Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Your doctor may occasionally change your dose to make sure you get the best results from the medication.

Try to take the medicine at the same time each day. Follow the directions on your prescription label. To be sure you get the correct dose of liquid citalopram, measure the liquid with a marked measuring spoon or medicine cup, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.

It may take 4 weeks or longer before you start feeling better. Do not stop using citalopram without first talking to your doctor. You may have unpleasant side effects if you stop taking this medication suddenly.

Store citalopram at room temperature away from moisture and heat.

You may have an increased risk of suicidal thoughts or behavior at the start of treatment with an antidepressant medication, especially if you are under 18 years old. Talk with your doctor about this risk. While you are taking citalopram you will need to be monitored for worsening symptoms of depression and/or suicidal thoughts during the first weeks of treatment, or whenever your dose is changed. In addition to you watching for changes in your own symptoms, your family or other caregivers should be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

Do not use citalopram if you are using an MAO inhibitor such as:

• isocarboxazid (Marplan®)
• tranylcypromine (Parnate®)
• phenelzine (Nardil®)
• rasagiline (Azilect®)
• selegiline (Eldepryl®, Emsam®)

Serious and sometimes fatal reactions can occur when these medicines are taken with citalopram. You must wait at least 14 days after stopping an MAO inhibitor before you can take citalopram. After you stop taking citalopram, you must wait at least 14 days before you start taking an MAOI.

Before taking citalopram, tell your doctor if you are allergic to any drugs, or if you have:

• History of drug abuse or suicidal thoughts
• Seizure Disorder Such As Epilepsy
• Bipolar Disorder (manic depression)
• Kidney Disease
• Liver Disease

If you have any of these conditions, you may not be able to use citalopram, or you may need a dosage adjustment or special tests during treatment.

SSRI antidepressants may cause serious or life-threatening lung problems in newborn babies whose mothers take the medication during pregnancy. However, you may have a relapse of depression if you stop taking your antidepressant during pregnancy. If you are planning a pregnancy, or if you become pregnant while taking citalopram, do not stop taking the medication without first talking to your doctor. Citalopram can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Take the missed dose as soon as you remember. However, if it is almost time for the next regularly scheduled dose, skip the missed dose and take the next one as directed. Do not take extra medicine to make up the missed dose.

Seek emergency medical attention if you think you have taken too much of this medication. Symptoms of a citalopram overdose may include:

• nausea
• vomiting
• tremor
• sweating
• rapid heartbeat
• confusion
• dizziness
• seizures
• coma

Do not take citalopram together with:

• escitalopram (Lexapro®)
• isocarboxazid (Marplan®)
• phenelzine (Nardil®)
• rasagiline (Azilect®)
• selegiline (Eldepryl®, Emsam®)
• tranylcypromine (Parnate®)

Avoid drinking alcohol, which can increase some of the side effects of citalopram.

Avoid using other medicines that make you sleepy such as:

• cold medicine
• pain medication
• muscle relaxers
• medicine for seizures
• other medication for depression or anxiety

They can add to sleepiness caused by citalopram.

Citalopram can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Side Effects

Get emergency medical help if you have any of these signs of an allergic reaction:

• skin rash or hives
• difficulty breathing
• swelling of your face, lips, tongue, or throat

Contact your doctor promptly if you have any of the following side effects, especially if they are new symptoms or if they get worse:

• mood changes
• anxiety
• panic attacks
• trouble sleeping
• irritability
• agitation
• aggressiveness
• severe restlessness
• mania (mental and/ or physical hyperactivity)
• thoughts of suicide or hurting yourself

Call your doctor at once if you have any of these serious side effects:

• Seizure (convulsions)
• Tremors, Shivering, Muscle Stiffness or Twitching
• Problems With Balance or Coordination
• Agitation, Confusion, Sweating, Fast Heartbeat

Less serious side effects may be more likely to occur, such as:

• Feeling Nervous, Restless, or Unable to Sit Still
• Drowsiness, Dizziness, Trouble Concentrating
• Sleep Problems (insomnia)
• Nausea, Gas, Upset Stomach
• Loss of Appetite
• Weight Changes
• Urinating More Than Usual
• Decreased Sex Drive, Impotence, or Difficulty Having An Orgasm
• Dry or Watery Mouth
• Yawning
• Ringing In Your Ears

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

Talk to your doctor before taking any medicine for pain, arthritis, fever, or swelling. This includes:

• aspirin
• ibuprofen (Advil®, Motrin®)
• naproxen (Aleve®, Naprosyn®)
• diclofenac (Voltaren®)
• indomethacin
• piroxicam (Feldene®)
• nabumetone (Relafen®)
• etodolac (Lodine®)

Taking any of these drugs with citalopram may cause you to bruise or bleed easily.

Before taking citalopram, tell your doctor if you are using any of the following medicines:

• Carbamazepine (Tegretol®)
• Cimetidine (Tagamet®)
• Lithium (Lithobid®, Eskalith®)
• warfarin (Coumadin®)
• amitriptyline (Elavil®)
• escitalopram (Lexapro®)
• fluoxetine (Prozac®, Sarafem®)
• fluvoxamine (Luvox®)
• imipramine (Tofranil®)
• nortriptyline (Pamelor®)
• paroxetine (Paxil®)
• sertraline (Zoloft®)
• Almotriptan (Axert®)
• frovatriptan (Frova®)
• sumatriptan (Imitrex®)
• naratriptan (Amerge®)
• rizatriptan (Maxalt®)
• zolmitriptan (Zomig®)

If you are using any of these drugs, you may not be able to use citalopram, or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect citalopram. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.