Its absorption does not increase when taken with food, [2] but doing so can help prevent nausea. Nausea is often caused when the 5HT3 receptors actively absorb free serotonin, as this receptor is present within the digestive tract. This side effect, if present, should subside as the body adjusts to the medication. Citalopram is considered safe and well tolerated in the therapeutic dose range. Distinct from some other agents in its class, it exhibits linear pharmacokinetics and minimal drug interaction potential, making it a better choice for the elderly or comorbid patients.

Specifically, common side effects include difficulty becoming aroused, lack of interest in sex, and anorgasmia trouble achieving orgasm. One study showed, however, when remission of major depressive disorder is achieved, quality of life and sexual satisfaction is reported to be higher in spite of sexual side effects. Other side effects, such as increased apathy and emotional flattening, may be caused by the decrease in dopamine release associated with increased serotonin.

Citalopram is also a mild antihistamine , which may be responsible for some of its sedating properties. Because citalopram is extensively metabolized, excretion of unchanged drug in urine is a minor route of elimination. Information For Patients Physicians are advised to discuss the following issues with patients for whom they prescribe Celexa. Patients should be cautioned about the risk of serotonin syndrome with the concomitant use of Celexa and triptans, tramadol or other serotonergic agents.

Patients should be advised that taking Celexa can cause mild pupillary dilation, which in susceptible individuals, can lead to an episode of angle closure glaucoma. Pre-existing glaucoma is almost always open-angle glaucoma because angle closure glaucoma, when diagnosed, can be treated definitively with iridectomy.

Open-angle glaucoma is not a risk factor for angle closure glaucoma. Patients may wish to be examined to determine whether they are susceptible to angle closure, and have a prophylactic procedure e.

Although in controlled studies Celexa has not been shown to impair psychomotor performance, any psychoactive drug may impair judgment, thinking, or motor skills, so patients should be cautioned about operating hazardous machinery, including automobiles, until they are reasonably certain that Celexa therapy does not affect their ability to engage in such activities.

Patients should be told that, although Celexa has not been shown in experiments with normal subjects to increase the mental and motor skill impairments caused by alcohol, the concomitant use of Celexa and alcohol in depressed patients is not advised. Patients should be advised to inform their physician if they are taking, or plan to take, any prescription or over-the-counter drugs, as there is a potential for interactions. Patients should be cautioned about the concomitant use of Celexa and NSAIDs, aspirin, warfarin, or other drugs that affect coagulation since combined use of psychotropic drugs that interfere with serotonin reuptake and these agents has been associated with an increased risk of bleeding.

Patients should be advised to notify their physician if they become pregnant or intend to become pregnant during therapy. Patients should be advised to notify their physician if they are breastfeeding an infant. While patients may notice improvement with Celexa therapy in 1 to 4 weeks, they should be advised to continue therapy as directed. Prescribers or other health professionals should inform patients, their families, and their caregivers about the benefits and risks associated with treatment with Celexa and should counsel them in its appropriate use.

The prescriber or health professional should instruct patients, their families, and their caregivers to read the Medication Guide and should assist them in understanding its contents. Patients should be given the opportunity to discuss the contents of the Medication Guide and to obtain answers to any questions they may have. The complete text of the Medication Guide is reprinted at the end of this document.

Patients should be advised of the following issues and asked to alert their prescriber if these occur while taking Celexa. Clinical Worsening And Suicide Risk Patients, their families, and their caregivers should be encouraged to be alert to the emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia psychomotor restlessness , hypomania, mania, other unusual changes in behavior, worsening of depression, and suicidal ideation, especially early during antidepressant treatment and when the dose is adjusted up or down.

Families and caregivers of patients should be advised to look for the emergence of such symptoms on a day-to-day basis, since changes may be abrupt. Such symptoms should be reported to the patient's prescriber or health professional, especially if they are severe, abrupt in onset, or were not part of the patient's presenting symptoms. Symptoms such as these may be associated with an increased risk for suicidal thinking and behavior and indicate a need for very close monitoring and possibly changes in the medication.

Laboratory Tests There are no specific laboratory tests recommended. During the postmarketing evaluation of citalopram, Celexa overdoses, including overdoses of up to mg, have been reported.

