Do not take Citalopram:
- if you are allergic to citalopram or any of the other ingredients of this medicine (listed in section 6).
- if you are taking or have recently taken medicines called monoamine oxidase inhibitors (MAOIs; amongst others used to treat depression, e.g. moclobemide). You may have to wait for up to 14 days after quitting the use of a MAOI. The MAOI selegiline (used to treat Parkinson’s disease) may be used, but not in doses exceeding 10 mg per day. When changing from Citalopram to MAOIs, you have to wait for at least seven days before you start taking MAOIs.
- if you are born with or have had an episode of abnormal heart rhythm (seen at ECG; an examination to evaluate how the heart is functioning).
- if you take medicines for heart rhythm problems or that may affect the heart’s rhythm. Also refer to the section “Other medicines and Citalopram” below.
- if you are taking linezolid (used to treat bacterial infections), unless you are closely observed by your doctor and your blood pressure is monitored.
If any of this applies to you please inform your doctor before taking Citalopram.
Warnings and precautions
Talk to your doctor before taking Citalopram:
- if you are taking any other medicines (see “Other medicines and Citalopram”).
- if you suffer or have suffered from heart problems or have recently had a heart attack.
- if you have a low resting heart-rate and/or you know that you may have salt depletion as a result of prolonged severe diarrhoea and vomiting (being sick) or usage of diuretics (water tablets).
- if you experience a fast or irregular heartbeat, fainting, collapse or dizziness on standing up which may indicate abnormal functioning of the heart rate.
- if you have diabetes.
- if you have epilepsy or a history of fits or start suffering from seizures during treatment with Citalopram.
- if you are having electro-convulsive therapy (ECT).
- if you suffer from episodes of mania/hypomania (overactive behaviour or thoughts).
- if you have a history of bleeding disorders or bleed easily or if you use medicines which possibly increase tendency to bleed (see section “Other medicines and Citalopram”).
- if you have other psychiatric conditions (psychosis).
- if you suffer from liver or kidney problems.
- if you are above 65 years of age.
- if you have eye problems, such as certain kinds of glaucoma (increased pressure in the eye).
Thoughts of suicide and worsening of your depression
If you are depressed you can sometimes have thoughts of harming or killing yourself. These may be increased when first starting antidepressants, since these medicines all take time to work, usually about two weeks but sometimes longer.
You may be more likely to think like this:
- If you have previously had thoughts about killing or harming yourself.
- If you are a young adult. Information from clinical trials has shown an increased risk of suicidal behaviour in adults aged less than 25 years with psychiatric conditions who were treated with an antidepressant.
If you have thoughts of harming or killing yourself at any time, contact your doctor or go to a hospital straight away.
You may find it helpful to tell a relative or close friend that you are depressed, and ask them to read this leaflet. You might ask them to tell you if they think your depression is getting worse, or if they are worried about changes in your behaviour.
Use in children and adolescents under 18 years of age
Citalopram should normally not be used for children and adolescents under 18 years. Also, you should know that patients under 18 have an increased risk of side-effects such as suicide attempt, suicidal thoughts and hostility (predominantly aggression, oppositional behaviour and anger) when they take this class of medicines. Despite this, your doctor may prescribe Citalopram for patients under 18 because he/she decides that this is in their best interests. If your doctor has prescribed Citalopram for a patient under 18 and you want to discuss this, please go back to your doctor. You should inform your doctor if any of the symptoms listed above develop or worsen when patients under 18 are taking Citalopram. Also, the long-term safety effects concerning growth, maturation and cognitive and behavioural development of Citalopram in this age group have not yet been demonstrated.
Sense of restlessness/psychomotor agitation
Take special care if you develop symptoms such as inner sense of restlessness and psychomotor agitation such as an inability to sit or stand still usually associated with subjective distress (akathisia).
This is most likely to occur within the first few weeks of treatment (see section 4. “Possible side effects”).
Tell your doctor immediately, if some of the symptoms listed under section 4. “Possible side effects” are developing during therapy with Citalopram, because then you may have something called serotonin syndrome.
Reduced levels of sodium in the blood
Citalopram can in rare cases, predominantly in elderly female patients, cause reduced levels of sodium in the blood and an inappropriate secretion of a hormone of the brain regulating the water balance of the body (syndrome of inappropriate anti-diuretic hormone secretion [SIADH]). Inform your doctor if you start feeling sick and unwell with weak muscles or confused while being treated with Citalopram.
