Buy Celexa Online

What is Celexa?

Celexa (citalopram) is an antidepressant in a group of drugs called selective serotonin reuptake inhibitors (SSRIs).

Celexa is used to treat depression.

Celexa may also be used for purposes not listed in this medication guide.

Important information about Celexa

You should not use Celexa if you are allergic to citalopram, if you also take pimozide, or if you are being treated with methylene blue injection.

Do not use Celexa if you have taken an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, and tranylcypromine.

Some young people have thoughts about suicide when first taking an antidepressant. Your doctor will need to check your progress at regular visits while you are using Celexa. Your family or other caregivers should also be alert to changes in your mood or symptoms.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Before taking Celexa

You should not use Celexa if you are allergic to citalopram, if you also take pimozide, or if you are being treated with methylene blue injection.

Do not use Celexa if you have taken an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, and tranylcypromine.

To make sure Celexa is safe for you, tell your doctor if you have:

  • a bleeding or blood clotting disorder;

  • liver or kidney disease;

  • seizures or epilepsy;

  • heart disease, heart failure, a heart rhythm disorder, slow heartbeats, or recent history of heart attack;

  • personal or family history of Long QT syndrome;

  • an electrolyte imbalance (such as low levels of potassium or magnesium in your blood);

  • bipolar disorder (manic depression); or

  • a history of drug abuse or suicidal thoughts.

Some young people have thoughts about suicide when first taking an antidepressant. Your doctor will need to check your progress at regular visits while you are using Celexa. Your family or other caregivers should also be alert to changes in your mood or symptoms.

FDA pregnancy category C. Taking Celexa during pregnancy may cause serious lung problems in the baby. However, you may have a relapse of depression if you stop taking your antidepressant. Tell your doctor right away if you become pregnant while taking Celexa. Do not start or stop taking this medicine during pregnancy without your doctor's advice.

Citalopram can pass into breast milk and may harm a nursing baby. You should not breast-feed while you are using citalopram.

Do not give Celexa to anyone under 18 years old without medical advice.

How should I take Celexa?

Take Celexa exactly as prescribed by your doctor. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Measure liquid Celexa with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.

It may take 4 weeks or longer before your symptoms improve. Keep using the medication as directed and tell your doctor if your symptoms do not improve after 4 weeks of treatment.

Do not stop using Celexa suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to safely stop using Celexa.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking Celexa?

Ask your doctor before taking a nonsteroidal anti-inflammatory drug (NSAID) for pain, arthritis, fever, or swelling. This includes aspirin, celecoxib, diclofenac, indomethacin, meloxicam, and others, and others. Using an NSAID with citalopram may cause you to bruise or bleed easily.

Drinking alcohol can increase certain side effects of citalopram.

Celexa may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Celexa side effects

Get emergency medical help if you have any of these signs of an allergic reaction to Celexa: skin rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have:

  • very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, feeling like you might pass out;

  • agitation, hallucinations, overactive reflexes, nausea, vomiting, diarrhea, loss of coordination, feeling like you might pass out;

  • headache with chest pain and severe dizziness, fainting, fast or pounding heartbeats; or

  • headache, slurred speech, severe weakness, muscle cramps, feeling unsteady, seizure (convulsions), shallow breathing (breathing may stop).

Common Celexa side effects may include:

  • drowsiness, tired feeling;

  • sleep problems (insomnia);

  • mild nausea, diarrhea, upset stomach, dry mouth;

  • cold symptoms such as stuffy nose, sneezing, sore throat, cough;

  • increased sweating or urination, weight changes; or

  • decreased sex drive, impotence, or difficulty having an orgasm.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Celexa Dosing Information

Usual Adult Dose of Celexa for Depression:

Initial dose: 20 mg orally once a day.
Maintenance dose: 20 to 40 mg/day. The initial dose may be increased in 20 mg increments not more often than once a week up to a maximum of 40 mg per day.

Usual Geriatric Dose of Celexa for Depression:

20 mg/day orally is the maximum recommended dose for patients who are greater than 60 years of age.

Usual Pediatric Dose of Celexa for Depression:

Children Up To 11 Years:
Initial dose: 10 mg orally once daily; increase dose slowly by 5 mg/day every 2 weeks as clinically needed; dosage range: 20 to 40 mg/day

12 to 18 Years:
Initial: 20 mg orally once daily; increase dose slowly by 10 mg/day every 2 weeks as clinically needed; dosage range: 20 to 40 mg/day

Usual Pediatric Dose of Celexa for Obsessive Compulsive Disorder:

Children Up To 11 years: Initial: 5-10 mg/day given once daily; increase dose slowly by 5 mg/day every 2 weeks as clinically needed; dosage range: 10 to 40 mg/day.
12 to 18 years: Initial: 10 to 20 mg/day given once daily; increase dose slowly by 10 mg/day every 2 weeks as clinically needed; dosage range: 10 to 40 mg/day.

