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CITALOPRAM

(Also Known As: CELEXA)

Take this medicine only as directed by your doctor to benefit your condition as much as possible. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.

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. Your doctor should check your progress at regular visits during this time. Also, you may need to keep taking citalopram for 6 months or longer to help prevent the return of the depression.

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 oral dosage form (solution and tablets):
  • 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• Do not keep outdated medicine or medicine no longer needed.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.

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 (especially if it is the third trimester) or if you may become pregnant.

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 Citalopram must be used with caution in children with depression. Studies have shown occurrences of children thinking about suicide or attempting suicide in clinical trials for this medicine. More study is needed to be sure citalopram is safe and effective in children.

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) or
• Buspirone (e.g., BuSpar) or
• Certain tricyclic antidepressants (amitriptyline [e.g., Elavil], clomipramine [e.g., Anafranil], or imipramine [e.g., Tofranil]) or
• Dextromethorphan (cough medicine) or
• Levodopa (e.g., Sinemet) or
• Lithium (e.g., Eskalith) or
• Meperidine (e.g., Demerol) or
• Moclobemide (e.g., Manerix) or
• Nefazodone (e.g., Serzone) or
• Pentazocine (e.g., Talwin) or
• Selective serotonin reuptake inhibitors, other (fluoxetine [e.g., Prozac], fluvoxamine [e.g., Luvox], paroxetine [e.g., Paxil], sertraline [e.g., Zoloft]) or
• Street drugs (LSD, MDMA [e.g., ecstasy], marijuana) or
• Tramadol (e.g., Ultram) or
• Trazodone (e.g., Desyrel) or
• Triptans (e.g., Imitrex) or
• Tryptophan or
• 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

• Linezolid (e.g., Zyvox) Serious adverse effects may result if this medicine is used at the same time as citalopram

• 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

• Bipolar disorder (history of) May be activated

• Diabetes mellitus (sugar diabetes) Hypoglycemia has occurred rarely in diabetic patients receiving citalopram

• Heart attack (recent history of) or
• Heart disease (unstable) use in patients with these conditions have not been adequately studied

• 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