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Precautions
Antidepressants increased the risk compared to placebo of suicidal thinking and behavior in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of Celexa or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicide with antidepressants compared to placebo in adults beyond age of 24.

People with major depressive disorder may experience worsening of their depression and the possibility of the emergence of suicidal idealization and worsening behavior. All patients being treated with antidepressants for any indication ought to be monitored appropriately and observed closely for worsening behavior that might lead to suicide. The following symptoms have been observed in patients being treated with antidepressants: anxiety, agitation, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (pysychomotor restlessness), hypomania, and mania.

There  are a few symptoms when discontinuing Celexa and other SSRIs and SNRIs that have been reported by patients in the past.This is why it is important that patients  be monitored when discontinuing treatment The potential adverse events upon discontinuing this drug include: dysphoric mood, irritability, agitation, vertigo, dizziness, problems with senses, anxiety, confusion, headache, lethargy, emotional liability, insomnia and hypomania. In addition SSRI and SNRIs use, including Celexa, may increase the risk of bleeding.

 

Concomitant use of aspirin, non-steroidal anti-inflammatory drugs, warafin, and other anticoagulants may be risky, speak to your doctor before using medication simultaneously. There have been reports of certain drugs that interfere with serotonin reuptake and the occurrence of gastrointestinal bleeding. Patients should use caution with the concomitant use of Celexa and NSAIDs, aspirin, or other drugs that affect coagulation. Hyponatremia may occur as a result of treatment with SSRIS and SNRIs including Celexa. Cases with serum sodium lower than 100 mmol/L have been reported. Signs and symptoms of hyponatremia include: headache, difficulty concentrating, memory impairment, confusion weakness, unsteadiness, etc.

Celexa has not been studied in patients with seizures; extreme caution should be used in these cases. Caution is advisable in patients with diseases or conditions that produce altered metabolism or hemodynamic responses. Celexa has not been studied in patients with a history of myocardial infarction or unstable heart disease. There is a risk of impairment of fertility in males. Safety and effectiveness is pediatric population has not been established. When treating pregnant women with Celexa during the third trimester, the physician should carefully consider the potential risks and benefits of treatment.

Drug Interactions
All SSRIs, including citalopram, should not be taken with any of the mono-amine oxidase (MAO) inhibitor-class of antidepressants, for example, isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), selegiline (Eldepryl), and procarbazine (Matulane). Such combinations may lead to confusion, high blood pressure, tremor, and hyperactivity. If treatment is to be changed from citalopram to an MAOI or vice-versa, there should be a 14 day period without either drug before the alternative drug is started. Tryptophan, a common dietary supplement, can cause headaches, nausea, sweating, and dizziness when taken with any SSRI. Use of an SSRI with aspirin, non-steroidal anti-inflammatory drugs or other drugs that affect bleeding may increase the likelihood of upper gastrointestinal bleeding.

There may be an interaction between citalopram and any of the following: alcohol, anticoagulants (e.g.,warfarin),anti-HIV medications (e.g., indinavir, lopinavir, ritonavir), antiplatelets (e.g., acetylsalicylic acid (ASA), clopidogrel), atypical antipsychotic medications (e.g., risperidone, ziprasidone),"azole" antifungals (e.g., fluconazole, itraconazole,ketoconazole), beta-blockers (e.g., propranolol, metoprolol), bromocriptine), carbamazepine, cimetidine, ciprofloxacin, clozapine, desipramine, dextromethorphan, imipramine, isoniazid,  linezolid, lithium,  l-tryptophan,  macrolide antibiotics (e.g., clarithromycin, erythromycin),MAO inhibitors (e.g., selegiline, phenelzine, tranylcypromine),  metoclopramide), NSAIDs (e.g., ibuprofen, indomethacin),  omeprazole, opioid pain relievers (i.e., fentanyl, morphine, pentazocine), other SSRIs (e.g., fluoxetine, sertraline), SNRIs (e.g., venlafaxine, duloxetine), phenytoin, pimozide, quinine, selegiline,  sibutramine, St. John's wort, tramadol, trazodone,  triptans (e.g., sumatriptan).

Consult a doctor before taking any other medication.

Adverse effects/side effects
Tell your doctor if you experience side effects that are severe and bothersome, which might include: abdominal pain, agitation, anxiety, diarrhea, dizziness, drowsiness, dry mouth, fatigue, fever, heartburn, increased sweating, increased yawning, loss of appetite, nausea, painful periods, sexual difficulties, shakiness, sore throat, stuffy or runny nose, trouble sleeping, vomiting.

Check with your doctor as if any of the following more serious side effects occur:
Behavior similar to drunkenness, bleeding gums, blurred vision, confusion, dizziness or fainting, increase in frequency of urination or amount of urine produced, or trouble holding or releasing urine, irregular heartbeat, lack of emotion, loss of memory, menstrual changes, mood or mental changes, nervousness, nosebleed, purple or red spots on skin, severe agitation, severe migraine, skin rash or itching, slow or irregular heartbeat (less than 50 beats per minute), sore throat, fever, and chills, trouble breathing, unusual or sudden body or facial movements or postures

Stop taking the medication and seek immediate medical attention if any of the following occur: chest pain, seizure or convulsions, serotonin syndrome (signs include agitation, confusion, diarrhea, fever, overactive reflexes, poor coordination, restlessness, shivering, sweating, talking or acting with excitement you cannot control, trembling or shaking, twitching), thoughts of suicide or hurting yourself.

Overdose
Symptoms of overdose include nausea, vomiting, tremor, sweating, rapid heartbeat, confusion, dizziness, seizures, and coma. In case of overdose contact you local emergency room or poison control.

Storage Instructions
Store at room temperature at 77 degrees F (25 degrees C) away from light and moisture. Brief storage between 59-86 degrees F (15-30 degrees C) is permitted. Do not store in the bathroom. Keep all medicines away from children and pets.
 

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