Drug Profiles:
citalopram hydrobromide
Celexa®

CAUTION: Federal law prohibits dispensing without prescription.

Before Using This Medicine
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For citalopram, the following should be considered:

Allergies-
Tell your doctor if you have ever had any unusual or allergic reaction to citalopram. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy-
Studies have not been done in pregnant women. However, studies in animals have shown that citalopram may cause decreased survival rates and slowed growth in offspring when given to the mother in doses many times higher than the usual human dose. Before taking this medicine, make sure your doctor knows if you are pregnant or if you may become pregnant. Pregnancy Category C.

Breast-feeding-
Citalopram passes into breast milk and may cause unwanted effects, such as drowsiness, decreased feeding, and weight loss in the breast-fed baby. It may be necessary for you to take another medicine or to stop breast-feeding during treatment. Be sure you have discussed the risks and benefits of the medicine with your doctor.

Children-
Studies on this medicine have been done only in adult patients, and there is no specific information comparing use of citalopram in children with use in other age groups.

Older adults-
This medicine has been tested and has not been shown to cause different side effects or problems in older people than it does in younger adults. However, citalopram is removed from the body more slowly in older people and an older person may need a lower dose than a younger adult.

Other medicines-
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking citalopram, it is especially important that your health care professional know if you are taking any of the following:

• Bromocriptine (e.g., Parlodel)
• Buspirone (e.g., BuSpar)
• Certain tricyclic antidepressants (amitriptyline [e.g., Elavil], clomipramine [e.g., Anafranil], or imipramine [e.g., Tofranil])
• Dextromethorphan (cough medicine)
• Levodopa (e.g., Sinemet)
• Lithium (e.g., Eskalith)
• Meperidine (e.g., Demerol)
• Moclobemide (e.g., Manerix)
• Nefazodone (e.g., Serzone)
• Pentazocine (e.g., Talwin)
• Selective serotonin reuptake inhibitors, other (fluoxetine [e.g., Prozac], fluvoxamine [e.g., Luvox], paroxetine [e.g., Paxil], sertraline [e.g., Zoloft])
• Street drugs (LSD, MDMA [e.g., ecstasy], marijuana) or
• Tramadol (e.g., Ultram)
• Trazodone (e.g., Desyrel)
• Triptans (e.g., Imitrex, Maxalt, Zomig, Amerge, Axert, Frova)
• Tryptophan
• Venlafaxine (e.g., Effexor)—Using these medicines with citalopram may increase the chance of developing a rare, but very serious, unwanted effect known as the serotonin syndrome. This syndrome may cause confusion, diarrhea, fever, poor coordination, restlessness, shivering, sweating, talking or acting with excitement you cannot control, trembling or shaking, or twitching. If you develop these symptoms, contact your doctor as soon as possible
• Monoamine oxidase (MAO) inhibitors (furazolidone [e.g., Furoxone], isocarboxazid [e.g., Marplan], phenelzine [e.g., Nardil], procarbazine [e.g., Matulane], selegiline [e.g., Eldepryl], tranylcypromine [e.g., Parnate])—
• Do not take citalopram while you are taking or within 2 weeks of taking an MAO inhibitor. If you do, you may develop confusion, agitation, restlessness, stomach or intestinal symptoms, sudden high body temperature, extremely high blood pressure, severe convulsions, or the serotonin syndrome. At least 14 days should pass between stopping treatment with one medicine (citalopram or the MAO inhibitor) and starting treatment with the other.

Other medical problems-
The presence of other medical problems may affect the use of citalopram. Make sure you tell your doctor if you have any other medical problems, especially:

• Bipolar disorder (history of)—May be activated
• Diabetes mellitus (sugar diabetes)—Hypoglycemia has occurred rarely in diabetic patients receiving citalopram
• Kidney disease, severe— Until enough patients have been evaluated, caution is recommended for patients with severe kidney disease
• Liver disease—Higher blood levels of citalopram may occur, increasing the chance of having unwanted effects. You may need to take a lower dose than a person without kidney or liver disease
• Mania (history of)—May be activated
• Seizure disorders (history of)—The risk of having seizures may be increased.

