How to take Citalopram?
Ensure to read and understand the Patient Information Leaflet provided by your pharmacist before you start using Citalopram. If there are any doubts ask your doctor or pharmacist.

Take Citalopram tablet with a glass of water with or without food as per your doctor's advice. Usually it is recommended to take once a day just either morning or evening.

Your dosage will be decided upon your medical condition, age, laboratory tests, your response to the medication and other medications that you are taking. Take Citalopram exactly as it was prescribed for you. Do not take in doses which are either larger or for longer than what is recommended by your doctor.Inform your doctor about any medications that you are taking including prescription medications, over the counter medications, vitamins, supplements and herbal remedies. Your dosage for a day should not exceed 40mg.

If you are taking the suspension (liquid form) you need to have a special medicine spoon to measure the dose in order to get the accurate dosage. Do not use a household spoon as it will not be the accurate dosage.

In order to reduce the side effects your doctor may start Citalopram at a low dosage and gradually will increase the dosage over time. Take Citalopram exactly as it was prescribed for you. Do not take in doses which are either larger or for longer than what is recommended by your doctor. Make sure to take Citalopram regularly to get the most benefit from it.

Citalopram needs to be continued even if you feel well. It should not be discontinued without consulting your doctor. Sometimes your condition may get worse when you stop the medication abruptly. It may also cause mood swings, tiredness, headache, sleep changes, brief feelings similar to that of electric shock. In order to stop this medication your doctor may decrease your dosage gradually. If you develop any new symptoms keep your doctor well informed.

To feel a benefit from Citalopram it may take 1 to 4 weeks and may take about several weeks to get full benefit.

Precaution
Prior to taking Citalopram inform your doctor if you have

• any allergies to Citalopram  or any other allergies
• personal or family history of bipolar/manic depressive disorder
• seizures
• liver disease
• kidney disease
• low sodium in the blood
• personal or family history of suicide attempts
• peptic ulcer disease
• bleeding problems
• personal or family history of glaucoma
• have QT prolongation in the EKG

If you have certain medical conditions or taking other medications that may cause QT prolongation, can increase the risk of QT prolongation. Prior to taking Citalopram, inform your doctor of all the drugs you take and if you have any of the conditions listed here: certain heart problems (such as slow heartbeat, heart failure, recent heart attack, QT prolongation in the EKG), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death).

Risk of QT prolongation will be increased by low levels of potassium and magnesium in the blood. This risk may increase if you are taking certain drugs or certain conditions like diarrhea, sweating and vomiting. Discuss with your doctor how to use Citalopram safely and effectively.

Citalopram may make you dizzy, confused or disoriented. Consumption of alcohol or marijuana can increase the risk of drowsiness. Do not operate machinery, drive a car or do anything that require alertness until you can do it safely.  Understand how this medication affects you.  Do not take any alcoholic beverages.

If you are having surgery prior to your surgery, inform your doctor or the dentist of all the products (prescription, non- prescription medications, herbal products, vitamin and supplements) you are taking.

Older adult patients may be more sensitive to the side effects of this drug. They may experience

• drowsiness
• constipation
• QT prolongation
• confusion
• trouble urinating

Older adults have a higher risk of falling due to drowsiness and confusion.

Loss of appetite and weight loss often seen in children as a side effect among those who are taking Citalopram. Children may be more sensitive to side effects of this medication. Need to monitor weight and height in children who are taking Citalopram.

If you are pregnant you must take Citalopram only if it's absolutely necessary. Unborn baby may be harmed by Citalopram. If the mother has been taking Citalopram during the last 3 months of the pregnancy the babies may rarely develop withdrawal symptoms such as breathing or feeding difficulties, muscle stiffness, seizures or constant crying. Consult your doctor immediately If you notice these symptoms in your new born. If you are planning a pregnancy, become pregnant or think you may be pregnant discuss with your doctor the risks and the benefits involved.

Nursing mothers must discuss with the doctor if it is safe to feed the baby while taking Citalopram as it passes into breast milk and may have undesirable effects on a nursing infant.

Side Effects
Your doctor prescribed this medicine after carefully analyzing the benefits over the risks involved. Most people do not experience any serious side effects.

• dry mouth
• loss of appetite
• nausea
• drowsiness
• tiredness
• sweating
• blurred vision
• yawning

Inform your doctor immediately if you experience any of the serious side effects mentioned below.

• low libido
• shaking (tremor)
• easy bruising / bleeding
• changes in sexual ability

A serious allergy reaction is extremely rare with Citalopram. In case you show the following symptoms get to the emergency clinic

• itching
• fainting
• black stools
• swelling in the face, throat, tongue, throat
• rash  - itching
• vomit that looks like coffee grounds
• irregular / fast heartbeat
• eye pain / swelling/ vision changes/ widened pupils

If you have an erection which lasts more than 5 hours seek medical treatment.

Interaction
Inform your doctor about any medications that you are taking including prescription medications, over the counter medications, vitamins, supplements and herbal remedies.  Do not start, stop and change the dosage of any medicine without your doctor's permission.

Some of the medications which cause drowsiness may interact with Citalopram is

• blood thinners (warfarin)
• antiplatelet drugs (clopidogrel)
• NSAIDS (ibruprofen)

Citalopram when taken with aspirin the risk of bleeding is increased. If your doctor has prescribed a low dosage aspirin in order to prevent a heart attack or a stroke you should continue taking it unless your doctor advices you otherwise.

Citalopram taken together with MAO inhibitors can cause serious drug interaction. You need to avoid MAO inhibitors (linezolid, rasagiline, phenelzine, procabazine, methylene blue, isocarboxazid, safinamide, tranylcypromine) during the time of treatment.  

Most MAO shouldn't be  taken for two weeks before  and after treatment with Citalopram.