Side Effects of Using Citalopram

Patient/caregiver was educated on side effects of using Citalopram as below:

1. General allergic reactions: Citalopram use can result in general allergic reactions, such as, skin rashes, hives, and itching. Some patients can present with symptoms of severe allergic and anaphylactic response with citalopram, such as, difficulty breathing, swelling of face, lips, throat, and tongue, with consequent difficulty breathing. Seek emergency medical help for such findings, especially with difficulty breathing, for any appropriate measures to be considered.
2. Bleeding episodes: Citalopram intake can thin the blood and increase risk for bleeding in the skin and mucus membranes. Patients can present with bleeding spots on the skin, internal abdominal bleeding with fresh blood or partially digested blood in the stool, and bleeding in the urine staining the urine brownish red. While taking citalopram, keep a close watch on the stool and urine color for any red discoloration, indicating fresh bleeds. Report to your physician regarding any bleeding spots in the skin, episodes of fresh bleed with the stool and urine, after starting to take citalopram. Partially digested blood can stain the stool black and tarry, which also must be reported to the physician.
3. Cardiovascular side effects: Citalopram carries the risk of lowering the blood pressure. Hypotension, secondary to citalopram intake, can lead to episodes of confusion and dizziness, thus increasing the risk for fall and accidents. Citalopram also carries the risk of causing and/or aggravating cardiac arrhythmias. Individuals with cardiac arrhythmias can present with episodes of chest pain, rapid heart rate, palpitations, dizziness, and shortness of breath, and can lead to severe debility and death.
4. Central nervous system side effects: Citalopram can induce some dizziness and make one drowsy. Starting the medication at a low dose, watching for the response, and gradually changing the dose, to help optimum control of your symptoms, can contribute to controlling/reducing the risk for drowsiness and dizziness due to the medication. If the dizziness becomes bothersome, report it to your physician and other health care personnel, for any change in plan of care to be considered. Stay away from activities, such as, driving and operating heavy machinery, until you are used to the side effects caused by citalopram intake. Also, avoid taking citalopram together with any other medications you may have on your list that also carry potential to cause dizziness, as both the medications could complement each other on causing dizziness, posing a severe threat. Observing a 1 -2 hour interval between taking such medications can help prevent episodes of dizziness and risk. Citalopram use can also result in sleep disturbance with poor quality sleep, hallucinations, and compromised memory. If the sleep disturbance becomes bothersome, report it to your physician for any appropriate recommendation. Observing discipline with sleep time and compliance with recommended exercise schedule can help promote sleep. Avoiding stimuli, such as computer, radio, and television an hour before bedtime can help prevent disturbance and train the sleep pattern. Avoid drinking excessive caffeinated drinks and alcoholic beverages, as they contribute heavily to insomnia and sleep disturbance. Citalopram use carries risk of deterioration of mood disorders and worsening of clinical symptoms of mood disorders. Individuals can present with complaints such as, feeling low, anxiety, panic attacks, trouble sleeping, gross appetite changes, impulsiveness, agitation, aggression, and suicidal thoughts. Report to your physician regarding these complaints promptly, for any change in plan of care to be considered. Continue taking citalopram, as recommended, even if your mood feels better. Discontinuing the medication abruptly, without your physician’s recommendation, can result in disruption of chemical balance in the brain, resulting in worsening of mood disorder.  Individuals can present with severe withdrawal symptoms, such as, listlessness, lack of energy, exacerbation of depressive symptoms, anxiety, sleep disturbances, appetite changes, hallucinations, and mania. Discontinuing the medication should be only upon recommendation by your physician.
5. Other constitutional side-effects: Individuals taking citalopram can also present with sexual dysfunctions, such as, compromised interest in sex, difficulty attaining and maintaining erection, and/or difficulty having an orgasm.
6. Gastrointestinal side-effects: Citalopram use can result in common general constitutional symptoms such as, nausea and vomiting, especially when taken on empty stomach. Taking dose of citalopram with a glass of water, and some food or 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. Citalopram use can also induce extreme dry mouth and constipation. Sucking on a sugar free hard candy can help with symptomatic relief of dry mouth. Compliance with daily fluid intake recommendations and hydration measures can help with relief from constipation. Observing compliance with fiber intake recommendations in the diet can also help with preventing constipation with citalopram. If you experience any further bothersome constipation, report it to your physician for a recommendation on laxative/stool softener use.
7. Musculoskeletal side-effects: Citalopram intake carries the risk of causing seizures, especially in individuals with history of seizures. Individuals can present with sudden episodes of loss of consciousness, intense convulsions with muscle contractions, bowel and bladder incontinence. Do not ignore seizure episodes and report them to your physician promptly for any appropriate measures to be considered. Citalopram intake can also induce a life-threatening reaction called Neuroleptic Malignant Syndrome (NMS). Individuals with NMS can present with high fever, episodes of confusion, intense muscle rigidity and contractions, elevated blood pressure, and rapid heart rate. Potassium ion usually is maintained within close limits in the blood and body fluids and any sudden increase or decrease in blood potassium levels can lead to severe cardiac arrhythmias. Uncontrolled seizure activity and intense muscle contractions from citalopram use can lead to muscle damage and breakdown. Potassium ion from within the damaged muscle cells can leak out into the blood and body fluids, thus causing an acute increase in blood potassium levels. This acute elevation of potassium levels in the blood from citalopram use can lead to life-threatening cardiac arrhythmias. Individuals can present with episodes of chest pain, intense shortness of breath, altered heartbeat, ineffective heart contractions, dizziness/loss of consciousness from arrhythmias. Report them to your physician promptly for any appropriate measures to be considered.
8. Genitourinary side-effects: Citalopram can also induce frequency of urination or polyuria. Individuals with history of poorly controlled diabetes, frequent urinary tract infections, and intake of diuretics can also present with frequent urination. Such individuals taking citalopram, must be aware of this side-effect, as citalopram can aggravate the discomfort of polyuria significantly. Severely increased frequency of urination can contribute to loss of body fluid and dehydration. Dehydrated individuals can present with low blood pressure, episodes of confusion, increased risk for falls & accidents, and increased risk for urinary tract infections. Observing compliance with timed voiding recommendations and other hygienic practices can help reduce the discomfort of polyuria. Compliance with daily fluid intake recommendations and rehydration measures can help with preventing dehydration and development of any UTIs.
9. Serotonin syndrome: 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 a few other antidepressants, such as, imipramine, fluoxetine, and sertraline, can significantly increase the serotonin levels in the body and lead to development of serotonin syndrome. Report symptoms of serotonin syndrome to your physician promptly for any appropriate measures to be considered.
10. Vision changes: Citalopram use can result in pupillary dilation and obstruction to the drainage of fluid (aqueous humor) inside the eye. This blockage of fluid in the eye can result in increase in the intraocular pressure, leading to glaucoma. Individuals with glaucoma can present with eye pain, headache, and blurred vision with haloes around light.

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