Proper Use of This Medicine
It is important to use this medicine properly:

• Take this medicine only as directed by your doctor
• Citalopram may be taken with or without food on a full or empty stomach. If your doctor tells you to take it a certain way, follow your doctor's instructions.
• You may have to take citalopram for 4 weeks before you begin to feel better
• Do not stop taking this medication without checking first with your doctor.

Dosing-
The dose of citalopram will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of citalopram. If your dose is different, do not change it unless your doctor tells you to do so.

The number of tablets that you take depends on the strength of the medicine.

For depression:

• Adults—To start, usually 20 milligrams (mg) once a day, taken either in the morning or evening. Your doctor may increase your dose gradually if needed. However, the dose usually is not more than 60 mg a day.
• Children—Use and dose must be determined by the doctor.
  Older adults—Usually 20 milligrams (mg) once a day, taken either in the morning or evening. Your doctor may increase your dose gradually if needed. However, the dose usually is not more than 40 mg a day.

Missed Dose-
Because citalopram may be taken by different patients at different times of the day, you and your doctor should discuss what to do if you miss any doses.

Storage-
To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

Precautions While Using This Medicine

• It is important that your doctor check your progress at regular visits, to allow for changes in your dose and to help reduce any side effects.
• Do not take citalopram with or within 14 days of taking an MAO inhibitor (furazolidone, isocarboxazid, phenelzine, procarbazine, selegiline, tranylcypromine). Do not take an MAO inhibitor within 14 days of taking citalopram
• Avoid drinking alcoholic beverages while you are taking citalopram.
• This medicine may cause some people to become drowsy, to have trouble thinking, or to have problems with movement. Make sure you know how you react to citalopram before you drive, use machines, or do anything else that could be dangerous if you are not alert or well-coordinated.

Side Effects of This Medicine
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention. One rare, but very serious, effect that may occur is the serotonin syndrome. This syndrome (group of symptoms) is more likely to occur shortly after an increase in citalopram dose.

Check with your doctor as soon as possible if any of the following side effects occur:

• More common: Decrease in sexual desire or ability
• Less common: Agitation; blurred vision; confusion; fever; increase in frequency of urination or amount of urine produced; lack of emotion; loss of memory; menstrual changes; skin rash or itching; trouble in breathing
• Rare: Anxiety; behavior change similar to drunkenness; bleeding gums; breast tenderness or enlargement or unusual secretion of milk (in females); difficulty in concentrating; dizziness or fainting; increased hunger; irregular heartbeat; low blood sodium (confusion, convulsions [seizures], drowsiness, dryness of mouth, increased thirst, lack of energy); mood or mental changes; nervousness; nose bleed; painful urination; purple or red spots on skin; sore throat, fever, and chills; red or irritated eyes; redness, tenderness, itching, burning, or peeling of skin; serotonin syndrome (agitation, confusion, diarrhea, fever, overactive reflexes, poor coordination, restlessness, shivering, sweating, talking or acting with excitement you cannot control, trembling or shaking, twitching); shakiness; slow or irregular heartbeat (less than 50 beats per minute); trouble in holding or releasing urine; unusual or sudden body or facial movements or postures

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:

• More common: Drowsiness; dryness of mouth; nausea; trouble in sleeping
• Less commonL Abdominal pain; anxiety; change in sense of taste; diarrhea; gas; headache (severe and throbbing); heartburn; increased sweating ; increased yawning; loss of appetite; pain in muscles or joints; stuffy or runny nose; tingling, burning, or prickly feelings on skin; tooth grinding; trembling or shaking; unusual increase or decrease in weight; unusual tiredness or weakness; vomiting; watering of mouth

After you stop using this medicine, your body may need time to adjust. The length of time this takes depends on the amount of medicine you were using and how long you used it. During this period of time check with your doctor if you notice any of the following side effects:

• Anxiety; dizziness; nervousness; trembling or shaking

Brand Names-

U.S. and Canada: Celexa®