Citalopram Side Effects

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Answer the side-effect intent for citalopram without diagnosing; distinguish common from serious reactions and give safe next-step/reporting guidance.

Part of mental health medication side effects side effects.

What is citalopram?

Citalopram contains the active ingredient Citalopram.

• Active ingredient — Citalopram
• Registration number — 36/1.2/0469
• Registration holder — Oethmaan Biosims (Pty) Ltd

It is approved for:

• Depression and prevention of relapse
• Panic disorders
• Obsessive-compulsive disorder (OCD)

Common side effects of citalopram

Not everyone gets side effects. The effects below are those listed in the South African approved leaflet, grouped using the leaflet’s own frequency wording.

Frequent side effects

• Decreased sex drive (men and women)
• Sleep problems, sleepiness, tremor
• Nausea, diarrhoea, dry mouth
• Excessive sweating
• Sexual problems (including difficulty maintaining an erection for sexual activity)
• Tiredness

Frequency not known side effects

• A decrease in blood platelets, which increases risk of bleeding or bruising
• Reduced water excretion due to high levels of a hormone
• Low levels of salt and potassium in the blood
• Decreased or increased appetite, decreased or increased weight
• Agitation, anxiety, nervousness, feeling confused, abnormal orgasms in women, sleep problems including unusual dreams, aggression, feeling detached from yourself, hallucinations, abnormally high mood, panic attacks, teeth grinding, restlessness
• Feeling of “pins and needles”, dizziness, poor concentration, fainting, fits (seizures), muscle twitching, involuntary movements or problems with balance or co-ordination
• Enlarged dilated pupils, vision problems
• Ringing in the ears
• Slow heartbeat, rapid and irregular heartbeat sensations
• Unexplained bleeding, low blood pressure that happens when standing up from sitting or lying down
• Yawning, stuffy nose, nosebleed
• Indigestion, vomiting, constipation, bleeding from the gut including the back passage
• Itchy skin, hives, hair loss, rash, purplish rash, sensitivity to sunlight, bruising of the skin, rapid swelling of the tissues around the neck, face, mouth and/or throat
• Muscle pain, joint pain
• Difficulty passing urine, problems urinating
• Sexual dysfunction, ejaculation problems in men, heavy periods, producing breast milk in men and in women that are not nursing, irregular menstrual period
• Feeling weak, headache, feeling unwell, yawning, swollen ankles, feet and legs, high temperature
• Laboratory test may show the following: o blood test results for liver function levels differing from normal

Serious side effects and warning signs

This leaflet does not set out a separate list of serious side effects. The general warning signs below apply to any medicine.

General warning signs that apply to any medicine

How long can side effects last?

How long a side effect lasts depends on the effect, the product, how long it has been used, and the person. Some effects ease within days as the body adjusts. Others continue for as long as the product is used. A few can persist after stopping, and some need review rather than waiting.

• Settling effects — mild effects that ease over the first days or weeks of use
• Ongoing effects — effects that continue while the product is being used and improve after stopping
• Persistent effects — effects that continue after stopping and need medical review
• Delayed effects — effects that appear after weeks or months rather than immediately

Which of these applies to a particular effect is a clinical question. If a side effect is not settling, is getting worse, or is affecting your daily life, that is worth a conversation with a pharmacist or doctor regardless of how long it has been going on.

Factors that may affect side effects

The approved leaflet identifies the following cautions and factors.