Withdrawal symptoms seen on discontinuation
Please see “If you stop taking Citalopram”.
Other medicines and Citalopram
Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines.
DO NOT TAKE Citalopram if you take medicines for heart rhythm problems or medicines that may affect the heart’s rhythm, e.g. such as Class IA and III antiarrhythmics, antipsychotics (e.g. phenothiazine derivatives, pimozide, haloperidol), tricyclic antidepressants, certain antimicrobial agents (e.g. sparfloxacin, moxifloxacin, erythromycin IV, pentamidine, anti-malarian treatment particularly halofantrine), certain antihistamines (astemizole, mizolastine). If you have any further questions about this you should speak to your doctor.
If you are taking or have recently taken any of the medicines in the list below, and you have not already discussed these with your doctor, go back to your doctor and ask what to do.
monoamine oxidase inhibitors and linezolid (see “Do not take Citalopram“)
- selegiline (used to treat Parkinson’s disease)
- buspirone (used to treat anxiety disorders)
- medicines called triptans such as sumatriptan (used to treat migraine)
- tramadol (medicine used to treat severe pain)
anticoagulants, dipyridamol and ticlopidine (medicines to thin the blood)
- acetylsalicylic acid, non-steroidal anti-inflammatory drugs (NSAID’s) such as ibuprofen (medicines used to treat inflammation and pain)
- neuroleptics (phenothiazines [e.g. thioridazine], thioxanthenes, butyrophenones [e.g. haloperidol]), atypical antipsychotics, e.g. risperidone (medicines used to treat certain psychiatric conditions)
- tricyclic antidepressants (medicines used to treat depression)
herbal remedies containing St. John's wort (Hypericum perforatum)
- cimetidine, omeprazole, esomeprazole, lansoprazole (medicines used to lower the production of stomach acid)
- lithium (medicine used to treat mania) and tryptophan (serotonin-precursors)
- imipramine, desipramine, clomipramine, nortriptyline (medicines used to treat depression)
- fluvoxamine (medicine used to treat depression and obsessive compulsive disorder)
- mefloquin (medicine used to treat malaria)
- bupropion (medicine used to treat depression and to support to give up smoking)
- flecainide, propafenone (medicines used to treat irregular heartbeat)
- metoprolol (medicine used to treat cardiac failure)
- medicinal products which may cause low blood levels of potassium or magnesium. Please ask you doctor or pharmacist if the medicinal product(s) you are taking/using concomitantly with Citalopram belong(s) to this group.
Citalopram with food and alcohol
It is recommended not to drink alcohol during treatment with Citalopram.
Citalopram can be taken with or without food.
Pregnancy, breast-feeding and fertility
Do not take Citalopram if you are pregnant or planning to become pregnant, unless your doctor considers it absolutely necessary.
Make sure your midwife and/or doctor know you are on Citalopram. When taken during pregnancy, particularly in the last 3 months of pregnancy, medicines like Citalopram may increase the risk of a serious condition in babies, called persistent pulmonary hypertension of the newborn (PPHN), making the baby breathe faster and appear bluish. These symptoms usually begin during the first 24 hours after the baby is born. If this happens to your baby you should contact your midwife and/or doctor immediately.
Also, if you take Citalopram during the last 3 months of your pregnancy and until the date of birth you should be aware that the following effects may be seen in your newborn: fits, being too hot or cold, feeding difficulties, vomiting, low blood sugar, stiff or floppy muscles, overactive reflexes, tremor, jitteriness, irritability, lethargy, constant crying, sleepiness or sleeping difficulties. If your newborn baby gets any of these symptoms please contact your midwife and/or doctor immediately.
If you are breast-feeding, ask your doctor for advice. You should not breast-feed your baby when taking Citalopram because small amounts of the medicine can pass into the breast milk.
Citalopram has been shown to reduce the quality of sperm in animal studies. Theoretically, this could affect fertility, but impact on human fertility has not been observed as yet.
Driving and using machines
Citalopram has minor or moderate influence on the ability to drive and use machines.
Do not drive or use machines until you know how Citalopram affects you. Please ask your doctor or pharmacist if you are unsure about anything.