Patient/caregiver was educated on precautions to be exercised while taking citalopram as follows:
- Serotonin is one chemical in the brain, which in permissible amounts, is believed to reduce anxiety and promote happiness and well-being. Very excessive concentrations of serotonin in the brain can lead to serotonin syndrome. Individuals with serotonin syndrome can present with mania, excitement, hallucinations, agitation, insomnia, pounding heartbeat, very rapid heart rate, overactive reflexes, and diarrhea. Citalopram use, especially along with other antidepressants acting on the same lines, such as, fluoxetine, paroxetine, and sertraline, can significantly increase the serotonin levels in the body and lead to development of serotonin syndrome. Citalopram use along with a few other antidepressants, such as, phenelzine, selegiline, and tranylcypromine can also significantly increase the serotonin levels in the body and lead to development of serotonin syndrome. Citalopram use is discouraged along with these medications. Caution must be exercised even when discontinuing on any of the above mentioned antidepressant medications with potential to increase serotonin levels and starting on citalopram, by observing a window period of atleast 2 weeks, before the transition to citalopram is made. This helps with complete elimination of these medications from the body, reduce the risk for interaction with citalopram, and reduce risk for development of serotonin syndrome.
- Citalopram use, especially on empty stomach, can result in common general constitutional symptoms such as, nausea and vomiting. Taking dose of citalopram with a glass of water, after having some food or a snack can help avoid having unpleasant gastrointestinal symptoms with the medication.
- Citalopram use can increase the activity of bowels and induce diarrhea. Proper hydration measures and compliance with daily fluid intake & rehydration measures recommended can help with relief from fluid and electrolyte loss secondary to diarrhea. Report to your physician regarding any uncontrolled, bothersome diarrhea, for any additional management measures to be considered.
