Citalopram (Cipramil): Uses, Side Effects & Dosage
Complete guide to citalopram: understand uses, side effects, dosage, and safety information.
What is Citalopram?
Citalopram is a selective serotonin reuptake inhibitor (SSRI) antidepressant medication used primarily to treat depression, including major depressive disorder (MDD). The medication is available under several brand names, including Cipramil and Paxoran. Citalopram works by increasing the amount of serotonin in the brain, a hormone that helps regulate mood and emotional well-being. By preventing the reabsorption of serotonin in the brain, citalopram allows more of this neurotransmitter to remain available, which can help alleviate depressive symptoms and improve overall mental health.
How to Take Citalopram
Citalopram is prescribed as a once-daily dose, and it is important to take it exactly as your doctor directs. You can generally choose a time that suits your schedule, but consistency is key to treatment success. Try to take your doses at the same time each day to maintain steady medication levels in your body. Several strengths of tablets are available, and your doctor will specify which strength is appropriate for your individual needs based on your medical condition and response to treatment.
Dosage Considerations
If you are being treated for a panic disorder, your doctor may prescribe a low starting dose. This approach is used because some people develop anxiety during the first two weeks of treatment, and slowly increasing the dose helps minimize this side effect. If you have been prescribed Cipramil oral drops, your doctor will indicate the correct number of drops to take each day. To administer the drops properly, count the correct number into a drink of water, orange juice, or apple juice, stir briefly, and drink immediately.
How Long Does Citalopram Take to Work?
Citalopram usually takes 4 to 6 weeks to work fully, although some people notice small improvements in sleep or appetite sooner. It is important to understand that everyone responds differently to medication, so for some individuals it may work quicker or take slightly longer. It may take up to four weeks after starting treatment before you feel the full benefit, and you should not stop taking the medication if you feel it is not helping immediately. If you feel that you are not getting any better after the initial period, or if you experience any troublesome side effects, speak with your doctor.
How Long Can You Stay on Citalopram?
How long you can stay on citalopram varies depending on individual circumstances and response to treatment. Many people take citalopram for at least 6 to 12 months after starting to feel better, as this helps reduce the risk of depression symptoms returning. Some individuals may need to continue the medication for a longer period. Your doctor will work with you to determine the appropriate duration of treatment based on your specific situation and mental health needs.
Common Side Effects of Citalopram
The common side effects of citalopram include nausea, dry mouth, sleepiness, sweating, dizziness, and changes in appetite or weight. The unwanted effects often improve as your body adjusts to the new medicine, but you should speak with your doctor or pharmacist if any of these continue or become troublesome. A full list of possible side effects can be found in the manufacturer’s information leaflet supplied with your medicine.
Other Reported Side Effects
Beyond the common side effects, citalopram may cause additional unwanted effects including increased sweating, difficulty sleeping, lack of appetite, loss of weight, aches and pains, tingling feelings, reduced sexual drive or ability, ringing in your ears, yawning, the sensation of having a ‘thumping’ heart (palpitations), and runny nose or itching. If any of these become troublesome, speak with your doctor for guidance on managing them. Some people may also experience indigestion, constipation, or diarrhea, which can often be managed through dietary adjustments.
Serious Side Effects
Although rare, a few people taking citalopram have developed an allergic-type reaction. If you develop any swelling around your face, any difficulties breathing, or a severe rash, you should contact your doctor straightaway. Serious side effects that require immediate medical attention include chest pain, shortness of breath, dizziness, fainting, fever, sweating, confusion, fast or irregular heartbeat, severe muscle stiffness or twitching, agitation, hallucinations, loss of coordination, vomiting, or diarrhea. In rare cases, loss of consciousness (coma) can occur. Additionally, some people may experience large hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs, which requires urgent medical evaluation.
Managing Citalopram Side Effects
There are several practical strategies you can use to manage common side effects while taking citalopram:
| Side Effect | Management Strategy |
|---|---|
| Feeling sick or being sick, indigestion, constipation or diarrhea | Stick to simple foods and drink plenty of water |
| Feeling sleepy, weak or tired | Do not drive and do not use tools or machines; schedule activities accordingly |
| Dry mouth | Try chewing sugar-free gum or sucking sugar-free sweets |
| Increased sweating, difficulty sleeping, lack of appetite, loss of weight, aches and pains, tingling, reduced sexual drive, ringing in ears, yawning, palpitations, runny nose, itching | If symptoms become troublesome, consult your doctor for further advice |
Important Precautions and Warnings
Before starting citalopram, inform your doctor about any pre-existing medical conditions or concerns. You should not take citalopram if you have certain conditions or are taking specific medications that may interact dangerously with it.
When NOT to Take Citalopram
Do not take citalopram if you have a condition called congenital long QT syndrome, as at high doses citalopram can cause changes in the way your heart beats. You should see your doctor immediately if you experience an irregular heartbeat, shortness of breath, dizziness, or fainting while taking citalopram. Additionally, do not use citalopram if you have ever had an allergic reaction to the medication or any of its ingredients.
Medical Conditions Requiring Caution
Tell your doctor before taking citalopram if you have any of the following conditions:
- Liver or kidney disorders
- Heart condition or irregular heartbeat
- Epilepsy or a history of seizures
- High blood sugar levels (diabetes mellitus)
- Raised pressure in your eye(s) (glaucoma)
- A bleeding disorder or tendency to bleed easily
- Ever had abnormally ‘high’ moods, called mania
- Severe kidney disease or liver disease
- Bradycardia (slow heart rate) or recent heart attack
- Heart failure
- Heart rhythm problems
- Low potassium in the blood (hypokalemia)
- Low magnesium in the blood (hypomagnesemia)
If you have any of these conditions, your doctor may need to adjust your dose or monitor you more closely during treatment.
