Side effects

of Citalopram
Sexual dysfunction[edit]
Sexual dysfunction is often a side effect with SSRIs.[43] Some people experience persistent sexual
side effects when taking SSRIs or after discontinuing them.[44] Symptoms of medication-induced
sexual dysfunction from antidepressants include difficulty with orgasm, erection, or ejaculation.
[44]
Other symptoms may be genital anesthesia, anhedonia, decreased libido, vaginal lubrication
issues, and nipple insensitivity in women. Rates are unknown, and there is no established treatment.
[45]

Abnormal heart rhythm[edit]

In August 2011, the FDA announced, "Citalopram causes dose-dependent QT interval prolongation.
Citalopram should no longer be prescribed at doses greater than 40 mg per day". [46] A further
clarification issued in March 2012, restricted the maximum dose to 20 mg for subgroups of patients,
including those older than 60 years and those taking an inhibitor of cytochrome P450 2C19.7. [47]
Endocrine effects[edit]
As with other SSRIs, citalopram can cause an increase in serum prolactin level.[48] Citalopram has no
significant effect on insulin sensitivity in women of reproductive age[49] and no changes in glycaemic
control were seen in another trial.[50]
Exposure in pregnancy[edit]
Antidepressant exposure (including citalopram) during pregnancy is associated with shorter duration
of gestation (by three days), increased risk of preterm delivery (by 55%), lower birth weight (by 75 g),
and lower Apgar scores (by <0.4 points). Antidepressant exposure is not associated with an
increased risk of spontaneous abortion.[51] It is uncertain whether there is an increased prevalence of
septal heart defects among children whose mothers were prescribed an SSRI in early pregnancy. [52]
[53]

Overdose[edit]
Overdosage may result in vomiting, sedation, disturbances in heart rhythm, dizziness, sweating,
nausea, tremor, and rarely amnesia, confusion, coma, or convulsions.[34]: 105 Overdose deaths have
occurred, sometimes involving other drugs, but also with citalopram as the sole agent. Citalopram
and N-desmethylcitalopram may be quantified in blood or plasma to confirm a diagnosis of poisoning
in hospitalized patients or to assist in a medicolegal death investigation. Blood or plasma citalopram
concentrations are usually in a range of 50-400 μg/L in persons receiving the drug therapeutically,
1000–3000 μg/L in patients who survive acute overdosage and 3–30 mg/L in those who do not
survive.[46][54][55] It is the most dangerous of SSRIs in overdose.[56]
Suicidality[edit]
In the United States, citalopram carries a boxed warning stating it may increase suicidal thinking and
behavior in those under age 24.[37]
Discontinuation Syndrome[edit]
SSRI discontinuation syndrome has been reported when treatment is stopped. It includes sensory,
gastrointestinal symptoms, dizziness, lethargy, and sleep disturbances, as well as psychological
symptoms such as anxiety/agitation, irritability, and poor concentration. [57] Electric shock-like
sensations are typical for SSRI discontinuation.[58] Withdrawal symptoms can occur when this
medicine is suddenly stopped, such as paraesthesiae, sleeping problems (difficulty sleeping and
intense dreams), feeling dizzy, agitated or anxious, nausea, vomiting, tremors, confusion, sweating,
headache, diarrhea, palpitations, changes in emotions, irritability, and eye or eyesight problems.
Treatment with citalopram should be reduced gradually when treatment is finished. [59]

Interactions[edit]
Serotonin Syndrome[edit]
Citalopram should not be taken with St John's wort, tryptophan or 5-HTP as the resulting drug
interaction could lead to serotonin syndrome.[60] With St John's wort, this may be caused by
compounds in the plant extract reducing the efficacy of the hepatic cytochrome P450 enzymes that
process citalopram.[61] Tryptophan and 5-HTP are precursors to serotonin.[62] When taken with an
SSRI, such as citalopram, this can lead to levels of serotonin that can be lethal. This may also be the
case when SSRIs are taken with SRAs (serotonin releasing agents) such as in the case of MDMA. It
is possible that SSRIs could reduce the effects associated due to an SRA, since SSRIs stop the
reuptake of Serotonin by blocking SERT. This would allow less serotonin in and out of the
transporters, thus decreasing the likelihood of neurotoxic effects. However, these concerns are still
disputed as the exact pharmacodynamic effects of citalopram and MDMA have yet to be fully
identified.[citation needed] Citalopram is contraindicated in individuals taking MAOIs, owing to a potential
for serotonin syndrome.
Other interactions[edit]
SSRIs, including citalopram, can increase the risk of bleeding, especially when coupled
with aspirin, NSAIDs, warfarin, or other anticoagulants.[37] Taking citalopram with omeprazole may
cause higher blood levels of citalopram. This is a potentially dangerous interaction, so dosage
adjustments may be needed or alternatives may be prescribed.[63][64][10]