What other drugs will affect Celexa?

Taking Celexa with other drugs that make you sleepy or slow your breathing can increase these effects. Ask your doctor before taking Celexa with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.

Ask your doctor before taking a nonsteroidal anti-inflammatory drug (NSAID) for pain, arthritis, fever, or swelling. This includes aspirin, celecoxib, diclofenac, indomethacin, meloxicam, and others, and others. Using an NSAID with Celexa may cause you to bruise or bleed easily.

Many drugs can interact with Celexa. Not all possible interactions are listed here. Tell your doctor about all your medications and any you start or stop using during treatment with citalopram, especially:

  • other antidepressants--amitriptyline, doxepin, clomipramine, desipramine, imipramine, nortriptyline, protriptyline, trimipramine;

  • lithium;

  • St. John's wort;

  • tacrolimus;

  • trytophan (sometimes called L-tryptophan)

  • arsenic trioxide, vandetanib;

  • an antibiotic--azithromycin, clarithromycin, erythromycin, levofloxacin, moxifloxacin, pentamidine;

  • anti-malaria medication--chloroquine, halofantrine, mefloquine;

  • a blood thinner such as warfarin, Coumadin;

  • heart rhythm medication--amiodarone, dofetilide, disopyramide, dronedarone, flecainide, ibutilide, procainamide, propafenone, quinidine, sotalol;

  • HIV or AIDS medications;

  • medicine to prevent or treat nausea and vomiting--dolasetron, droperidol, ondansetron;

  • medicines to treat psychiatric disorders--chlorpromazine, clozapine, haloperidol, mesoridazine, pimozide, thioridazine, ziprasidone;

  • migraine headache medicine--sumatriptan, zolmitriptan;

  • pain medication--fentanyl, methadone, tramadol;

  • seizure medication; or

  • stomach acid reducers--cimetidine, lansoprazole, omeprazole.

This list is not complete and many other drugs can interact with Celexa. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Give a list of all your medicines to any healthcare provider who treats you.

For the Consumer

Applies to citalopram: oral solution, oral tablet

Along with its needed effects, citalopram (the active ingredient contained in Celexa) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking citalopram:

Less common
  • Agitation
  • blurred vision
  • confusion
  • fever
  • increase in the frequency of urination or amount of urine produced
  • lack of emotion
  • loss of memory
  • menstrual changes
  • skin rash or itching
  • trouble with breathing
Rare
  • Behavior change similar to drunkenness
  • bleeding gums
  • breast tenderness or enlargement or unusual secretion of milk (in females)
  • chills
  • convulsions (seizures)
  • diarrhea
  • difficulty with concentrating
  • dizziness or fainting
  • drowsiness
  • increased hunger
  • increased thirst
  • irregular heartbeat
  • lack of energy
  • lethargy
  • nosebleed
  • overactive reflexes
  • painful urination
  • poor coordination
  • purple or red spots on the skin
  • rapid weight gain
  • red or irritated eyes
  • redness, tenderness, itching, burning, or peeling of the skin
  • shivering
  • slow or irregular heartbeat (less than 50 beats per minute)
  • sore throat
  • stupor
  • sweating
  • swelling of the face, ankles, or hands
  • talking or acting with excitement you cannot control
  • trembling, shaking, or twitching
  • trouble with holding or releasing urine
  • unusual or sudden body or facial movements or postures
  • unusual tiredness or weakness
Incidence not known
  • Abdominal or stomach pain
  • back or leg pains
  • black, tarry stools
  • bloating
  • bloody stools
  • chest pain
  • confusion as to time, place, or person
  • constipation
  • cough
  • darkened urine
  • difficult or fast breathing
  • difficulty with swallowing
  • drooling
  • fast, slow, or irregular heartbeat
  • general body swelling
  • hive-like swelling on the face, eyelids, lips, tongue, or throat
  • hives
  • holding false beliefs that cannot be changed by fact
  • impaired consciousness, ranging from confusion to coma
  • indigestion
  • itching, puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • loss of appetite
  • loss of bladder control
  • loss of consciousness
  • muscle cramps or spasms
  • muscle tightness
  • muscle twitching or jerking
  • pale skin
  • penile erections, frequent or continuing
  • recurrent fainting
  • rhythmic movement of the muscles
  • seeing, hearing, or feeling things that are not there
  • shortness of breath
  • swelling of the breasts or unusual milk production
  • tenderness, pain, swelling, warmth, skin discoloration, and prominent superficial veins over the affected area
  • tightness in the chest
  • total body jerking
  • twitching, twisting, uncontrolled repetitive movements of the tongue, lips, face, arms, or legs
  • uncontrolled jerking or twisting movements
  • unusual excitement
  • vomiting of blood or material that looks like coffee grounds
  • yellowing of the eyes or skin

