Citalopram: Uses, Dosage, Side Effects, and Safety Information

Citalopram is a selective serotonin reuptake inhibitor, or SSRI, used to treat major depressive disorder, also called MDD. It increases the availability of serotonin signaling in the brain and can help improve mood and other symptoms of depression. This guide covers citalopram uses, dosage, side effects, precautions, drug interactions, use in pregnancy and breastfeeding, brand names and its approximate price in India.

Citalopram Boxed Warning, Suicidal Thoughts in Young People

Citalopram and other antidepressants can increase the risk of suicidal thinking and behavior in children, adolescents, and young adults up to about age 24, particularly when starting treatment or after a dose change. This does not mean every person taking citalopram will experience this risk, but patients, family members, and caregivers should watch closely for new or worsening depression, unusual changes in behavior, or suicidal thoughts, and contact a doctor urgently if these occur. This risk needs to be weighed against the risk of leaving depression untreated, and the decision to use citalopram in this age group should be made with a doctor. Do not stop citalopram abruptly because of these symptoms, contact your doctor right away instead.

Common Indications of Citalopram

Major depressive disorder, MDD.

Off Label Uses

Generalized anxiety disorder. Panic disorder.

These are off label uses, meaning they are not the primary approved indication for citalopram in many countries, and approved indications can vary by country. Use for these conditions should be guided by a doctor.

Citalopram Dosage and Administration

The doses below are general reference only. Take citalopram only as prescribed by your doctor.

Depression. Start with 20 mg once daily. The dose may be increased to 40 mg daily after at least one week, if appropriate.

Maximum. 40 mg per day for most adults.

Anxiety, off label. 20 mg once daily, may increase to 40 mg, following the same dosing principles as for depression.

Lower maximum dose of 20 mg per day required in people over 60 years, people with hepatic impairment, people who are known poor metabolizers of the CYP2C19 enzyme, and people taking a CYP2C19 inhibitor, such as cimetidine.

This lower maximum applies because these factors increase citalopram levels in the body and raise the risk of QT prolongation at higher doses. Dosing is determined by your prescribing doctor, and the dose should not be changed independently.

Citalopram is available in oral tablets and liquid formulations, and can be taken with or without food.

QT Prolongation Warning for Citalopram

Citalopram can cause a dose dependent change in the heart’s electrical activity called QT prolongation. In rare but potentially serious cases, this can lead to a dangerous irregular heartbeat. Citalopram should generally be avoided in people with congenital long QT syndrome, bradycardia, meaning slow heart rate, low potassium, known as hypokalemia, low magnesium, known as hypomagnesemia, a recent acute heart attack, uncompensated heart failure, or concurrent use of other medicines that can significantly prolong the QT interval.

Tell your doctor if you experience dizziness, fainting, or a fast or irregular heartbeat while taking citalopram, as these require medical attention.

Adverse Effects of Citalopram

Nausea, vomiting, and dry mouth. Drowsiness or insomnia. Sexual dysfunction. Emergence or worsening of anxiety, agitation, or unusual changes in mood or behavior, especially early in treatment or after a dose change, see the Boxed Warning above. Hyponatremia, meaning low sodium levels, particularly in older adults or people taking diuretics. Activation of mania or hypomania, particularly in people with bipolar disorder. Increased seizure risk; use with caution in people with a seizure disorder. Angle closure glaucoma in susceptible individuals. Increased bleeding risk, especially when combined with NSAIDs, aspirin, anticoagulants, or antiplatelet medicines.

Driving and alertness: Citalopram can cause drowsiness and may affect judgment, thinking or reaction time. Do not drive or operate machinery until you know how it affects you, and avoid alcohol, which can make these effects worse.

Citalopram Serotonin Syndrome and Drug Interactions

MAO inhibitors. Combining citalopram with an MAO inhibitor, or starting citalopram too soon after stopping one, can cause serotonin syndrome. Citalopram should not be started within 14 days of stopping an MAOI, and an MAOI should not be started within 14 days of stopping citalopram.

Other serotonergic drugs. Combining citalopram with other medicines that increase serotonin, such as other antidepressants, certain migraine medicines called triptans, tramadol, or St. John’s Wort, can also increase the risk of serotonin syndrome, though not every combination will cause it.

Serotonin syndrome can be life threatening. Seek urgent medical attention if symptoms such as severe agitation, confusion, high fever, marked muscle rigidity, or significant changes in heart rate occur.

Medicines that prolong the QT interval or inhibit CYP2C19 can increase citalopram levels or heart rhythm risk, as described above.

Blood thinners and NSAIDs. Citalopram may increase the risk of bleeding when combined with these.

Always tell your doctor about all medicines and supplements you’re taking.

Stopping Citalopram

Do not stop citalopram suddenly. Abrupt discontinuation can cause symptoms such as dizziness, irritability, nausea, sensory disturbances, and sleep disturbances or other withdrawal like symptoms. If treatment needs to stop, it should generally be reduced gradually under medical guidance rather than stopped suddenly.

Contraindications of Citalopram

Hypersensitivity to citalopram. Concomitant use with an MAO inhibitor. Starting citalopram within 14 days of stopping an MAOI. Starting an MAOI within 14 days of stopping citalopram. Concurrent use with pimozide.

Pregnancy, Breastfeeding, Liver, and Kidney Considerations for Citalopram

• Pregnancy. Citalopram should only be used during pregnancy if a doctor decides it’s necessary. SSRI use later in pregnancy has been associated with neonatal adaptation symptoms and a small increased risk of persistent pulmonary hypertension of the newborn. Discuss the risks and benefits with your doctor; do not stop citalopram abruptly because of pregnancy.
• Breastfeeding. Citalopram passes into breast milk. It may be used in some breastfeeding patients when the benefits outweigh potential risks, but the infant should be monitored for symptoms such as excessive sleepiness, poor feeding, or unusual behavior. Discuss breastfeeding with your doctor before starting or changing treatment.
• Liver. Hepatic impairment is one of the reasons the maximum recommended dose is 20 mg per day rather than 40 mg per day, as noted above.
• Kidneys. Caution is advised in patients with severe kidney impairment.

Popular Brand Names of Citalopram

• India: Citadep, Citopam
• US: Celexa

Availability, strengths, and formulations can vary by country.

Citalopram Price in India

Citadep 20 mg, 10 tablets, costs approximately 40 to 45 rupees per strip.

Prices may vary depending on the brand, strength, pack size, pharmacy, location, availability, and discounts. This is an approximate price for the specified product and is not a universal price for all citalopram products.

How HealthPil Can Help

If you have depression, anxiety symptoms, or concerns about citalopram, a qualified doctor can review your symptoms, medical history, current medicines, and treatment response to determine whether this treatment is appropriate. HealthPil can connect you with a qualified doctor for an online consultation.