magnesium stearate, microcrystalline cellulose, polyethylene glycol, sodium starch glycolate, and titanium dioxide.

40 mg
Each white to off-white, oval, film-coated tablet, imprinted "40" on one side and scored on the other side, contains citalopram 40 mg as citalopram HBr. Nonmedicinal ingredients: colloidal silicon dioxide, hydroxypropyl cellulose, hydroxypropyl methylcellulose, lactose monohydrate, magnesium stearate, microcrystalline cellulose, polyethylene glycol, sodium starch glycolate, and titanium dioxide.

How should I use this medication?

The usual recommended starting dose is 20 mg daily. Your doctor may increase the dose as appropriate. It should be taken once daily in the morning or evening, with or without food.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice. Do not stop taking this medication suddenly without first contacting your health care provider.

Store this medication at room temperature, protect it from moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Citalopram should not be taken by anyone who:

• is allergic to citalopram or to any of the ingredients of the medication
• is taking pimozide (an antipsychotic medication)
• has taken a type of medication known as an MAO inhibitor (e.g., phenelzine, tranylcypromine, moclobemide) within the past 2 weeks - do not start treatment with an MAO inhibitor until at least 2 weeks after discontinuing citalopram treatment

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent. The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

abdominal pain agitation anxiety diarrhea dizziness drowsiness dry mouth fatigue fever heartburn increased sweating

increased yawning loss of appetite nausea painful periods sexual difficulties shakiness sore throat stuffy or runny nose trouble sleeping vomiting

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

behaviour similar to drunkenness bleeding gums blurred vision confusion dizziness or fainting increase in frequency of urination or amount of urine produced, or trouble holding or releasing urine irregular heartbeat lack of emotion loss of memory menstrual changes

mood or mental changes nervousness nosebleed purple or red spots on skin severe agitation severe migraine skin rash or itching slow or irregular heartbeat (less than 50 beats per minute) sore throat, fever, and chills trouble breathing unusual or sudden body or facial movements or postures

Stop taking the medication and seek immediate medical attention if any of the following occur:

• chest pain
• seizure or convulsions
• serotonin syndrome (signs include agitation, confusion, diarrhea, fever, overactive reflexes, poor coordination, restlessness, shivering, sweating, talking or acting with excitement you cannot control, trembling or shaking, twitching)
• thoughts of suicide or hurting yourself

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin taking a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Abnormal heart rhythm: Citalopram may cause an abnormal heart rhythm, especially at higher doses. Your doctor may occasionally monitor your heart rate and rhythm with a test called an electrocardiogram. People with a history of a heart rhythm disturbance called QT prolongation should not take this medication. If you have congestive heart failure, slow heart rhythm, are at risk of low potassium or magnesium levels because of certain illnesses or medications, or you are taking certain medications that can affect the heart rhythm (e.g., amiodarone, sotalol), you should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Bleeding disorders: Citalopram may increase bruising and bleeding from cuts that may take longer to stop. People with bleeding disorders or a history of bleeding problems should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Diabetes: Citalopram may lower blood sugar levels (hypoglycemia). People with diabetes should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Drowsiness/reduced alertness: Citalopram may cause drowsiness for some who take it. Avoid activities that require mental alertness, judgment, and physical coordination (such as driving a car or performing hazardous tasks) until you establish that citalopram does not affect you in this way.

Heart disease: Citalopram may cause decreased heart rate for some people. People with heart disease should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Kidney function: People with severely reduced kidney function should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function: People with reduced liver function should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Mania or hypomania: Citalopram may cause activation of mania or hypomania. People with a history of mania or bipolar disorder should be closely monitored by their doctor while taking this medication.

Seizures: People with a history of seizures should be closely monitored by their doctor when taking citalopram. If you develop seizures, contact your doctor or seek medical attention immediately.

Stopping the medication: Stopping this medication suddenly may lead to side effects. If you are thinking of stopping the medication, check with your doctor first.

Suicidal or agitated behaviour: People taking this medication may feel agitated (restless, anxious, aggressive, emotional, and feeling not like themselves) or they may want to hurt themselves or others. These symptoms may occur within several weeks after people start taking this medication. People should be closely monitored by their doctor for emotional and behavioural changes. If you experience any of these symptoms while taking this medication, contact your doctor immediately.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking citalopram, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children and is not indicated for use in children under the age of 18. There have been reports that using this and similar medications in children under 18 years old may cause behavioural and emotional changes such as suicidal thoughts and behaviour.

Seniors: Because this medication is removed from the body by the kidney and liver, seniors may be at increased risk of side effects if they use this medication. If you are over 65, discuss with your doctor whether any special monitoring is required.

What other drugs could interact with this medication?

There may be an interaction between citalopram and any of the following:

alcohol anticoagulants (e.g.,warfarin) anti-HIV medications (e.g., indinavir, lopinavir, ritonavir) antiplatelets (e.g., acetylsalicylic acid (ASA), clopidogrel) atypical antipsychotic medications (e.g., risperidone, ziprasidone) "azole" antifungals (e.g., fluconazole, itraconazole,ketoconazole) beta-blockers (e.g., propranolol, metoprolol) bromocriptine carbamazepine cimetidine ciprofloxacin clozapine desipramine dextromethorphan imipramine isoniazid linezolid

lithium l-tryptophan macrolide antibiotics (e.g., clarithromycin, erythromycin) MAO inhibitors (e.g., selegiline, phenelzine, tranylcypromine) metoclopramide NSAIDs (e.g., ibuprofen, indomethacin) omeprazole opioid pain relievers (i.e., fentanyl, morphine, pentazocine) other SSRIs (e.g., fluoxetine, sertraline) SNRIs (e.g., venlafaxine, duloxetine) phenytoin pimozide quinine selegiline sibutramine St. John's wort tramadol trazodone triptans (e.g., sumatriptan)

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

All material © 1996-2013 MediResource Inc. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.