Do not use it at all if

• If you are allergic (hypersensitive) to citalopram or any of the ingredients in the formulation
• If you are taking any other medication for depression such as monoamine oxidase inhibitor (MAOI). At least 14 days should elapse between stopping the MAOI and starting with CITALOPRAM 20 OETHMAAN
• If you have severely impaired kidney function
• If you are taking pimozide (a medicine used in Tourette’s syndrome)
• If you are taking linezolid, an antibiotic
• If you are born with or have had an episode of abnormal heart rhythm known as QT interval prolongation (seen at ECG; an examination to evaluate how the heart is functioning)
• If you are pregnant or breastfeeding
• CITALOPRAM 20 OETHMAAN must not be used by children under the age of 18 years

Use with care, and tell your doctor, if

• If you are an elderly person
• If you have liver or kidney impairment
• If you get seizures (epilepsy) or have a history thereof
• If you are receiving electroconvulsive treatment (ECT)
• If you have mania or a history of mania
• If you have pre-existing slow heart rate
• If you are a diabetic (high blood sugar)
• If you have suicidal thoughts. If you are depressed and/or have anxiety disorders you can sometimes experience increased anxiety symptoms or have thoughts of harming or killing yourselves. These may be increased when first starting antidepressants, including CITALOPRAM 20 OETHMAAN, since these medicines all take time to work, usually about two weeks but sometimes longer. If you have thoughts of harming or killing yourself at any time, contact your doctor or go to a hospital straight away
• If you have a decreased level of sodium in the blood
• If you start feeling restless and cannot sit or stand still (akathisia), contact your doctor or pharmacist
• If you experience a combination of the below mentioned symptoms, CITALOPRAM 20 OETHMAAN should be stopped:
• Agitation, confusion, disorientation, muscle spasms, hyper-reflexia, tremor, rigidity, incoordination, fever, sweating and diarrhoea
• If you have bleeding disorders or appearance of bruises or unusual bleeding or if you are taking any medicine that thins the blood
• There has been a relation between a group of medicine called SSRI and SNRI and heavy bleeding following birth. CITALOPRAM 20 OETHMAAN belongs to the group of medicines called SSRIs. If you have any bleeding disorders or are pregnant, your doctor will have to change your treatment to an alternative group of medicines
• If you are taking a herbal medicine St. John’s Wort for the treatment of depression
• If you suffer or have suffered from heart problems or have recently had a heart attack
• If you have a low resting heart rate and/or you know that you may have salt depletion as a result of prolonged severe diarrhoea and vomiting (being sick) or usage of diuretics (water tablets)
• If you experience a fast or irregular heartbeat, fainting, collapse or dizziness on standing up which may indicate abnormal functioning of the heart rate
• If you have or have previously had eye problems, such as certain kinds of glaucoma (increased pressure in the eye)

Pregnancy and breastfeeding

• If you are pregnant or breastfeeding, think you may be pregnant or are planning to have a baby, please consult your doctor, pharmacist or other healthcare provider for advice before taking this medicine
• Safety in pregnancy and breastfeeding has not been established
• Pregnant women should not take CITALOPRAM 20 OETHMAAN nor should mothers breastfeed their babies while taking this medicine, unless you and your doctor have discussed the risks and benefits involved
• Pregnancy Caution should be exercised when used during pregnancy, especially during late pregnancy or just before giving birth since the following effects have been reported in newborn children: irritability, tremor, muscle weakness, persistent crying, and difficulty in sucking or in sleeping
• When taken during pregnancy, particularly in the last 3 months of pregnancy, CITALOPRAM 20 OETHMAAN may increase the risk of a serious condition in babies, called persistent pulmonary hypertension of the newborn (PPHN), making the baby breathe faster and appear bluish
• If this happens to your baby, you should contact your midwife and/or doctor immediately

Interactions and medicines to check

The approved leaflet names these interactions.