Some side effects of citalopram may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
  • Decrease in sexual desire or ability
  • sleepiness or unusual drowsiness
Less common
  • Body aches or pain
  • change in sense of taste
  • gas
  • headache (severe and throbbing)
  • heartburn
  • increased sweating
  • increased yawning
  • loss of voice
  • pain in the muscles or joints
  • sneezing
  • stuffy or runny nose
  • tingling, burning, or prickly feelings on the skin
  • tooth grinding
  • unusual increase or decrease in weight
  • watering of the mouth
Incidence not known
  • Bruising
  • inability to sit still
  • large, flat, blue or purplish patches in the skin
  • need to keep moving
  • uncontrolled eye movements

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Applies to citalopram: oral solution, oral tablet

Nervous system

Nearly all selective serotonin reuptake inhibitors, mixed serotonin/norepinephrine reuptake inhibitors, and tricyclic antidepressants cause sleep abnormalities to some extent. These antidepressants have marked dose-dependent effects on rapid eye movement (REM) sleep, causing reductions in the overall amount of REM sleep over the night and delays the first entry into REM sleep (increased REM sleep onset latency (ROL)), both in healthy subjects and depressed patients. The antidepressants that increase serotonin function appear to have the greatest effect on REM sleep. The reduction in REM sleep is greatest early in treatment, but gradually returns towards baseline during long-term therapy; however, ROL remains long. Following discontinuation of therapy the amount of REM sleep tends to rebound. Some of these drugs (i.e., bupropion, mirtazapine, nefazodone, trazodone, trimipramine) appear to have a modest or minimal effect on REM sleep.

Nervous system side effects including headache (26%), dry mouth (20%), increased sweating (11%), tremor (8%), dizziness (2%), and sleep abnormalities have been reported. Paresthesia, and migraine have been reported frequently. Hyperkinesia, vertigo, hypertonia, extrapyramidal disorder, leg cramps, involuntary muscle contractions, hypokinesia, neuralgia, dystonia, abnormal gait, hypesthesia and ataxia have been reported infrequently. Neuroleptic malignant syndrome, serotonin syndrome, abnormal coordination, hyperesthesia, ptosis, stupor, and choreoathetosis have rarely been reported. Akathisia, dyskinesia, and grand mal convulsions have been reported to be temporally associated with citalopram treatment.

Gastrointestinal

Gastrointestinal side effects including nausea (up to 21%), diarrhea (8%), and dyspepsia (5%) have been reported. Increased saliva and flatulence have been reported frequently. Gastritis, gastroenteritis, stomatitis, eructation, hemorrhoids, dysphagia, teeth grinding, gingivitis, and esophagitis have been reported infrequently. Colitis, gastric ulcer, cholecystitis, cholelithiasis, duodenal ulcer, gastroesophageal reflux, glossitis, jaundice, diverticulosis, rectal hemorrhage, pancreatitis, and hiccups have rarely been reported. Gastrointestinal hemorrhage has been reported to be temporally associated with the use of citalopram (the active ingredient contained in Celexa)

A study of 26,005 antidepressant users has reported 3.6 times more upper GI bleeding episodes with the use of SSRIs relative to the population who did not receive antidepressant medications. Upper gastrointestinal tract bleeding was observed in 4.1 times more frequently in patients receiving citalopram.

Psychiatric

Psychiatric side effects including somnolence (18%), insomnia (up to 15%), anxiety (4%), anorexia (4%), agitation (3%), dysmenorrhea (3%), decreased libido (2%), and yawning (2%) have been reported. Impaired concentration, amnesia, apathy, depression, increased appetite, aggravated depression, suicide attempt, and confusion have been reported frequently. Increased libido, aggressive reaction, paranoia, drug dependence, depersonalization, hallucination, euphoria, psychotic depression, delusion, paranoid reaction, emotional lability, panic reaction, and psychosis have been reported infrequently. Catatonic reaction, withdrawal syndrome and melancholia have been reported rarely. Delirium has been reported to be temporally associated with citalopram (the active ingredient contained in Celexa) treatment.

Genitourinary

Genitourinary side effects including ejaculatory disorder (primarily ejaculatory delay) (6%), and impotence (3%) have been reported. Amenorrhea has been reported frequently. Female reproductive disorders including galactorrhea, breast pain, breast enlargement, and vaginal hemorrhage have been reported infrequently. Priapism has been reported rarely. A case of spontaneous ejaculation has also been reported.

