Citalopram: uses, dosing, side effects & brands

Citalopram capsules contain citalopram, a selective serotonin reuptake inhibitor (SSRI).

The FDA classifies citalopram as a serotonin reuptake inhibitor. Selective serotonin reuptake inhibitors (SSRIs) block the transporter that pulls serotonin back into nerve cells, so more of this mood-related chemical stays in the gaps between neurons to keep signaling. They act mainly on serotonin, which tends to mean fewer side effects than older antidepressants. If you are checking whether it is safe to combine with something else, the class is what matters — two drugs from the same class usually should not be stacked.

The label says published studies have NOT established an increased risk of major birth defects or miscarriage with citalopram use in pregnancy. However, it does name real risks: use in the month before delivery is linked to a less-than-2-fold increase in postpartum hemorrhage, and third-trimester SSRI exposure carries risks of persistent pulmonary hypertension of the newborn (PPHN, ~1-2 per 1,000 live births) and poor neonatal adaptation (neonates may have respiratory distress, feeding difficulty, jitteriness, and other complications requiring prolonged hospitalization). The label also stresses the risk of untreated depression, noting women who stop antidepressants in pregnancy are more likely to relapse, and directs providers to weigh both. A pregnancy exposure registry for antidepressants exists (1-844-405-6185). Decisions about use or stopping should be made only with the prescriber. This is what citalopram's FDA label says; whether to use it in pregnancy is your prescriber's decision.

In the label's Weight Changes section, patients treated with citalopram in controlled trials experienced a weight loss of about 0.5 kg compared with no change for placebo patients. The adverse-reaction listing notes both decreased and increased weight as frequent metabolic events, but the controlled-trial finding the label reports is a small mean weight loss versus placebo.

The label describes a Discontinuation Syndrome: adverse reactions can occur when citalopram is stopped, especially if stopped abruptly. Named symptoms include nausea, sweating, dysphoric mood, irritability, agitation, dizziness, sensory disturbances (such as paresthesia and electric-shock sensations), tremor, anxiety, confusion, headache, lethargy, emotional lability, insomnia, hypomania, tinnitus, and seizures. The label directs that the dose be reduced gradually under a prescriber's supervision rather than stopping abruptly, and tells patients not to stop on their own but to discuss any tapering regimen with their healthcare provider. This discontinuation warning is in Warnings and Precautions, not in the boxed warning (the boxed warning concerns suicidal thoughts and behaviors). Do not stop citalopram on your own — any change is a prescriber-managed decision.

The elimination half-life of citalopram is about 35 hours — that is how long the body takes to clear half of a dose. The half-life runs longer in some people — roughly 30-50% longer in older adults and about doubled with reduced liver function; citalopram's metabolites are at least 8 times less potent and are not a longer-acting concern. Half-life is not the same as how long a drug test can detect the drug, and it varies with age, kidney and liver function.

It depends on the medicine. We check it against the FDA labels rather than guessing: our interaction checker searches each drug's own label for the other and quotes what it says, naming the section it came from. Run citalopram against whatever else you take — and remember that a label not naming a drug is not the same as that combination being safe.

We track 2 citalopram-containing products in the U.S.: Celexa and Citalopram Hydrobromide. They are the same active ingredient; they differ in form, manufacturer, price and FDA recall record.

Across the brands we track, citalopram is currently marketed as tablet, per the FDA's National Drug Code Directory. Each form is dosed differently — follow the label for the exact product you were prescribed.

Yes. Our catalog lists 1 generic citalopram product alongside the brand versions. A generic has the same active ingredient and must meet the FDA's bioequivalence standard; it usually costs less. Ask your pharmacist which one your plan covers.

It works gradually, not overnight. You may notice some early changes — sleep, appetite or energy — within the first 1 to 2 weeks, but the full effect on mood or anxiety usually takes about 4 to 6 weeks (sometimes up to 8). That delay is normal and is why prescribers ask you not to judge it too soon or stop early; give it time and stay in touch about side effects, and never stop abruptly.

The most common are nausea, dry mouth, drowsiness, trouble sleeping, increased sweating, and mild tremor. These usually show up in the first week or two and ease as your body adjusts over a few weeks; taking the dose with food helps the nausea. Sexual side effects such as lower desire or delayed orgasm, and small weight changes, are more likely to persist while you keep taking it.

Citalopram has a boxed warning for increased suicidal thoughts and behavior in people under 25, especially in the first weeks or after a dose change, so get help right away for new or worsening depression, agitation, or thoughts of self-harm. It can also prolong the QT interval (a heart-rhythm change), so fainting or a pounding, irregular heartbeat is an emergency. Serotonin syndrome, agitation, fever, fast heartbeat, muscle stiffness or twitching, shivering, or diarrhea, also needs immediate care.

The FDA limits citalopram to 40 mg a day because higher doses cause more QT-interval prolongation, a heart-rhythm change that can trigger dangerous arrhythmias. The limit drops to 20 mg a day for people over 60, those with liver problems, and those taking certain interacting drugs or who are CYP2C19 poor metabolizers. Do not exceed your prescribed dose.

Normal, usually temporary effects are mild nausea, dry mouth, sleepiness or insomnia, and sweating, keep your prescriber informed but you generally don't stop. Call promptly for a fast or irregular heartbeat, fainting, seizures, confusion, or signs of low sodium (headache, weakness, confusion, more common in older adults). Do not stop citalopram abruptly on your own, that can cause dizziness, flu-like feelings, and electric-shock sensations; taper with your doctor.