Citalopram 10mg Tablets

Citalopram is a selective serotonin reuptake inhibitor (SSRI). It potently blocks the reuptake of serotonin (5-HT) into presynaptic neurons in the central nervous system, leading to an increased concentration of serotonin in the synaptic cleft and enhanced serotonergic neurotransmission. It has minimal effects on norepinephrine and dopamine reuptake.

Urgent Side Effects: Seek Medical Help Right Away

Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek medical attention immediately:

Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of low sodium levels, including:
+ Headache
+ Trouble focusing
+ Memory problems
+ Feeling confused
+ Weakness
+ Seizures
+ Change in balance
Signs of bleeding, such as:
+ Vomiting or coughing up blood
+ Vomit that looks like coffee grounds
+ Blood in the urine
+ Black, red, or tarry stools
+ Bleeding from the gums
+ Abnormal vaginal bleeding
+ Bruises without a cause or that get bigger
+ Uncontrollable bleeding
Chest pain or pressure
Fast, slow, or abnormal heartbeat
Shortness of breath
Dizziness or fainting
Seizures
Unexplained weight changes
Painful erection (hard penis) or an erection that lasts longer than 4 hours
Changes in menstrual period
Sex problems, including:
+ Decreased interest in sex
+ Trouble having an orgasm
+ Ejaculation problems
+ Difficulty getting or maintaining an erection

If you experience any of these symptoms, consult your doctor. Additionally, be aware of the risk of serotonin syndrome, a potentially life-threatening condition. If you take certain other medications, your risk may be higher. Seek medical help immediately if you experience:

Agitation
Change in balance
Confusion
Hallucinations
Fever
Fast or abnormal heartbeat
Flushing
Muscle twitching or stiffness
Seizures
Shivering or shaking
Excessive sweating
Severe diarrhea, stomach upset, or vomiting
Severe headache

Other Possible Side Effects

Most medications can cause side effects, but many people experience none or only mild symptoms. If you notice any of the following side effects or any other unusual symptoms, contact your doctor or seek medical attention:

Dizziness
Drowsiness
Fatigue
Weakness
Dry mouth
Constipation
Diarrhea
Stomach upset
Vomiting
Decreased appetite
Trouble sleeping
Shakiness
Excessive sweating
Yawning
Signs of a common cold

This is not an exhaustive list of possible side effects. If you have questions or concerns, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.

Before Taking This Medication: Important Information to Share with Your Doctor

It is essential to inform your doctor about the following:

Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Describe the allergic reaction you experienced, including the symptoms that occurred.
Certain heart conditions, including:
+ A prolonged QTc interval on an electrocardiogram (ECG) or other abnormal heart rhythms
+ A slow heartbeat
+ Low potassium or magnesium levels
A history of heart failure (a weakened heart) or a recent heart attack
Current or recent use of specific medications, such as:
+ Linezolid or methylene blue
+ Escitalopram or pimozide
+ Any medications that can cause a prolonged QT interval, a type of abnormal heartbeat (your doctor or pharmacist can help you determine if any of your medications have this potential)
Use of certain medications for depression or Parkinson's disease within the last 14 days, including:
+ Isocarboxazid
+ Phenelzine
+ Tranylcypromine
+ Selegiline
+ Rasagiline (note that taking these medications with this drug can lead to very high blood pressure)

This list is not exhaustive, and it is crucial to inform your doctor and pharmacist about all your medications, including:

Prescription and over-the-counter (OTC) medications
Natural products
Vitamins

Your doctor and pharmacist will help you determine if it is safe to take this medication with your existing medications and health conditions. Do not start, stop, or change the dose of any medication without consulting your doctor first.

Important Warnings and Cautions for Patients Taking This Medication

If you are taking this medication, it is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, about your treatment.

Precautions and Safety Measures

Avoid driving and engaging in activities that require alertness until you understand how this medication affects you.
Do not stop taking this medication abruptly without consulting your doctor, as this may increase the risk of side effects. If you need to discontinue the medication, your doctor will guide you on how to gradually stop taking it.
This medication can cause abnormal heart rhythms (long QT on ECG), which may lead to sudden death. Discuss this risk with your doctor.
Refrain from consuming alcohol while taking this medication.
Before using marijuana, cannabis, or prescription/over-the-counter medications that may cause drowsiness, consult your doctor.

Depression and Treatment Response

You may experience improvements in sleep and appetite soon after starting this medication. However, other symptoms of depression may take up to 4 weeks to improve.

Potential Risks and Side Effects

This medication may increase the risk of bleeding, which can be life-threatening in some cases. Discuss this risk with your doctor.
Certain individuals may be more prone to eye problems while taking this medication. Your doctor may recommend an eye exam to assess your risk. If you experience eye pain, changes in vision, or swelling/redness in or around the eye, contact your doctor immediately.
This medication can cause low sodium levels, which can be life-threatening and lead to seizures, loss of consciousness, breathing difficulties, or death.
If you are 60 years or older, use this medication with caution, as you may be more susceptible to side effects.

