Celexa: 7 things you should know

Medically reviewed by Carmen Pope, BPharm. Last updated on July 5, 2023.

1. How it works

• Celexa is a brand (trade) name for citalopram which may be used to treat depression and other mood disorders.
• Experts believe Celexa (citalopram) works by rebalancing chemicals in the brain, such as serotonin, that are imbalanced in people with anxiety, depression, and other disorders. Its activity against other neurotransmitters is much less potent than other antidepressants.
• Celexa belongs to a group of medicines called Selective Serotonin Reuptake Inhibitors (SSRIs). SSRIs are thought to work by preventing the reuptake of serotonin by nerves, leading to an increase in serotonin concentrations within the nerve synapse (space between two nerves).

2. Upsides

• May be used in the treatment of moderate-to-severe depression (Major Depressive Disorder).
• Less likely to cause drowsiness than some other antidepressants.
• Has also been used off-label for other conditions such as anxiety, alcoholism, eating disorders, fibromyalgia, and obsessive-compulsive disorder.
• SSRIs in general, are better tolerated than many other medicines used in the treatment of depression.
• Celexa is less likely than some other SSRIs to interact with other medications.
• SSRIs in general, are better tolerated than many other medicines used in the treatment of depression.
• Administer at a starting dose of 20 mg/day. This may be increased to the maximum dose of 40 mg/day after at least one week.
• No dosage adjustment is necessary for people with mild to moderate kidney disease. Use with caution in severe kidney disease.
• May be administered with or without food.
• Administered once daily, either in the morning or evening.
• Celexa is available as a generic under the name citalopram.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

• Insomnia, dry mouth, drowsiness, nausea, increased sweating, and sexual dysfunction. Side effects may be more likely with Celexa (citalopram) compared to escitalopram, another SSRI.
• May increase the risk of suicidal thoughts or behavior in young adults (similar to other antidepressants).
• Interaction or overdosage may cause serotonin syndrome (symptoms include agitation, hallucinations, fast heart rate, dizziness, muscle tremor, nausea, vomiting, and diarrhea).
• May cause a discontinuation syndrome if abruptly stopped or interrupted (symptoms include nausea, vomiting, diarrhea, headaches, sweating, tremors, vivid dreams, and insomnia)
• May affect the heart and heart rhythm (for example, prolong the QT interval); more likely at dosages greater than 40mg/day.
• May not be suitable for people with preexisting cardiac disease or abnormalities or with low potassium or low magnesium levels.
• May also precipitate seizures or glaucoma in susceptible people; decrease sodium levels in the blood and affect a person's ability to concentrate or perform hazardous tasks. Avoid alcohol while taking Celexa.
• May precipitate a manic or mixed episode in people with bipolar disorder.
• May impair your judgment and affect your ability to drive or operate machinery. Alcohol should be avoided.
• May increase the risk of bleeding, especially if used with other drugs that also increase bleeding risk.
• May cause a lowering of total body sodium (called hyponatremia); elderly people or people taking diuretics or already dehydrated may be more at risk.
• May interact with several other drugs including those metabolized by hepatic enzymes CYP 3A4 and 2C19, other antidepressants, and medicines that also cause serotonin release (such as tramadol, St John's wort, and opioids).
• May cause prolongation of the QT interval especially when used in conjunction with other QT-prolonging medications. Due to the risk of QT prolongation, the maximum recommended dose is 40 mg/day. 20 mg/day is the maximum recommended dosage for seniors older than 60 years, people with liver disease, or CYP2C19 poor metabolizers, or those taking cimetidine, omeprazole, or another CYP2C19 inhibitor.
• Rarely causes seizures.
• Complications, such as prolonged hospitalization, respiratory support, and tube feeding, have been reported in neonates exposed to Celexa during the third trimester of pregnancy. Weigh up the potential benefits versus the risks in women exposed to Celexa during the third trimester. Celexa is excreted into breastmilk and there have been reports of drowsiness, decreased feeding, and weight loss reported in the breastfeeding infant.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

4. Bottom Line

Celexa is an effective antidepressant but it may cause more side effects than other SSRIs, such as escitalopram. 20 mg/day is the maximum recommended dosage for seniors older than 60 years, people with liver disease, or CYP2C19 poor metabolizers, or those taking cimetidine, omeprazole, or another CYP2C19 inhibitor. Be cautious when using during the third trimester of pregnancy.

