Citalopram

Commonly reported side effects of citalopram include: drowsiness, ejaculatory disorder, nausea, insomnia, and diaphoresis. Other side effects include: suicidal tendencies, agitation, diarrhea, impotence, sinusitis, anxiety, confusion, exacerbation of depression, lack of concentration, tremor, vomiting, anorexia, and xerostomia. See below for a comprehensive list of adverse effects.

Applies to citalopram: oral solution, oral tablet

Along with its needed effects, citalopram may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking citalopram:

Less common

• Agitation
• blurred vision
• confusion
• fever
• increase in the frequency of urination or amount of urine produced
• lack of emotion
• loss of memory
• menstrual changes
• skin rash or itching
• trouble breathing

Rare

• Behavior change similar to drunkenness
• bleeding gums
• breast tenderness or enlargement or unusual secretion of milk (in females)
• chills
• convulsions (seizures)
• diarrhea
• difficulty with concentrating
• dizziness or fainting
• drowsiness
• increased hunger
• increased thirst
• irregular heartbeat
• lack of energy
• lethargy
• nosebleed
• overactive reflexes
• painful urination
• poor coordination
• purple or red spots on the skin
• rapid weight gain
• red or irritated eyes
• redness, tenderness, itching, burning, or peeling of the skin
• shivering
• slow or irregular heartbeat (less than 50 beats per minute)
• sore throat
• stupor
• sweating
• swelling of the face, ankles, or hands
• talking or acting with excitement you cannot control
• trembling, shaking, or twitching
• trouble with holding or releasing urine
• unusual or sudden body or facial movements or postures
• unusual tiredness or weakness

Incidence not known

• Abdominal or stomach pain
• back or leg pains
• black, tarry stools
• bloating
• bloody stools
• chest pain
• confusion as to time, place, or person
• constipation
• cough
• darkened urine
• difficult or fast breathing
• difficulty with swallowing
• drooling
• fast, slow, or irregular heartbeat
• general body swelling
• hive-like swelling on the face, eyelids, lips, tongue, or throat
• hives
• holding false beliefs that cannot be changed by fact
• impaired consciousness, ranging from confusion to coma
• indigestion
• itching, puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
• loss of appetite
• loss of bladder control
• loss of consciousness
• muscle cramps or spasms
• muscle tightness
• muscle twitching or jerking
• painful or prolonged erection of the penis
• pale skin
• penile erections, frequent or continuing
• recurrent fainting
• rhythmic movement of the muscles
• seeing, hearing, or feeling things that are not there
• swelling of the breasts or unusual milk production
• tenderness, pain, swelling, warmth, skin discoloration, and prominent superficial veins over the affected area
• tightness in the chest
• total body jerking
• twitching, twisting, uncontrolled repetitive movements of the tongue, lips, face, arms, or legs
• uncontrolled jerking or twisting movements
• unusual excitement
• vomiting of blood or material that looks like coffee grounds
• yellowing of the eyes or skin

Some side effects of citalopram may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

• Decrease in sexual desire or ability
• sleepiness or unusual drowsiness

Less common

• Body aches or pain
• change in sense of taste
• gas
• headache (severe and throbbing)
• heartburn
• increased sweating
• increased yawning
• loss of voice
• pain in the muscles or joints
• sneezing
• stuffy or runny nose
• tingling, burning, or prickly feelings on the skin
• tooth grinding
• unusual increase or decrease in weight
• watering of the mouth

Incidence not known

• Bruising
• inability to sit still
• large, flat, blue or purplish patches in the skin
• need to keep moving
• uncontrolled eye movements

Applies to citalopram: oral solution, oral tablet

The side effects observed with citalopram in clinical trials were generally reported as mild and transient, occurring most frequently in the first 1 to 2 weeks of therapy, and attenuating subsequently. The most commonly reported side effects were nausea, somnolence, dry mouth, increased sweating, tremor, diarrhea, and ejaculation disorder.