Drug Interactions
Citalopram can interact with many other medications, so it is essential to tell your doctor about any medicines you are taking. This includes medicines available to buy without a prescription, as well as herbal and complementary medicines. If you buy any medicines, check with a pharmacist that they are safe to take with citalopram, as several medicines available from general retail outlets can interfere with this treatment.
Medications to Avoid
Do not take citalopram with monoamine-oxidase inhibitors (MAOIs). Do not start taking citalopram during the 14 days after you stop an MAOI, and wait 14 days after stopping citalopram before you start taking an MAOI. If you take these medications together or do not allow the proper amount of time between them, you may develop confusion, agitation, restlessness, stomach or intestinal symptoms, a sudden high body temperature, an extremely high blood pressure, or severe seizures.
Do not take the herbal remedy St John’s wort while taking citalopram, and ask for advice before buying any anti-inflammatory painkillers. Additionally, citalopram should not be taken with pimozide, a medication usually used to treat Tourette syndrome.
Risk of Serotonin Syndrome
Citalopram may cause a serious condition called serotonin syndrome if taken together with certain medicines. Do not use citalopram with buspirone, fentanyl, lithium, methylene blue injection, tryptophan, or amphetamines. Be cautious with pain or migraine medicines such as meperidine, methadone, rizatriptan, sumatriptan, and tramadol. Although rare, there is an increased risk of serotonin syndrome when citalopram is used with other medications that increase serotonin, such as other antidepressants, migraine medications called triptans (for example, Imitrex), some pain medications (such as tramadol or Ultram), amphetamines, and the antibiotic linezolid (Zyvox).
Special Considerations
Diabetes Management
If you have diabetes, you may need to check your blood sugar (glucose) more frequently, as citalopram may affect the levels of sugar in your blood. Your doctor will be able to advise you about appropriate monitoring and any necessary adjustments to your diabetes management plan.
Electroconvulsive Therapy
If you are being treated with electroconvulsive therapy (ECT), inform your doctor before starting citalopram, as this may affect your treatment plan.
Discontinuing Citalopram
Suddenly stopping citalopram may cause unwanted discontinuation symptoms such as dizziness, headache, and nausea. Your doctor will tell you when and how citalopram should be discontinued and will typically gradually reduce the amount you are using over a period of one to two weeks before stopping completely.
Frequently Asked Questions (FAQs)
Q: How quickly will citalopram start working?
A: Citalopram usually takes 4 to 6 weeks to work fully, though some people notice small improvements in sleep or appetite within the first 1 to 2 weeks. Everyone responds differently, so the timeline can vary slightly between individuals.
Q: Can I stop taking citalopram whenever I want?
A: No, you should not suddenly stop taking citalopram. Discontinuing the medication abruptly can cause unwanted symptoms such as dizziness, headache, and nausea. Always consult your doctor, who will gradually reduce your dose over one to two weeks before stopping completely.
Q: What should I do if I miss a dose?
A: If you miss a dose, take it as soon as you remember, unless it is almost time for your next dose. In that case, skip the missed dose and continue with your regular dosing schedule. Never double your dose to make up for a missed one.
Q: Is it safe to take citalopram with alcohol?
A: You should avoid consuming alcohol while taking citalopram, as it can increase the risk of side effects such as drowsiness and dizziness. Consult your doctor for specific guidance based on your individual situation.
Q: Can citalopram affect my sex drive?
A: Yes, reduced sexual drive or ability is a reported side effect of citalopram. If this becomes problematic, discuss it with your doctor, who may adjust your dose or recommend other solutions. These symptoms have occasionally continued even after stopping treatment.
Q: How long will I need to take citalopram?
A: Many people take citalopram for 6 to 12 months after feeling better to reduce the risk of depression returning. Some individuals may need to take it longer. Your doctor will help determine the appropriate duration for your specific needs.
Q: Are there any foods or supplements I should avoid with citalopram?
A: You should avoid St John’s wort, an herbal remedy that can interfere with citalopram. Before taking any over-the-counter anti-inflammatory painkillers or other supplements, check with your pharmacist to ensure they are safe to combine with citalopram.
Q: What should I do if I experience an allergic reaction?
A: Although allergic reactions to citalopram are quite rare, contact your doctor immediately if you develop any swelling around your face, difficulties breathing, or a severe rash. These may indicate a serious allergic reaction requiring urgent medical attention.
References
- Citalopram (Antidepressant): Side Effects, Uses, and More — Patient.info. 2024. https://patient.info/medicine/citalopram-cipramil-paxoran
- Citalopram (oral route) – Side effects & dosage — Mayo Clinic. 2024. https://www.mayoclinic.org/drugs-supplements/citalopram-oral-route/description/drg-20062980
- Citalopram (Celexa) — National Alliance on Mental Illness (NAMI). 2024. https://www.nami.org/treatments-and-approaches/mental-health-medications/types-of-medication/citalopram-celexa/
- Cipramil – NPS MedicineWise — NPS MedicineWise. 2024. https://www.nps.org.au/medicine-finder/cipramil-tablets
- Citalopram: MedlinePlus Drug Information — U.S. National Library of Medicine. 2024. https://medlineplus.gov/druginfo/meds/a699001.html
- About citalopram — NHS. 2024. https://www.nhs.uk/medicines/citalopram/about-citalopram/
- Citalopram (Celexa): Depression Treatment — Cleveland Clinic. 2024. https://my.clevelandclinic.org/health/drugs/18726-citalopram-tablets
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