Celexa Makes Direct Online Debut - in the UK

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Citalopram is one of the common SSRIs is a selective serotonin reuptake inhibitor (SSRI) widely prescribed for depressive illness. It is sold as the brand Celexa and also in generic form; in the UK other trade names such as Cipramil may be used. Clinicians sometimes use citalopram for panic disorder and certain anxiety presentations when judged appropriate.

Macro view of facts:

• Active substance: citalopram hydrobromide.
• Main indication: major depressive disorder; occasional use in anxiety and panic disorder.
• Common UK tablet strengths: 10 mg, 20 mg and 40 mg. Typical adult maximum is 40 mg daily; older adults and those with cardiac risk factors are usually limited to 20 mg daily because of QT prolongation concerns.

Need fast navigation? Go straight to Techniques for Taking It or see Engagements and exchanges for medicines that affect citalopram.

Before you start anything

Tell the prescriber or pharmacist about any of the following so they can decide whether extra checks are needed or whether a different treatment would be safer:

• Existing heart problems, a history of long QT interval, or use of drugs known to affect heart rhythm.
• Past or present epilepsy or seizure disorder.
• Personal or family history of bipolar disorder, mania or hypomania.
• Impairment in kidney or liver function.
• The disease of impaired insulin action, diabetes, or changes in weight or appetite that concern you.
• Current or recent electroconvulsive therapy (ECT).
• Thoughts of self-harm or previous suicide attempts.
• Allergy to citalopram, escitalopram or any tablet ingredients.
• Pregnancy, plans for pregnancy, or breastfeeding.

If you are using herbal products or supplements such as Herb St Johns wort, or over-the-counter cold remedies, mention these during the consultation.

Citalopram helps with depressive symptoms intake guidelines

Take one dose each day, at about the same time, with a glass of water. Tablets can be taken with or without food. Always follow the instructions on your NHS or private prescription and any additional advice from your clinician. Avoid changing the dose or stopping suddenly without medical guidance; gradual dose reduction is commonly recommended to reduce withdrawal symptoms.

Clinical improvement may require several weeks of regular treatment. If you believe an deliberate overdose has occurred, contact NHS 111, your local emergency number or attend A and E right away.

The youth population and adolescents should only receive citalopram under specialist care. For guidance on fitness to drive and related safety matters see Usage monitoring, Precautionary steps and Driving.

What you should do after a i missed one dose

If you fail to remember a dose, take it as soon as you recall, unless the next dose is due within about four hours. If the next dose is near, skip the the medication dose was missed and continue the usual regimen. Do not double your dose to make up for a missed one.

Medicines and other substances that interact

Do not consolidate with

• Monoamine oxidase inhibitors (MAOIs) such as phenelzine, tranylcypromine and some formulations of selegiline; allow clinician-recommended washout intervals when switching.
• Pimozide as a neuroleptic drug or cisapride and older antipsychotics like thioridazine, which increase cardiac risk.
• Lexapro is the brand name for Escitalopram — do not take two competing SSRIs together.
• Hypericum perforatum and tryptophan supplements because they can raise serotonin and risk serotonin syndrome.
• Certain appetite suppressants previously used for weight loss, such as dexfenfluramine and sibutramine.

Use this with prudent care. or verify dose

• Other antidepressants along with many antipsychotics (for example chlorpromazine or prochlorperazine).
• Linezolid for treating serious infections or methylene blue delivered intravenously. due to MAOI-like effects.
• Triptans for migraine, such as sumatriptan and rizatriptan.
• Drugs that raise bleeding risk: warfarin, direct oral anticoagulants (DOACs) and low molecular weight heparins.
• NSAIDs and aspirin-containing products.
• Anticonvulsants such as carbamazepine that can change citalopram levels.
• Drugs that alter metabolism such as cimetidine or strong CYP inhibitors which may increase citalopram exposure.
• Certain antiretrovirals and stimulant medicines including amphetamine.

The list is incomplete and may grow. Provide your clinician with a full list of prescription medicines, over-the-counter products, herbal remedies, alcohol use, nicotine and recreational drugs so the study maps how a reciprocal exchanges evolve over time. can be checked.