As with other SSRIs, a fatal outcome in a patient who has taken an overdose of citalopram has been rarely reported. In more rare cases, observed symptoms included amnesia , confusion, coma, convulsions, hyperventilation , cyanosis , rhabdomyolysis , and ECG changes including QTc prolongation, nodal rhythm, ventricular arrhythmia , and very rare cases of torsade de pointes.

Acute renal failure has been very rarely reported accompanying overdose. Generally these symptoms are self-limiting and usually resolve within 2 weeks, though in some individuals they may be prolonged months or more.

QT prolongation Citalopram has been found to cause a dose-dependent prolongation of the QT-interval. Cases of QT interval prolongation and ventricular arrhythmia including torsade de pointes have been reported during the post-marketing period, predominantly in patients of female gender, with hypokalemia, or with pre-existing QT prolongation or other cardiac diseases see sections 4. Caution is advised in patients with significant bradycardia; or in patients with recent acute myocardial infarction or uncompensated heart failure.

Electrolyte disturbances such as hypokalaemia and hypomagnesaemia increase the risk for malignant arrhythmias and should be corrected before treatment with citalopram is started. If patients with stable cardiac disease are treated, an ECG review should be considered before treatment is started.

If signs of cardiac arrhythmia occur during treatment with citalopram, the treatment should be withdrawn and an ECG should be performed. ECG monitoring may be advisable in case of overdose or conditions of altered metabolism with increased peak levels, e. Excipients The tablets contain lactose monohydrate. Patients with rare hereditary problems of galactose intolerance, the Lapp deficiency or glucose-galactose malabsorption should not receive this medicine. Contraindicated combinations QT interval prolongation Pharmacokinetic and pharmacodynamic studies between citalopram and other medicinal products that prolong the QT interval have not been performed.

An additive effect of citalopram and these medicinal products cannot be excluded. Therefore, co-administration of citalopram with medicinal products that prolong the QT interval, such as Class IA and III antiarrhythmics, antipsychotics e. Symptoms of an active substance interaction with a MAOI include: The co-administration of pimozide and citalopram resulted in a mean increase in the QTc interval of approximately 10 msec. Due to the interaction noted at a low dose of pimozide, concomitant administration of citalopram and pimozide is contraindicated.

The concomitant use of citalopram and selegiline in doses above 10 mg daily is contraindicated see section 4. Serotonergic medicinal products Lithium and tryptophan No pharmacodynamic interactions have been found in clinical studies in which citalopram has been given concomitantly with lithium. However there have been reports of enhanced effects when SSRIs have been given with lithium or tryptophan and therefore the concomitant use of citalopram with these medicinal products should be undertaken with caution.

Routine monitoring of lithium levels should be continued as usual. Co-administration with serotonergic drugs e. St John's wort Dynamic interactions between SSRIs and herbal remedy St John's wort Hypericum perforatum can occur, resulting in an increase in undesirable effects see section 4. Pharmacokinetic interactions have not been investigated.

ECT electroconvusive therapy There are no clinical studies establishing the risks or benefits of the combined use of electroconvulsive therapy ECT and citalopram see section 4. Alcohol No pharmacodynamic or pharmacokinetic interactions have been demonstrated between citalopram and alcohol.

However, the combination of citalopram and alcohol is not advisable. Medicinal products lowering the seizure threshold SSRIs can lower the seizure threshold. Caution is advised when concomitantly using other medicinal products capable of lowering the seizure threshold e. Desipramine, imipramine In a pharmacokinetic study no effect was demonstrated on either citalopram or imipramine levels,although the level of desipramine, the primary metabolite of imipramine was increased.

When desipramine is combined with citalopram, an increase of the desipramine plasma concentration has been observed. A reduction of the desipramine dose may be needed.

Neuroleptics Experience with citalopram has not revealed any clinically relevant interactions with neuroleptics. However, as with other SSRIs, the possibility of a pharmacodynamic interaction cannot be excluded. No pharmacodynamic interactions have been noted in clinical studies in which citalopram has been given concomitantly with benzodiazepines, neuroleptics, analgesics, lithium, alcohol, antihistamines, antihypertensive drugs, beta-blockers and other cardiovascular drugs.

