Patients who are allergic to citalopram, any other SSRI drug, or any component of the preparation should not take citalopram.
Patients with liver problems and elderly patients (over age 65) need to take smaller amounts of the drug. Dosage for these patients should start at 20 mg but can be increased to 40 mg daily if needed. Patients with kidney problems do not need dosage adjustments. Patients with history of mania, suicide attempts, or seizure disorders should start citalopram with caution and only under close physician supervision. There is no clinical data available on the use of citalopram in children and adolescents.
More than 15% of patients develop insomnia while taking citalopram. Nausea and dry mouth occur in about 20% patients being treated with citalopram. Patients also experience tremor, anxiety, agitation, yawning, headaches, dizziness, restlessness, and sedation with citalopram therapy. These side effects usually diminish or disappear with continued use of the drug, although it may take up to four weeks for this to occur.
A drop in blood pressure and increased heart rate have been associated with citalopram use. In general, patients do not experience weight gain or loss after starting citalopram.
Sexual dysfunction, which includes decreased sex drive in women and difficulty ejaculating in men, is also associated with the use of citalopram. In some patients, it may take up to 12 weeks for these side effects to disappear. In some patients these sexual side effects never resolve. If sexual side effects continue, the dose of citalopram may be reduced, patients can also have drug holidays where the weekend dose is either decreased or skipped, or they can discuss with their physician the risks and benefits of switching to another antidepressant.
Ajna Hamidovic Pharm.D., The Gale Group Inc., Gale, Detroit,