Vigilant monitoring, risk mitigation measures and driving

• Attend follow-up appointments so your prescriber can assess response and unintended effects. Mood may worsen in the first few weeks or after dose changes; contact your clinician promptly if this happens or if new thoughts of self-harm appear.
• When stopping treatment a gradual taper is usually safer to limit withdrawal effects; follow the schedule your prescriber provides.
• Citalopram is a prescription antidepressant can cause drowsiness, dizziness or slower reactions. Do not drive or operate heavy machinery if your ability to do so is impaired. In the UK driving while impaired by medication is an offense.
• Limit alcohol during treatment as it can increase sedation and possibly worsen depression or anxiety.
• If you have cardiac risk factors your clinician may consider baseline ECG monitoring and logging because higher doses can prolong the QT interval.
• Simple measures such as chewing sugar-free gum or sipping water can help relieve dry mouth.

Adverse events and when to seek medical attention

Emergency signs - seek urgent help

• Allergic reactions: widespread rash, itching, hives, or swelling of the face, lips or throat.
• Symptoms of serotonin syndrome: marked agitation, confusion, high temperature, heavy sweating, rapid heartbeat or muscle stiffness.
• Paroxysmal seizure events or unexplained collapse.
• Severe dizziness, fainting or change in consciousness.
• New psychotic symptoms such as hallucinations or loss of reality contact.
• Bleeding without a known cause or bruising that occurs easily that may signal a problem.
• New or increasing suicidal ideation or significant behavioral changes.

Routine effects that often settle

• Headache syndrome or mild dizziness.
• Nausea, altered appetite or weight change.
• Sweat levels are elevated.
• Vision is foggy.
• Fragmented sleep patterns including insomnia or vivid dreams.
• Sexual follow-on effects such as reduced libido or changes in performance.

If you suspect an adverse reaction you can report it using the MHRA Yellow Card scheme. Details can be found here Status of Legality and Buying Online next section.

Secure handling, securing storage ensures that valuables stay safe. and disposal activity

• Store drugs where children cannot see them or get to them.
• Store at typical room temperature, for example 15 to 30 C (59 to 86 F), away from direct heat and moisture.
• Do not use tablets after the printed expiry date. Return unwanted or expired medicines to a pharmacy for safe disposal; do not put them in household waste or down the sink.

Choice alternate options with a rough UK consumer cost and price manual

If citalopram is unsuitable or ineffective, prescribers may suggest another option antidepressants. Choice depends on the condition, side-effect profile and other medical issues.

• Other SSRIs: sertraline, fluoxetine, paroxetine and escitalopram.
• SNRIs: venlafaxine and duloxetine.
• Remeron is mirtazapine, which may be preferred if sleep or appetite improvement is desired.
• Two commonly used tricyclic antidepressants are amitriptyline and nortriptyline., sometimes used in low doses for pain or insomnia.
• Newer or specialist options: vortioxetine and agomelatine (often initiated by specialist mental health services).

Estimated private medicine-only price tiers in the UK for about a 28 to 30 day supply (GBP):

• Generic citalopram 20 mg: around 2 to 10 GBP.
• Sertraline dosage or generic fluoxetine: roughly 2 to 12 GBP.
• Generic escitalopram: about 3 to 15 GBP; branded versions are higher.
• Venlafaxine generics: approximately 4 to 18 GBP; extended-release forms may cost more.
• Mirtazapine oral medication generic: typically 3 to 12 GBP.

On the NHS many prescriptions in England attract a fixed charge per item; check current NHS guidance for the exact fee. Prescriptions cost nothing in Scotland, Wales and Northern Ireland. Prices vary by strength, brand versus generic and pharmacy, so confirm costs with your dispensing pharmacy.

The legal position in the UK and buying advice

• Prescription status: citalopram is a Prescription Only Medicine (POM) and must be supplied with a valid prescription from an authorised prescriber.
• Buying online: use UK-registered pharmacies that display their General Pharmaceutical Council registration with the addition of the approved distance-selling logo. Avoid unlicensed overseas suppliers and websites that do not require a prescription.
• NHS prescription charges: adults in England usually pay a fixed charge per item. Check NHS sources for up-to-date charges and information on exemptions and prepayment certificates.
• Driving and safety: do not drive if the medication affects your ability to do so. Please consult a professional DVLA guidance for complex or long-term conditions.
• The phase of pregnancy and lactation: discuss risks and benefits with your clinician; do not stop medication without medical advice.
• Reporting unfavorable effects: suspected postmarketing effects can be reported to the MHRA Yellow Card scheme online or via the Yellow Card app; pharmacists can also advise on reporting.
• Disposal: return unused or out-of-date medicines to a pharmacy for safe disposal.

For quick navigation within this page return to the High level briefing or see Interactions across networks and Substances for a medicines check.