Citalopram

Citalopram can make some people think about hurting themselves or committing suicide. This can happen to anyone, including people who are under 18.

These thoughts may happen or get worse in the first few weeks of taking the tablets until the brain levels of serotonin become stable. Always tell a close friend or a family member if you feel this way.

You must go straight to hospital with your tablets if you have any of these thoughts. You must tell the doctor that you are taking citalopram. There are other things you can take instead.

Citalopram is a safe medication but rarely it can cause some serious side-effects.

Citlopram can affect the way your heart works and should be used carefully with certain medications.

A recent study found that citalopram and esitalopram (a very similar medicine) can change the way electricity goes through the heart (called the QT length). Before starting citalopram your doctor may check your heart using a ECG. If you're taking any other medicines that affect your heart, your doctor may decide to use a different medicine or check your heart on a regular basis.

Young people under 18 taking citalopram can get serious side-effects

• Young people under 18 have an increased risk of trying to kill themselves, thinking about killing themselves, and hostility (mostly aggression, oppositional behaviour and anger) when they take citalopram.
• This is why it is not licensed for people under 18 years. If you are under 18, make sure that you and your doctor have talked about what to do if you get these side effects and have a plan for what to do.
• You and your doctor may decide together that the benefits are greater than the risks for you.
• If you are taking citalopram and have not talked about this with your doctor, go back to them and talk it through. You might also want to talk to your parents or carers about it.

SSRIs can, but not very often, increase your risk of bleeding, including stomach or gut (intestinal) bleeding. Let your doctor know if you vomit blood or develop black or blood stained poo.

Do not stop taking the tablets until you talk to your doctor, or you may get withdrawal symptoms as well. Taking citalopram with food will lower the risk of stomach problems.

Some side-effects that do appear should get better after a few days. If they do not, you should go back to your doctor

If you get any side effects not listed here please look at the patient leaflet in the medicine pack or speak to your pharmacist or doctor

There are many possible side-effect when you start taking citalopram. Some people will have no side-effect and some people will have a few - it's hard to say which you will get as everyone is different. Most will get better after a few days, but if they do not and they are affecting your life, you should go back to your doctor.

Do not stop taking the tablets until you talk to your doctor, or you may get withdrawal symptoms as well.

Very common side effects (could affect more than 1 in 10 people)

• Difficulty sleeping (insomnia) - try taking your dose first thing in the morning
• Dry mouth (a dry mouth increases the risk of tooth decay, so do clean your teeth more often than usual and avoid drinking sugary drinks)
• Feeling sick (nausea) or vomiting - try taking your citalopram with or just after food. This tends to wear off after a few days.
• Lower sex drive, or (for men) problems with ejaculation and erection and (for women) failing to reach an orgasm - talk to your doctor or pharmcist if you get this. This can be a symptom of depression. 

Common side effect (could effect up to 1 in 10 people)

• Sleepiness - try taking just before going to bed
• Lower appetite, and loss of weight
• Agitation, anxiety, trembling, confusion and nervousness
• Loose poo (diarrhoea)
• Itching or prickling of the skin
• Pain in muscles and joints

You shouldn't be worried about these side effects. Some people will not get any side-effects at all. If you think you might have a side effect to your medicine, you should ask your doctor, nurse or pharmacist.

• There are other side-effects that you can get when taking this medicine - we have included the most common ones here.
• Please look at the paper leaflet inside your medicine box, or ask a doctor or pharmaxist, if you want to know if you're getting a side-effect from your medicine.
• If you do get a side-effect, you can report it yourself using the About HeadMeds

Tell your doctor or pharmacist before you take citalopram if you have any of these conditions

You need to talk to your doctor or pharmacist if you have, or have ever had:

• Liver disease
• Kidney disease
• Diabetes (you may need an adjustment of your antidiabetic therapy)
• Epilepsy or a history of seizures or fits
• A bleeding problem, or bleeding in the stomach or gut
• Mania or bipolar disorder
• Low blood levels of sodium
• Problems with your eyes, such as certain kinds of glaucoma (pressure in the eye).
• Heart problems, or a heart attack.
• A low heart-rate or long-lasting diarrhoea (loose poo), vomiting (being sick) or using diuretics (water tablets)
• A fast or irregular heartbeat, fainting, collapsing or dizziness when you stand up

Citalopram can interact with some other medicines and drugs

Do not take citalopram if you take:

• medicines for heart rhythm problems, or medicines that may affect the heart’s rhythm
• an antipsychotic
• tricyclic anti-depressants
• if you have taken a monoamine oxidase inhibitor antidepressant (MAOI) like moclobemide, phenelzine, isocarboxazid or tranylcypromine in the last 14 days
• the antibiotics sparfloxacin, moxifloxacin, erythromycin IV, pentamidine, or anti-malarial treatment like halofantrine
• the antihistamines astemizole or mizolastine

If you have any further questions about this you should speak to your doctor or pharmacist.

