Summary
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. Continue reading for a comprehensive list of adverse effects.
Applies to citalopram: oral solution, oral tablets.
Warning
-
Suicidality
- Antidepressants increased risk of suicidal thinking and behavior (suicidality) compared with placebo in children, adolescents, and young adults (18–24 years of age) with major depressive disorder and other psychiatric disorders; balance this risk with clinical need.370 371 399 Citalopram is not approved for use in pediatric patients.399 (See Pediatric Use under Cautions.)
- In pooled data analyses, risk of suicidality was not increased in adults >24 years of age and was reduced in adults ≥65 years of age with antidepressants compared with placebo.370 371 399
- Depression and certain other psychiatric disorders are themselves associated with an increased risk of suicide.370 371 376 399
- Appropriately monitor and closely observe all patients who are started on citalopram therapy for clinical worsening, suicidality, or unusual changes in behavior; involve family members and/or caregivers in this process.370 371 376 399 (See Worsening of Depression and Suicidality Risk under Cautions.)
Side effects include:
Nausea, dry mouth, insomnia, sweating, sexual dysfunction (ejaculatory disorder, impotence, decreased libido), tremor, diarrhea, somnolence, dyspepsia, fatigue, upper respiratory tract infection, rhinitis.
For Healthcare Professionals
Applies to citalopram: oral capsule, oral solution, oral tablet.
General
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.[Ref]
Nervous system
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[Ref]
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.[Ref]
Gastrointestinal
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[Ref]
Psychiatric
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[Ref]
Other
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[Ref]
Dermatologic
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[Ref]
Genitourinary
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[Ref]
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.[Ref]
Respiratory
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[Ref]
Cardiovascular
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[Ref]
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.[Ref]
Musculoskeletal
Epidemiological studies, primarily in patients aged 50 years or older, have shown an increased risk of bone fractures in patients receiving SSRIs or TCAs.[Ref]
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[Ref]
Metabolic
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[Ref]
Ocular
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[Ref]
Hepatic
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[Ref]
Immunologic
Common (1% to 10%): Influenza-like symptoms
Rare (less than 0.1%): Hay fever[Ref]
Hematologic
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[Ref]
Endocrine
Rare (less than 0.1%): Goiter, hypothyroidism
Frequency not reported: Inappropriate ADH secretion
Postmarketing reports: Prolactinemia[Ref]
Renal
Rare (less than 0.1%): Pyelonephritis, renal calculus, renal pain
Postmarketing reports: Acute renal failure[Ref]
Hypersensitivity
Frequency not reported: Anaphylactic reaction, hypersensitivity not otherwise specified
Postmarketing reports: Allergic reaction[Ref]