• Do not take any other medicines to treat depression (for example monoamine oxidase inhibitors, imipramine, other serotonergic medicines, and moclobemide) without consulting your doctor as they may interact with CITALOPRAM 20 OETHMAAN
• Do not use alcohol while using CITALOPRAM 20 OETHMAAN
• Medicines used to treat blood clotting such as warfarin may interact with CITALOPRAM 20 OETHMAAN. Consult your doctor if you are or have to use such medicines
• Medicines used to treat heart burn or stomach ulcer such as cimetidine interacts with the breakdown of citalopram, and the dose of CITALOPRAM 20 OETHMAAN should be changed. Tell your doctor if you are taking the following medicines:
• Sumatriptan (used to treat migraine)
• Tramadol (used for severe pain)
• Lithium or tryptophan (used for treatment of mental illness with depression)
• Desipramine (used to treat depression)
• Metoprolol (beta-blocker used to treat angina (chest pain) and high blood pressure)
• Selegiline (used to treat Parkinson’s disease)
• Blood thinning medicines e.g. warfarin, NSAIDs (such as ibuprofen, diclofenac) and aspirin
• Mefloquin (used to treat malaria), bupropion (used to treat depression) and tramadol (used to treat severe pain) due to a possible risk of a lowered threshold for seizures
• Neuroleptics (medicines to treat schizophrenia, psychosis) due to a possible risk of a lowered threshold for seizures (fits), and antidepressants
• Medicines that may affect the heart’s rhythm, e.g. Class IA and III antiarrhythmics, antipsychotics (e.g. fentiazine derviatives, phenothiazine derivatives, pimozide, haloperidol), tricyclic antidepressants, certain antimicrobial medicines (e.g. sparfloxacin, moxifloxacin, erythromycin IV, pentamidine), anti-malaria treatment particularly halofantrine, or certain antihistamines (astemizole, mizolastine), because taking one or more of these medicines with CITALOPRAM 20 OETHMAAN may increase the risk of changes in the electrical activity of the heart
• St. John’s Wort (herbal remedy for depression)
• Tell your doctor that you are taking CITALOPRAM 20 OETHMAAN before undergoing electroconvulsive therapy. CITALOPRAM 20 OETHMAAN with food and drink and alcohol The tablets can be taken with or without food. Avoid the use of alcohol

What to do if you experience side effects

If you think you are having a side effect, the response depends on how severe it is. Use the warning signs above first — if any of those apply, treat it as urgent.

If the symptom is severe or frightening

Get medical help immediately. Call 10177 for an ambulance, or 112 from a mobile phone, or go to the nearest emergency department. Take the product and its packaging with you if you can.

If the symptom is mild but bothering you

• Write down what the symptom is, when it started, and how it relates to when you take the product
• Check the leaflet that came with the product to see whether the symptom is listed
• Speak to your pharmacist — for many questions this is the fastest route to a useful answer
• Contact the prescriber if the symptom is affecting your daily life or is not settling

You can also report a suspected side effect in South Africa. Reporting does not replace getting medical advice, and you do not need to be certain the product was the cause.

When to seek urgent medical help

Some symptoms need medical attention straight away rather than an appointment in a few days. Do not wait to see whether they settle.

Get same-day medical advice if you have

• A high fever, or a rash together with feeling generally unwell
• Yellowing of the eyes or skin, or unusually dark urine
• Unusual bruising or bleeding that you cannot explain
• Severe or persistent vomiting or diarrhoea, especially if you cannot keep fluids down
• A sudden change in mood, or thoughts of harming yourself
• Any symptom that is rapidly getting worse

How to report a suspected side effect in South Africa

South Africa has an official system for reporting suspected side effects, run by the South African Health Products Regulatory Authority (SAHPRA). Reports from the public and from healthcare professionals are how safety signals get detected after a product is already in use.

Who can report

Anyone can report — you do not have to be a healthcare professional, and you do not need to prove that the product caused the problem. A suspicion is enough. Patients, caregivers and family members can all submit a report.

What to have ready

• The name of the product, its strength and form, and the batch number if you have it
• Why it was being used, and when it was started and stopped
• What the suspected reaction was, when it began, and how long it lasted
• Any other medicines, supplements or remedies being used at the same time
• Basic details about the person affected — age and sex are usually enough

How to report

SAHPRA accepts adverse reaction reports through its e-Services reporting system and through the Med Safety mobile app. Healthcare professionals can also report through the same routes. Current forms and access points are published on the SAHPRA site.

• SAHPRA Health Products Vigilance — the main vigilance and reporting hub
• SAHPRA e-Services — current adverse reaction reporting access

For a fuller walkthrough see how to report an adverse drug reaction.

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