Potentially life-threatening serotonin syndrome has been reported with SSRIs and SNRIs as monotherapy, but particularly with concomitant use of other serotonergic drugs and drugs that impair the metabolism of serotonin.

Very common (10% or more): Headache (up to 26.9%), somnolence (up to 17.9%), dizziness (up to 10.3%)

Common (1% to 10%): Amnesia, extrapyramidal disorder, migraine, paresthesia, tremor,

Uncommon (0.1% to 1%): Abnormal gait, ataxia, cerebrovascular accident, convulsions, dystonia, hypoesthesia, involuntary muscle contractions, neuralgia, speech disorder, syncope, hyperkinesia, hypertonia, hypokinesia, dyskinesia, vertigo, transient ischemic attack

Rare (less than 0.1%): Abnormal coordination, dyskinesia, grand mal convulsion, hyperesthesia, stupor

Frequency not reported: Akathisia, movement disorder, serotonin syndrome

Postmarketing reports: Choreoathetosis, myoclonus, neuroleptic malignant syndrome, nystagmus

Very common (10% or more): Nausea (up to 21.4%), dry mouth (up to 20%)

Common (1% to 10%): Abdominal pain, constipation, diarrhea, dyspepsia, flatulence, increased saliva, taste loss/perversion, vomiting

Uncommon (0.1% to 1%): Abnormal bleeding (predominantly of the mucous membranes), dysphagia, eructation, esophagitis, gastrointestinal bleeding, gastritis, gastroenteritis, gingivitis, hemorrhoids, stomatitis, teeth grinding

Rare (less than 0.1%): Colitis, diverticulitis, duodenal ulcer, gastric ulcer, gastroesophageal reflux, gingival bleeding, glossitis, rectal hemorrhage

Frequency not reported: Gastrointestinal hemorrhage

Postmarketing reports: Pancreatitis

Very common (10% or more): Insomnia (up to 18.8%)

Common (1% to 10%): Abnormal dreams, aggravated depression, agitation, anxiety, apathy, confusion, depression, impaired concentration, nervousness, suicide attempt, sleep disorder

Uncommon (0.1% to 1%): Aggressive reaction, delusion, depersonalization, drug dependence, emotional lability, euphoria, hallucination, mania, panic reaction, paranoid reaction, paroniria, psychosis, psychotic depression

Rare (less than 0.1%): Catatonic reaction, melancholia, suicide-related events

Frequency not reported: Bruxism, restlessness, panic attack, suicidal ideation/behavior

Postmarketing reports: Delirium, withdrawal syndrome

Very common (10% or more): Asthenia (up to 11.5%)

Common (1% to 10%): Fatigue, fever/pyrexia, tinnitus, asthenia

Rare (less than 0.1%): Facial edema, malaise, rigors

Postmarketing reports: Spontaneous abortion

Very common (10% or more): Increased sweating (up to 11.3%)

Common (1% to 10%): Rash, pruritus

Uncommon (0.1% to 1%): Abnormal bleeding of the skin, acne, alopecia, dermatitis, dry skin, eczema, flushing, photosensitivity reaction, psoriasis, purpura, skin discoloration, urticaria

Rare (less than 0.1%): Decreased sweating, cellulitis, hypertrichosis, keratitis, melanosis, pruritus ani

Frequency not reported: Angioedema, ecchymosis

Postmarketing reports: Epidermal necrolysis, erythema multiforme

Urinary retention and galactorrhea have been reported with other SSRIs.

The estimates of the incidence of untoward sexual experience and performance may underestimate their actual incidence, partly because patients and physicians may be reluctant to discuss this issue. In placebo-controlled clinical trials, ejaculation disorder (primarily ejaculation delay) was reported as a treatment-emergent side effect at an incidence of 6% and at least twice the incidence in placebo-treated male patients.

