Citalopram

If you’re taking citalopram for anxiety, you may need to take it for longer than six months.

You and your doctor should talk about how long you need to take citalopram before you begin treatment with the medication.

People who have had low mood or depression more than once may need to take citalopram for a couple of years or more. This is to stop themselves experiencing depression or low mood again.

Never stop the tablets suddenly because this may make you more at risk of experiencing low mood.

Speak to your doctor if you want to stop taking citalopram.

You will get the best effect from citalopram if you take it regularly at the dose prescribed by your doctor.

Make sure that you know your dose. If it's not written on the label, check with your pharmacist or doctor.

You should start by taking it in the morning. This will lower the chance of it affecting your sleep.

Try to get into a routine, like taking it when you have breakfast or brush your teeth.

If you find that it makes you sleepy, you can take it at nighttime instead.

Citalopram can be taken before or after food.

Swallow the tablet with a drink of water or liquid - if you chew it, it tastes bitter.

If you forget to take a dose, then just take it as soon as possible.

If you forget to take it by bedtime, just start again on the next day.

Do not take a double dose.

If you forget to take it for a few days, you may start getting withdrawal symptoms, which feel a bit like the flu. If you get these symptoms, see your doctor as soon as possible.

If you want to stop your tablets, please speak to your doctor first as it is better if they are stopped slowly over a few weeks rather than suddenly.

Stopping the medication causes the balance of chemicals in the brain to change.

When you start taking an SSRI, the brain adjusts to having a higher 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.

This does not mean you are addicted to the medicine - just that your brain has become used to citalopram to control the serotonin levels.

Withdrawal symptoms usually start a few days after stopping the medicine and might 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 spine (back)
• feeling anxious, confused or disorientated
• feeling or being sick or having diarrhoea (loose poo)
• sweating or shaking
• feeling restless or agitated or feeling emotional or irritable
• flu-like symptoms
• tinnitus (ringing in your ears)
• problems with your eyes, or fluttering/pounding heartbeat (palpitations) can happen, but not as often as the others symptoms listed above

You can stop taking citalopram safely with your doctor's help, who will show you how to reduce your dosage gradually.

If you have taken more citalopram than the dosage recommended by the doctor who prescribed it to you, you must get medical help immediately – even if you do not feel any different.

As part of depression some people think about hurting themselves or taking their own lives. Taking an antidepressant may not stop this. You must get some urgent help if you are having these sorts of thoughts. Speak to someone who is looking after you or go straight to hospital with your tablets.

Citalopram can sometimes also cause other serious side effects, including: allergic reactions (difficulty breathing, swelling of your face or throat, itching skin lumps), and other serious symptoms that you can find here. Go to a hospital if you get any of these symptoms, taking your medicine with you.

Do not take citalopram if you have taken a monoamine oxidase inhibitor antidepressant (MAOI) like moclobemide, phenelzine, isocarboxazid or tranylcypromine in the last 14 days.

Stopping citalopram suddenly can cause unpleasant withdrawal effects. Go to your doctor if you are thinking of stopping.

If you take citalopram while you are pregnant, it may affect the developing baby’s heart. Use good contraception while you are taking citalopram. It can also cause symptoms in newborn babies if you take it at the end of pregnancy. Talk to your doctor or midwife about this.

If you have taken more citalopram than the dosage recommended by the doctor who prescribed it to you, you must get medical help immediately – even if you do not feel any different. Go to A&E, taking your medicine with you, and tell doctors how much medication you have taken. Get a friend or family member to go with you in case you feel ill on the way.

You might get any of the following signs:

• changes in your heartbeat, going fast or unevenly
• nausea (feeling sick) or being sick
• having a seizure (fit)
• excessive sweating
• feeling sleepy
• passing out
• feeling shaky (tremor) or dizzy
• changing blood pressure (this might mean you feel dizzy when you stand up)  
• feeling agitated
• eye pupils getting bigger (dilating)
• skin taking on a blue tinge
• fingers and toes feeling cold
• fast breathing

If you take too much citalopram, you may be at risk of developing serotonin syndrome. Symptoms include a high fever, agitation, confusion, trembling, or weird movements of your muscles. This is rare, but you should watch out for it. Go straight to A&E if you experience these side effects.

While taking citalopram some people may think about hurting themselves or taking their own lives. 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 level of serotonin in the brain becomes stable.

You must go straight to hospital if you have these thoughts, taking your tablets with you. Ask a friend or family member to go with you to keep you safe on the way.

Stop taking citalopram and go to a doctor or hospital straight away if you get any of the following symptoms:

• difficulty breathing
• swelling of your face, lips, tongue or throat so that you cannot swallow or breathe
• really bad itching of the skin (with raised lumps)
• fast, uneven heartbeat and fainting - this could mean a life-threatening condition called torsades de pointes

Go to your doctor or the hospital straight away, but don't stop taking citalopram, if you get any of the following symptoms:

• you start having seizures (fits) for the first time, or if fits that you have had in the past happen more often
• your behaviour changes because you feel very happy or over-excited
• you experience tiredness, confusion and muscle-twitching - you may have a low blood-level of sodium

People under 18 who take citalopram can get serious side effects and have an increased risk of thinking about taking their own lives, trying to take their own lives, and hostility (mostly aggression, oppositional behaviour and anger). Therefore, it is not licensed for people under 18 years old.

If you are under 18, you and your doctor may decide that the benefits of taking citalopram outweigh the risks for you.

You should decide with your doctor what to do if you experience any side effects while taking citalopram. It’s a good idea to write these plans down and keep them somewhere safe. 

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 intestinal (stomach or gut) 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.

If you do get a side effect, please think about reporting it via the 'Yellow Card' scheme.

Very common side effects when taking citalopram (affecting more than one in ten people) include:

• insomnia (sleep problems) - try taking your dose first thing in the morning
• dry mouth (this can increase the risk of tooth decay, so clean your teeth more often than usual and avoid drinking sugary drinks)
• nausea (feeling sick) or vomiting - try taking your citalopram with or just after food. This tends to wear off after a few days
• headache
• lower sex drive, difficulty reaching orgasm, problems with ejaculation, or erection problems - talk to your doctor or pharmacist if you get this. This can be a symptom of depression itself

Common side effects (affecting up to one in ten people) include:

• sleepiness - try taking just before going to bed
• lower appetite, and loss of weight
• agitation, anxiety, trembling, confusion and nervousness
• diarrhoea (loose poo)
• itching or prickling of the skin

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

Citalopram and escitalopram (a very similar medicine) can change the way electricity goes through the heart (called the QT length). Escitalopram has less of this effect on the heart.

Before starting citalopram your doctor may check your heart using an electrocardiogram (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.