Citalopram
In stock
20mg · 10mg
from 33,06 £
In brief
Citalopram increases serotonin availability by reducing its reuptake into nerve cells. This SSRI is used for depression and panic disorder, with symptom improvement generally developing over time.
Basic information about citalopram
| International name | Citalopram (INN) |
|---|---|
| UK brand names | Cipramil, generic Citalopram (various manufacturers) |
| ATC code | N06AB04 |
| Available forms | 10/20/40 mg film-coated tablets, oral drops (40 mg/mL) |
| UK manufacturers | Teva, Sandoz, Zentiva, Accord Healthcare |
| Prescription status | Rx-only (not available OTC) |
Citalopram belongs to the SSRI class of antidepressants and has been prescribed in the UK since the early 1990s. Available under brand names like Cipramil or as generic versions, all formulations require prescription through NHS or private healthcare providers. The medicine comes primarily in tablet form. Though less common, oral drop formulations exist for patients needing dosage flexibility or with swallowing difficulties.
How citalopram works in your body
Citalopram increases serotonin levels by blocking its reabsorption in brain synapses. This neurotransmitter influences mood regulation, sleep patterns, and emotional processing. After swallowing, citalopram takes approximately 4 hours to reach peak concentration and may require 1-4 weeks to show noticeable mood improvements. The body processes it through liver enzymes (CYP3A4 and CYP2C19) before elimination, with an elimination half-life of about 1.5 days (around 36 hours), which allows once-daily dosing. Unlike some older antidepressants, citalopram has minimal impact on other neurotransmitters like dopamine or noradrenaline.
Important interactions requiring professional consultation:
- Monoamine oxidase inhibitors (MAOIs) – potentially fatal serotonin syndrome risk
- Blood thinners like warfarin – increased bleeding risk
- Alcohol – heightened sedation and impaired coordination
- Antiarrhythmic drugs – possible QT interval prolongation
Uses of citalopram
| Condition | UK status | Typical dosage range |
|---|---|---|
| Major depressive disorder (MDD) | Licensed in the UK | 20-40mg daily |
| Panic disorder | Licensed in the UK | 10-40mg daily |
| Obsessive-compulsive disorder (OCD) | Off-label | 20-40mg daily |
| Social phobia | Off-label | 20-40mg daily |
| PTSD | Off-label | 20-40mg daily |
NICE guidelines recommend citalopram as a treatment option for moderate-to-severe depression, often combined with talking therapies. Emerging evidence suggests potential benefits for certain anxiety conditions when first-line treatments prove ineffective. However, specialists exercise caution in prescribing for adolescents under 18 due to heightened suicide risk concerns. Pregnancy requires rigorous risk-benefit evaluation given possible neonatal complications, particularly in third-trimester use. Those with bipolar depression require careful mood monitoring due to potential manic episode triggers.
Recommended dosage guidelines
| Patient group | Starting dose | Maximum dose | Special considerations |
|---|---|---|---|
| Adults (MDD treatment) | 20mg daily | 40mg daily | Increase gradually if needed |
| Elderly (65+) | 10mg daily | 20mg daily | Enhanced heart rhythm monitoring |
| Liver impairment | 10mg daily | 20mg daily | Maximum 20mg regardless of severity |
| Severe kidney disease | 10mg daily | 20mg daily | Limited evidence – monitor closely |
Treatment duration varies significantly – depression cases typically require maintaining medication for 6 months after symptom remission. Sudden discontinuation often triggers withdrawal symptoms like dizziness or electric shock sensations. Specialist guidance recommends gradual tapering protocols over several weeks when stopping treatment. Dosage frequency remains straightforward: most patients take their full dose once daily regardless of meal timing. Consistency matters – bloodstream concentrations remain steadiest when doses occur at approximately 24-hour intervals.
Taking and storing citalopram properly
Administer citalopram orally with water – splitting or crushing tablets isn’t recommended unless directly advised by your GP. Develop medication-taking routines like pairing doses with morning tea or bedtime routines. If you forget a dose:
- Take immediately upon remembering
- If nearing next scheduled dose, skip the missed dose
- Never compensate with double dosing
Proper storage preserves stability:
– Keep tablets in original blister packaging
– Store below 25°C away from moisture
– Avoid bathroom medicine cabinets due to humidity
– Keep tablets in original blister packaging
– Store below 25°C away from moisture
– Avoid bathroom medicine cabinets due to humidity
Overdose symptoms include severe dizziness, tremors, rapid heart rate and disorientation. Immediate medical attention proves crucial – call 999 or go to A&E (or contact NHS 111 for advice) if ingestion exceeds prescribed amounts. Bring medication packaging to help clinicians assess toxicity levels.
