Citalopram

Brand names

• Celexa

Usage

To treat symptoms of major depression.

How it works

Citalopram increases brain levels of serotonin, a chemical that is thought to be linked to mood, emotions, and mental state.

Side effects

Serious

Chest pain, rapid or irregular heartbeat, lightheadedness or fainting.

Common

Delayed ejaculation (males), dry mouth, increased sweating, nausea, trembling, diarrhea, drowsiness, numbness, tingling, or prickling sensations, insomnia, vomiting, dizziness.

Less common

Fatigue, fever, loss of appetite, agitation, nasal congestion, sinus infection, erectile dysfunction (impotence).

Possible interactions

Other medicaments:

Citalopram may increase the effects of:

• dofetilide (Tikosyn) requiring dosing decreases.
• imipramine (Tofranil).
• metoprolol (Toprol, Lopressor, others) by increasing metoprolol blood levels.
• quinidine (Quinaglute).
• sildenafil (Viagra) by competing for CYP3A4.
• warfarin (Coumadin) and related oral anticoagulants. Test INR more often.

Citalopram taken concurrently with:



• azole antifungals (such as fluconazole, itraconazole and ketoconazole) may lead to higher than expected citalopram blood levels and increased risk of adverse effects.
• buspirone (Buspar) may lead to serotonin syndrome. Avoid the combination.
• carbamazepine (Tegretol, others) may blunt benefits of citalopram.
• cimetidine (Tagamet) may theoretically lead to increased citalopram levels.
• cisapride (Propulsid) may lead to excessive cisapride levels and risk of serotonin syndrome.
• clarithromycin (Biaxin) may lead to citalopram toxicity-avoid the combination.
• delavirdine (Rescriptor) may lead to citalopram toxicity.
• dextromethorphan (a cough suppressant in many "DM"-labeled nonprescription cough medicines) has resulted in visual hallucinations when combined with fluoxetine, a related medicine. Caution is advised if these medicaments are combined.
• diltiazem (Cardizem) may lead to excessive citalopram levels and possible serotonin syndrome.
• fenfluramine (Pondimin) may lead to serotonin syndrome - do not combine.
• lithium (Lithobid, others) may increase risk of enhanced effects from serotonin. Caution is advised.
• medicines that inhibit CYP3A4 or CYP2C19 may lead to higher than expected citalopram blood levels and increased citalopram toxicity risk.
• monoamine oxidase (MAO) type A inhibitor medicaments may cause confusion, agitation, high fever, seizures and dangerous elevations off blood pressure. Avoid combining these medicaments.
• naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex) or zolmitriptan (Zomig) may lead to increased risk of incoordination, weakness or excessive reflex responses.
• selegiline (Eldepryl) can result in serotonin toxicity syndrome. Avoid this combination.
• sibutramine (Meridia) may lead to serotonin syndrome.
• tryptophan will result in central nervous system toxicity. Avoid the combination.
• any tricyclic antidepressant (amitriptyline, nortriptyline, etc.) may result in increased antidepressant medicament levels and serotonin syndrome. Extreme caution is advised.
• tramadol (Ultram) may increase seizure risk.
• verapamil (Calan) may lead to excessive citalopram levels and possible serotonin syndrome.

Herbal medicines or minerals:

Since citalopram and St. John's wort may act to increase serotonin, the combination is not advised. St. John's wort also increases sun sensitivity. Since part of the way ginseng works may be as a MAO inhibitor, do not combine with citalopram. Ma huang, yohimbe, Indian snakeroot and kava kava are also best avoided while taking this medicine.

Beverages:

Grapefruit juice may lead to increased blood levels.

Alcohol:

This combination is not advisable.

Discontinuation:

Slow medicament elimination makes withdrawal effects unlikely, but call your doctor if you plan to stop this medicament for any reason.