Pregnancy, Breastfeeding, and Pediatric Considerations

If you are pregnant, planning to become pregnant, or breastfeeding, inform your doctor. You will need to discuss the benefits and risks of taking this medication during pregnancy or breastfeeding.
Taking this medication during the third trimester of pregnancy may increase the risk of bleeding after delivery and cause health problems in the newborn.
* In children and adolescents, this medication may affect growth in some cases. Regular growth checks may be necessary. Discuss this with your doctor.

• Monoamine Oxidase Inhibitors (MAOIs) - risk of serotonin syndrome (allow 14 days washout)
• Pimozide - risk of QTc prolongation and ventricular arrhythmias

• Other serotonergic drugs (e.g., triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, St. John's Wort, tryptophan, buspirone) - increased risk of serotonin syndrome
• Drugs that prolong the QT interval (e.g., Class IA and III antiarrhythmics, antipsychotics, macrolide antibiotics, fluoroquinolone antibiotics, certain antihistamines) - increased risk of QTc prolongation and Torsade de Pointes
• Anticoagulants (e.g., warfarin) and antiplatelet agents (e.g., aspirin, NSAIDs) - increased risk of bleeding
• Linezolid (reversible non-selective MAOI) - risk of serotonin syndrome

• CYP2C19 inhibitors (e.g., omeprazole, esomeprazole, fluoxetine, fluvoxamine) - may increase citalopram levels
• CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, ritonavir) - may increase citalopram levels
• Alcohol - may potentiate CNS depressant effects, though no pharmacokinetic interaction.

• Not available

• Worsening depression
• Emergence of suicidal thoughts or behaviors
• Unusual changes in behavior (e.g., agitation, irritability, hostility, impulsivity, akathisia, hypomania, mania)
• Symptoms of serotonin syndrome (e.g., agitation, hallucinations, delirium, tachycardia, labile blood pressure, dizziness, diaphoresis, flushing, hyperthermia, tremor, rigidity, myoclonus, hyperreflexia, incoordination, GI symptoms)
• Symptoms of QTc prolongation (e.g., palpitations, dizziness, syncope)
• Symptoms of hyponatremia (e.g., headache, difficulty concentrating, memory impairment, confusion, weakness, unsteadiness, seizures, hallucinations, syncope)

Generally avoided in the third trimester due to potential for neonatal complications (e.g., persistent pulmonary hypertension of the newborn, withdrawal symptoms). Use during pregnancy should only be considered if the potential benefit justifies the potential risk to the fetus.

Citalopram is excreted into breast milk. While generally considered compatible with breastfeeding (Lactation Risk Category L2), monitor the infant for adverse effects such as sedation, poor feeding, and weight gain. Consult with a healthcare provider.

Not FDA approved for pediatric depression. Black Box Warning regarding increased risk of suicidality in children, adolescents, and young adults. Use in this population should be carefully considered and closely monitored by a specialist.

Lower starting dose (10 mg/day) and lower maximum dose (20 mg/day) are recommended due to increased risk of QTc prolongation and hyponatremia. Elderly patients may be more sensitive to side effects.

• Citalopram has a dose-dependent risk of QTc prolongation; the maximum recommended dose is 40 mg/day for most adults and 20 mg/day for patients over 60, those with hepatic impairment, or those taking CYP2C19 inhibitors.
• Patients should be advised about the potential for serotonin syndrome, especially if combining with other serotonergic agents.
• Gradual tapering is crucial upon discontinuation to avoid withdrawal symptoms (e.g., dizziness, paresthesias, anxiety, agitation, nausea, tremor).
• Onset of antidepressant effect is typically 2-4 weeks, with full effect taking 4-6 weeks. Patients should be encouraged to continue treatment even if immediate improvement is not seen.
• Monitor for hyponatremia, especially in elderly patients or those on diuretics, due to the risk of SIADH.

• Other Selective Serotonin Reuptake Inhibitors (SSRIs): Sertraline, Fluoxetine, Paroxetine, Escitalopram, Fluvoxamine
• Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): Venlafaxine, Duloxetine, Desvenlafaxine
• Atypical Antidepressants: Bupropion, Mirtazapine, Trazodone, Vortioxetine, Vilazodone
• Tricyclic Antidepressants (TCAs): Amitriptyline, Nortriptyline, Imipramine
• Monoamine Oxidase Inhibitors (MAOIs): Phenelzine, Tranylcypromine, Selegiline (reserved for refractory cases)
• Psychotherapy (e.g., Cognitive Behavioral Therapy - CBT)

If your symptoms or health issues persist or worsen, it is essential to contact your doctor promptly. To ensure safe use, never share your medication with others or take someone else's medication. This medication is accompanied by a Medication Guide, which provides crucial information for patients. Please read this guide carefully and review it again whenever you receive a refill. If you have any questions or concerns about this medication, consult your doctor, pharmacist, or healthcare provider. In the event of a suspected overdose, immediately call the poison control center or seek emergency medical attention. When reporting the overdose, be prepared to provide details about the medication taken, the quantity, and the time it occurred.