Pharmacokinetic interactions Biotransformation of citalopram to demethylcitalopram is mediated by CYP2C19 approx. Loss of coordination can increase the risk of falling. Children may be more sensitive to the side effects of this drug, especially loss of appetite and weight loss. Monitor weight and height in children who are taking this drug. During pregnancy , this medication should be used only when clearly needed. It may harm an unborn baby. If you notice any of these symptoms in your newborn , tell the doctor promptly.

CITALOPRAM 20 MG TABLETS

Patients should be advised to notify their physician if they become pregnant or celexa to become pregnant during therapy. Cimetidine Cimetidine potent CYP2D6, 3A4 and 1A2 inhibitor caused a moderate increase in the average steady state levels of citalopram. Common symptoms in these cases include genital anesthesia, tab dysfunction, anhedonia, decreased libido, premature ejaculation, vaginal lubrication issues, celexa 20mg tab, and nipple insensitivity in women. Subsequent epidemiological studies, celexa 20mg tab, both of the case-control and cohort cheapest kamagra oral jelly online, tab demonstrated an association between use of psychotropic drugs that interfere with serotonin reuptake and the occurrence of upper gastrointestinal bleeding. John's Wort is clinically warranted, patients should exelon infra buy made aware of a potential increased risk for serotonin syndrome particularly during treatment initiation and dose increases. Reported clinical findings have included respiratory distress, celexa 20mg tab, cyanosis, apnea, seizures, temperature instability, feeding difficulty, vomiting, hypoglycemia, hypotonia, hypertonia, hyperreflexia, tremor, jitteriness, irritability, and constant 25mg toprol. Contact your doctor at once if you tab any of these symptoms. Reduced kidney and liver function Caution should be used 20mg the treatment of patients with reduced kidney 20mg liver function see section 4. There have been two reports of infants experiencing excessive somnolence, decreased feeding, and weight loss in association with breastfeeding from a citalopram-treated mother; in one case, the infant was reported to recover completely upon discontinuation of citalopram by its mother and in the second case, no follow-up information was available. Other medicines and Citalopram Tell your doctor or pharmacist if you are taking or have recently taken or might take any other medicines, celexa 20mg tab. It should be noted that Celexa is not approved for use in treating bipolar depression. While these events are generally self-limiting, there have been reports of serious discontinuation symptoms. The risk of withdrawal symptoms may be dependent on celexa factors including the duration and 20mg of therapy and the rate of dose reduction. If your doctor has prescribed this medicine for a patient under 18 and you want celexa discuss this, please go back to your doctor. Co-administration with serotonergic drugs e. Drug Interactions Serotonergic Drugs: Co-administration with metoprolol resulted in a twofold increase in the plasma levels of metoprolol, but did not statistically significant increase the effect of metoprolol on the blood pressure and cardiac rhythm.

Citalopram HBR

Seizures Seizures are a potential 20mg with antidepressant drugs. Such drugs include Class 1A e. Citalopram should not be used concomitantly with pimozide see also section 4. September Learn how and when to remove this template message Citalopram should not be taken with St Celexa worttryptophan or 5-HTP as the resulting drug interaction 20mg lead to serotonin syndrome. Check with your doctor if: Cases tab QT interval prolongation and ventricular arrhythmia including torsade de pointes have been reported during the post-marketing period, celexa 20mg tab, predominantly in patients of female gender, with hypokalemia, or with pre-existing QT prolongation or other cardiac diseases see sections 4. These symptoms celexa be due to either serotonergic effects or discontinuation symptoms. If your doctor has prescribed Citalopram for a patient under 18 and you want tab discuss this, please go tab to your doctor, celexa 20mg tab. This 20mg effect has the potential to narrow the eye celexa resulting in increased intraocular pressure and angle-closure glaucoma, especially in patients pre-disposed, celexa 20mg tab. Thus, patients should be cautioned about the use of such drugs concurrently with Citalopram HBr Tablets.

Citalopram and its side-effects - coming off Citalopram 20mg/day

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