Celexa® (citalopram)

Brand name: Celexa®

Generic name: citalopram (sye TAL oh pram)

Medication class: Selective serotonin reuptake inhibitor (SSRI) antidepressant

All FDA black box warnings are at the end of this fact sheet.  Please review before taking this medication.

What is Celexa® and what does it treat?

Citalopram is an antidepressant medication that works in the brain. It is approved for the treatment of major depressive disorder (MDD).

Symptoms of depression include:

What is the most important information I should know about Celexa®?

Do not stop taking citalopram even when you feel better. Only your healthcare provider can determine the length of treatment that is right for you.

Missing doses of citalopram may increase your risk for relapse in your symptoms.

Stopping citalopram abruptly may result in one or more of the following withdrawal symptoms: irritability, nausea, feeling dizzy, vomiting, nightmares, headache, and/or paresthesias (prickling, tingling sensation on the skin).

Depression is also a part of bipolar illness. People with bipolar disorder who take antidepressants may be at risk for "switching" from depression into mania. Symptoms of mania include "high" or irritable mood, very high self esteem, decreased need for sleep, pressure to keep talking, racing thoughts, being easily distracted, frequently involved in activities with a large risk for bad consequences (for example, excessive buying sprees).

Medical attention should be sought if serotonin syndrome is suspected. Please refer to serious side effects for signs/symptoms.

Are there specific concerns about Celexa® and pregnancy?

If you are planning on becoming pregnant, notify your healthcare provider to best manage your medications. People living with MDD who wish to become pregnant face important decisions. Untreated MDD has risks to the fetus, as well as the mother. It is important to discuss the risks and benefits of treatment with your doctor and caregivers. For women who take antidepressant medications during weeks 13 through the end of their pregnancy (second and third trimesters), there is a risk that the baby can be born before it is fully developed (before 37 weeks).

For mothers who have taken SSRIs during their pregnancy, there appears to be less than a 1% chance of infants developing persistent pulmonary hypertension. This is a potentially fatal condition that is associated with use of the antidepressant in the second half of pregnancy. However, women who discontinued antidepressant therapy were five times more likely to have a depression relapse than those who continued their antidepressant. If you are pregnant, please discuss the risks and benefits of antidepressant use with your healthcare provider.

Caution is advised with breastfeeding since citalopram does pass into breast milk.

What should I discuss with my healthcare provider before taking Celexa®?

How should I take Celexa®?

Citalopram is usually taken 1 time per day with or without food.

Typically patients begin at a low dose of medicine and the dose is increased slowly over several weeks.

The dose usually ranges from 20 mg to 40 mg once daily. For patients older than 60 years, the maximum recommended dose is 20 mg once daily. Only your healthcare provider can determine the correct dose for you.

The liquid should be measured with a dosing spoon or oral syringe which you can get from your pharmacy.

Consider using a calendar, pillbox, alarm clock, or cell to help you remember to take your medication. You may also ask a family member or friend to remind you or check in with you to be sure you are taking your medication.

What happens if I miss a dose of Celexa®?

If you miss a dose of citalopram, take it as soon as you remember, unless it is closer to the time of your next dose. Discuss this with your healthcare provider. Do not double your next dose or take more than what is prescribed.

What should I avoid while taking Celexa®?

Avoid drinking alcohol or using illegal drugs while you are taking antidepressant medications. They may decrease the benefits (e.g., worsen your condition) and increase adverse effects (e.g., sedation) of the medication.

What happens if I overdose with Celexa®?

If an overdose occurs, call your doctor or 911. You may need urgent medical care. You may also contact the poison control center at 1-800-222-1222.

A specific treatment to reverse the effects of citalopram does not exist.

What are the possible side effects of Celexa®?

Common Side Effects

These will often improve over the first week or two as you continue to take the medication.

Sexual side effects, such as problems with orgasm or ejaculatory delay often do not diminish over time.

Rare Side Effects

Increased bleeding (e.g., gums may bleed more easily), low sodium blood levels (symptoms of low sodium levels may include headache, weakness, difficulty concentrating and remembering), teeth grinding

Serious Side Effects

Serotonin syndrome (symptoms may include shivering, diarrhea, confusion, severe muscle tightness, fever, seizures, and death)

Seizure

Abnormal heart rhythm

Are there any risks of taking Celexa® for long periods of time?

To date, there are no known problems associated with long term use of citalopram. It is a safe and effective medication when used as directed.

What other medications may interact with Celexa®?

Citalopram should not be taken with or within 2 weeks of taking monoamine oxidase inhibitors (MAOIs). These include phenelzine (Nardil®), tranylcypromine (Parnate®), isocarboxazid (Marplan®), rasagiline (Azilect®), and selegeline (Emsam®).

Although rare, there is an increased risk of serotonin syndrome when citalopram is used with other medications that increase serotonin, such as other antidepressants, migraine medications called “triptans” (e.g., Imitrex®), some pain medications (e.g., tramadol (Ultram®)), and the antibiotic linezolid (Zyvox®).

Citalopram may increase the effects of other medications that can cause bleeding (e.g., ibuprofen (Advil®, Motrin®), and warfarin (Coumadin®) and aspirin).

Increased risk of QT prolongation when used with:

How long does it take for Celexa® to work?

Sleep, energy, or appetite may show some improvement within the first 1-2 weeks. Improvement in these physical symptoms can be an important early signal that the medication is working. Depressed mood and lack of interest in activities may need up to 6-8 weeks to fully improve.

Provided by the College of Psychiatric and Neurologic Pharmacists

(January 2013)


Summary of Black Box Warning:

Suicidal Thoughts or Actions in Children and Adults