Important precautions and restrictions
Absolute contraindications:
– Allergy to citalopram or SSRI antidepressants
– Current MAOI treatment (including linezolid antibiotic)
– Congenital long QT syndrome confirmed diagnosis
– Allergy to citalopram or SSRI antidepressants
– Current MAOI treatment (including linezolid antibiotic)
– Congenital long QT syndrome confirmed diagnosis
High-risk situations requiring thorough assessment:
– Personal/family history of bipolar disorder
– Poorly controlled epilepsy
– Recent myocardial infarction
– Severe electrolyte imbalances
– Personal/family history of bipolar disorder
– Poorly controlled epilepsy
– Recent myocardial infarction
– Severe electrolyte imbalances
An ECG may be advised for patients with heart disease or other risk factors due to QT-prolongation risks. Those considering pregnancy should consult specialists about potential fetal impacts. Young adults under 25 warrant particular mood monitoring during early treatment phases due to heightened suicide risk concerns. Report immediately any new or worsening depression symptoms to healthcare providers.
Side effects profile
Citalopram often causes manageable side effects that typically lessen after the first few weeks. Common reactions include nausea (especially when starting), dry mouth, excessive sweating, and sleep disturbances – either drowsiness or insomnia. Headaches and digestive discomfort like diarrhoea also frequently occur during initial treatment phases.
Less common but serious risks require urgent medical attention:
- Serotonin syndrome: Potentially life-threatening reaction causing agitation, fever and rapid heart rate
- Heart rhythm changes: dose-dependent QT prolongation, particularly at higher doses
- Worsening depression: Includes increased suicidal thoughts, especially in under-25s
Long-term users may experience weight fluctuations or sexual side effects like reduced libido. These antidepressant-related issues often require tailored solutions like timing adjustments or adjunct treatments.
To minimise reactions:
- Start with the dose prescribed by your doctor and increase gradually only if advised
- Take tablets with food to reduce nausea
- Report persistent or concerning effects to your GP immediately
Night-time dosing can help manage fatigue symptoms for many. Risk of serotonin syndrome escalates with certain drug combinations including tramadol or migraine medications.
Alternatives in the UK
Other options exist when citalopram proves unsuitable. Alternatives that may be considered include:
| Medication type | Benefits for UK patients | Key differences |
|---|---|---|
| Sertraline (SSRI) | First-line choice for anxiety with depression | Lower cardiac risk profile than citalopram |
| Escitalopram (SSRI) | Licensed for depression and several anxiety disorders | Active enantiomer of citalopram |
| Venlafaxine (SNRI) | Effective for treatment-resistant cases | Requires more monitoring; challenging discontinuation |
| Mirtazapine | Helps depression with insomnia or weight loss | Sedating; different side effect profile |
Talking therapies (NHS Talking Therapies, formerly IAPT) and lifestyle changes remain cornerstone options. Medication selection depends on individual symptoms and health factors.
Frequently asked questions about citalopram
Patients often share concerns about citalopram medication interactions and practical usage.
Alcohol consumption: Avoid alcohol while taking citalopram. Combining them can intensify drowsiness and impair cognitive function.
MAOI interactions: Never combine with MAOIs due to high risk of serotonin syndrome. Allow at least two weeks between stopping MAOIs and starting citalopram.
Weight management: Maintain regular exercise and monitor meals. If experiencing noticeable weight gain, discuss alternative SSRIs like sertraline.
Herbal supplements: Herbal supplements like St John’s wort may reduce citalopram effectiveness. Always declare supplement use to medical professionals.
Guidelines for proper citalopram use
Safety and efficacy require strict adherence to these protocols.
Correct administration:
Take dosage at consistent times daily. Swallow tablets whole with water.
Critical avoidances:
- Alcohol
- Unauthorised supplements
- Sudden discontinuation
Essential storage measures:
Use childproof containers in cool, dark locations below 25°C. Keep away from humidity.
Medication management:
Try not to skip doses. If you forget a dose, take it when you remember unless it is nearly time for the next one; never take a double dose.
Regulatory protocols:
Review information leaflets before starting treatment. Report side effects through MHRA Yellow Card Scheme. Combine pharmaceutical treatment with psychological therapy according to NICE depression treatment guidelines.
Consistent engagement with pharmacists enhances care coordination.