Common (1% to 10%): Abnormal orgasm/anorgasmia (female), amenorrhea, decreased libido, dysmenorrhea, ejaculation disorders/ejaculation delay, impotence, menstrual disorders, polyuria, ejaculation failure, micturition disorders

Uncommon (0.1% to 1%): Breast enlargement, breast pain, dysuria, galactorrhea, increased libido, menorrhagia, micturition frequency, nonpuerperal lactation, vaginal bleeding, vaginal hemorrhage, urinary incontinence, urinary retention

Rare (less than 0.1%): Hematuria, oliguria

Frequency not reported: Metrorrhagia, priapism

Common (1% to 10%): Coughing, pharyngitis, rhinitis, sinusitis, upper respiratory tract infection, yawning

Uncommon (0.1% to 1%): Bronchitis, dyspnea, epistaxis, pneumonia

Rare (less than 0.1%): Asthma, bronchospasm, hiccups, increased sputum, laryngitis, pneumonitis, pulmonary embolism

Common (1% to 10%): Chest pain, hypotension, palpitations, postural hypotension, tachycardia

Uncommon (0.1% to 1%): Angina pectoris, atrial fibrillation, bradycardia, cardiac failure, edema (extremities), extrasystoles, hematomas, hot flushes, hypertension, myocardial infarction, myocardial ischemia

Rare (less than 0.1%): Bundle branch block, cardiac arrest, phlebitis, QT prolongation, torsades de pointes

Frequency not reported: Ventricular arrhythmia, orthostatic hypotension

Postmarketing reports: Thrombosis

This drug has been associated with a dose-related QT-interval prolongation; there have been reports of QT-interval prolongation and ventricular arrhythmia, including torsade de pointes, particularly in females, patients with hypokalemia, or with pre-existing QT-interval prolongation, or other cardiac disease.

Epidemiological studies, primarily in patients aged 50 years or older, have shown an increased risk of bone fractures in patients receiving SSRIs or TCAs.

Common (1% to 10%): Arthralgia, back pain, myalgia

Uncommon (0.1% to 1%): Arthritis, leg cramps, muscle weakness, skeletal pain

Rare (less than 0.1%): Bursitis, osteoporosis

Postmarketing reports: Rhabdomyolysis

Common (1% to 10%): Anorexia, decreased/increased weight, decreased/increased appetite

Uncommon (0.1% to 1%): Abnormal glucose tolerance, thirst

Rare (less than 0.1%): Alcohol intolerance, dehydration, hypokalemia, hyponatremia, hypoglycemia, obesity

Common (1% to 10%): Abnormal accommodation

Uncommon (0.1% to 1%): Abnormal vision, conjunctivitis, dry eyes, eye pain, mydriasis

Rare (less than 0.1%): Abnormal lacrimation, cataract, diplopia, photophobia, ptosis

Frequency not reported: Visual disturbance, acute narrow angle glaucoma

Postmarketing reports: Angle-closure glaucoma

Common (1% to 10%): Increased alkaline phosphatase

Uncommon (0.1% to 1%): Increased ALT, GGT, and AST

Rare (less than 0.1%): Bilirubinemia, cholelithiasis, cholecystitis, hepatitis, jaundice

Frequency not reported: Abnormal liver function test

Postmarketing reports: Cholestatic hepatitis, hepatic necrosis

Common (1% to 10%): Influenza-like symptoms

Rare (less than 0.1%): Hay fever

Uncommon (0.1% to 1%): Anemia, leukopenia, leukocytosis, lymphadenopathy

Rare (less than 0.1%): Coagulation disorder, granulocytopenia, hemorrhage, hypochromic anemia, lymphocytosis, lymphopenia

Frequency not reported: Thrombocytopenia

Postmarketing reports: Decreased prothrombin, hemolytic anemia

Rare (less than 0.1%): Goiter, hypothyroidism

Frequency not reported: Inappropriate ADH secretion

Postmarketing reports: Prolactinemia

Rare (less than 0.1%): Pyelonephritis, renal calculus, renal pain

Postmarketing reports: Acute renal failure

Frequency not reported: Anaphylactic reaction, hypersensitivity not otherwise specified

Postmarketing reports: Allergic reaction