5. Tips

• May be taken with or without food.
• Blood tests may need to be taken before treatment to check electrolyte levels (for example potassium and magnesium) and these should be corrected before treatment begins.
• Dosages of more than 40mg/day are not recommended.
• Report to your doctor any signs of worsening depression or suicidal thoughts particularly during the first few months of therapy.
• Do not stop suddenly as withdrawal symptoms may occur; taper off slowly under medical supervision.
• May affect your ability to drive and operate machinery. Be cautious in performing hazardous tasks until the full effects of the drug are known.
• Report any incidences of abnormal bleeding, eye pain or vision problems, or any signs of low sodium levels such as a headache, weakness, or confusion.
• Report any problems with bleeding or bruising to your doctor, also report any unexplained skin changes (such as blisters or rashes), problems with urination, eye pain, swelling, or vision changes to your doctor.
• Seek urgent medical advice if symptoms consistent with serotonin syndrome (such as agitation, hallucinations, fast heart rate, dizziness, flushing, nausea, and diarrhea) develop.
• Tell your doctor if you are pregnant or you become pregnant while taking Celexa. Complications, such as prolonged hospitalization, respiratory support, and tube feeding, have been reported in neonates exposed to Celexa during the third trimester of pregnancy. Celexa is also excreted into breastmilk and there have been reports of drowsiness, decreased feeding, and weight loss in the breastfeeding infant.

6. Response and effectiveness

• Peak effects occur within 4 hours; however, it may take up to 4-6 weeks of regular dosing to achieve the maximal antidepressant effect.
• Side effects and therapeutic effects may be more pronounced with age. The maximum recommended dosage is 20 mg/day in people aged over 60 years.
• Escitalopram was developed to improve tolerability to Celexa.

7. Interactions

Medicines that interact with Celexa may either decrease its effect, affect how long it works, increase side effects, or have less of an effect when taken with Celexa. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with Celexa include:

• anticoagulants (blood thinners), such as warfarin, or other drugs that have blood-thinning effects such as aspirin or NSAIDs
• anticonvulsants, such as phenytoin, phenobarbital, or primidone
• antipsychotics (such as butyrophenones, phenothiazines, or thioxanthenes) and atypical antipsychotics (eg, olanzapine, quetiapine, ziprasidone)
• any medication that may cause drowsiness, such as benzodiazepines (eg, diazepam, lorazepam), first-generation antihistamines (such as doxylamine or promethazine), metoclopramide, or opioids (such as codeine, morphine)
• bupropion
• cimetidine
• lithium
• medications that may affect the heartbeat by prolonging the QT interval, such as amiodarone, encainide, or flecainide
• pimozide
• other antidepressants, such as tricyclic antidepressants (eg, amitriptyline), monoamine oxidase inhibitors (eg, isocarboxazid, phenelzine, and tranylcypromine), and SSRIs (eg, paroxetine, sertraline)
• other medications that affect serotonin, such as amphetamines, fentanyl, lithium, tramadol, triptans (eg, almotriptan, eletriptan, or sumatriptan), or St. John's Wort
• other medications that are metabolized by the same enzymes (CYP2C19 or CYP3A4)
• others, such as HIV medications (fosamprenavir, ritonavir)
• voriconazole.

Avoid drinking alcohol or taking illegal or recreational drugs while taking Celexa.

Note that this list is not all-inclusive and includes only common medications that may interact with Celexa. You should refer to the prescribing information for Celexa for a complete list of interactions.

References

• Celexa (citalopram) [Package Insert]. Revised: 02/2022. Allergan USA, Inc. https://www.drugs.com/pro/celexa.html

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Celexa only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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