Always talk to the doctor if you are taking other medicines. Tell the pharmacist you are taking citalopram when you buy medicines from a pharmacy (including things you put on your skin) for common illnesses.

• Problems can happen if you also take other mental health medicines, particularly with other types of antidepressants. Your doctor should leave some time in between if you are changing from one medicine to another.
• St. John’s Wort is a herbal medicine available in shops that is also used for low mood. This does not mix well with citalopram, so please tell your doctor or pharmacist if you are trying this or want to try it.
• Anti-inflammatory pain medicines like aspirin, ibuprofen and diclofenac, and medicines to stop clots (like warfarin), may cause bleeding if taken with citalopram.

Citalopram does not mix well with some other medicines

Other medicines that may cause problems when taken with citalopram are:

• linezolid (an antibiotic)
• sumatriptan (used to treat migraine)
• tramadol (a pain killer)
• lithium (used to prevent and treat mania)
• tryptophan, imipramine or desipramine (anti-depressants)
• selegiline (used to treat Parkinson’s disease)
• Cimetidine (used to treat stomach ulcers)
• Mefloquine (used to treat malaria)
• Bupropion (used to treat depression and to help stop smoking)
• Metoprolol (a beta blocker used to treat migraine, some heart problems and high blood pressure)

Citalopram does not mix well with street drugs or legal highs

We don't know exactly how citalopram interacts with street drugs and legal highs.

• Cannabis can make drowsiness worse with citalopram and give you a fast heartbeat.
• Methadone can make drowsiness worse with citalopram. The citalopram could increase the concentration of methadone in your body.
• Citalopram could raise the level of cocaine in your body, giving you a bigger reaction.
• Taking citalopram with cocaine or ecstasy or amphetamines could bring on serotonin syndrome. You could get a high temperature/fever, agitation, confusion, trembling or weird muscle movements. You need to go to hospital if this happens. Tell the doctor that you are taking citalopram.

Stopping the medication causes the balance of chemicals in the brain to alter

When you start taking a SSRI, your the brain adjusts to having a hihger level of serotonin around. If you stop taking the SSRI suddenly, the levels of serotonin start to drop and your brain can take a while to adapt to this change. You could get some symptoms from the change which are called withdrawal symptoms.

Stopping this medicine quickly, or reducing the dose too much at once, may cause uncomfortable symptoms called withdrawal. These do not mean you are addicted to the medicine - just that your brain has become used to them to control the serotonin levels.

Withdrawal symptoms usually start a few days after stopping the medicine

You can stop taking it safely with your doctor's help

• You will probably get uncomfortable withdrawal symptoms if you stop citalopram suddenly. It is better to agree stopping with a doctor who will reduce you gradually.
• These do not mean you are addicted to the medicine - just that your brain has become used to them to control the serotonin levels.

Some of the symptoms you might get include

• Dizziness or headaches
• numbness or tingling in hands or feet
• sleep disturbances (vivid dreams, nightmares, not being able to sleep)
• ‘electric shock’ feelings in the head, neck and back (spine)
• feeling anxious, confused or disorientated
• feeling or being sick, or having loose poo (diarrhoea)
• sweating or shaking
• feeling restless or agitated, or feeling emotional or irritable
• flu-like symptoms
• ringing in your ears (tinnitus)

Problems with your eyes, or fluttering/pounding heartbeat (palpitations) can happen, but not as often as the others above.

Go and speak to your doctor if you have missed a few doses or have decided to stop taking your medication. If you slowly reduce your medication, withdrawal symptoms are less likely to occur.

Withdrawal symptoms should stop after a few days. If they do not, or they are stopping you getting on with your life, you might need the help of a doctor.

If you agree with your doctor to stop the medicine, you will carry on with a lower dose for one to two weeks. This will stop you getting withdrawal symptoms.

You can stop taking it safely with your doctor’s help