Respiratory

Respiratory system side effects including upper respiratory tract infection (5%), rhinitis (5%), and sinusitis (3%) have been reported. Coughing has been reported frequently. Bronchitis, dyspnea, and pneumonia have been reported infrequently. Asthma, laryngitis, bronchospasm, pneumonitis and increased sputum have been reported rarely.

Other

Withdrawal effects are generally self-limiting. However, there have been reports of serious discontinuation symptoms. Patients should be monitored for withdrawal symptoms when discontinuing treatment with citalopram (the active ingredient contained in Celexa) Gradual reduction of the dose is recommended whenever possible. If intolerable symptoms occur due to a decrease in dosage or discontinuation of treatment, then resuming the previously prescribed dose may be appropriate. This may be followed by a more gradual reduction in dosage.

Other side effects occurring upon discontinuation of citalopram have been reported, particularly when the discontinuation has been abrupt. These withdrawal effects have included dysphoric mood, irritability, agitation, dizziness, sensory disturbances including unfavorable smell, anxiety, confusion, headache, lethargy, emotional lability, insomnia, and hypomania.

General

General side effects including fatigue (5% to 6%), fever (2%), and asthenia (1%) have been reported. Hot flushes, rigors, alcohol intolerance, syncope, and influenza-like symptoms have been reported infrequently. Hay fever has been reported rarely. Chest pain has been reported to be temporally associated with the use of citalopram (the active ingredient contained in Celexa) Serotonin syndrome has been reported in two patients who were concomitantly receiving linezolid (a reversible nonselective MAOI).

Musculoskeletal

While not reported for citalopram (the active ingredient contained in Celexa) in one study using the healthcare data from the province of Ontario, Canada reviewing 8,239 patients treated for hip fractures, the adjusted odds ratio for hip fracture was 2.4 for exposure to selective serotonin reuptake inhibitors (including fluoxetine, fluvoxamine, paroxetine, and sertraline), compared to participants who had no exposure to antidepressants. A similar odds ratio for hip fracture may be present for patients using citalopram.

Musculoskeletal system side effects including arthralgia (2%), and myalgia (2%) have been reported. Arthritis, muscle weakness, and skeletal pain have been reported infrequently. Bursitis and osteoporosis have rarely been reported. Rhabdomyolysis has been reported to be temporally associated with citalopram treatment.

Cardiovascular

Cardiovascular side effects including tachycardia, postural hypotension, and hypotension have been reported frequently. Hypertension, bradycardia, edema (extremities), angina pectoris, extrasystoles, cardiac failure, flushing, myocardial infarction, cerebrovascular accident, and myocardial ischemia have been reported infrequently. Transient ischemic attack, phlebitis, atrial fibrillation, cardiac arrest, bundle branch block, thrombocytopenia, ventricular arrhythmia, Torsades de pointes, and angioedema have rarely been reported. Prolonged QT interval has been reported to be temporally associated with citalopram (the active ingredient contained in Celexa) treatment.

Endocrine

Endocrine side effects including hypothyroidism, goiter, and gynecomastia have rarely been reported. Several cases of the syndrome of inappropriate secretion of antidiuretic hormone have been reported. Three cases of hyponatremia secondary to the syndrome of inappropriate secretion of antidiuretic hormone have also been reported. Prolactinemia has been reported to be temporally associated with citalopram (the active ingredient contained in Celexa) treatment.

Hematologic

Two studies have reported that concurrent use of a nonsteroidal anti-inflammatory drug or aspirin potentiated the risk of bleeding. These studies focused on upper gastrointestinal bleeding. However, the manufacturer has reported that there is reason to believe that bleeding at other sites may be similarly potentiated. Patients should be warned about the risk of bleeding from concurrent use of citalopram (the active ingredient contained in Celexa) and NSAIDS, aspirin, or other drugs that affect coagulation.

Hematologic side effects including purpura, anemia, epistaxis, leukocytosis, leukopenia, and lymphadenopathy have been reported infrequently. Pulmonary embolism, granulocytopenia, lymphocytosis, lymphopenia, hypochromic anemia, coagulation disorder, and gingival bleeding have rarely been reported. Decreased prothrombin, hemolytic anemia, and thrombosis have been reported to be temporally associated with citalopram treatment.

Bleeding episodes have been reported in patients treated with psychotropic drugs that interfere with serotonin reuptake. Subsequent epidemiological studies have reported an association between the use of psychotropic drugs that interfere with serotonin reuptake and the occurrence of upper gastrointestinal bleeding.

Metabolic

The results of one study appear to indicate that treatment with selective serotonin reuptake inhibitors (i.e., paroxetine, sertraline, citalopram (the active ingredient contained in Celexa) may cause an increase in serum total cholesterol, HDL cholesterol, and/or LDL cholesterol. However, additional studies are necessary to confirm these findings.

Numerous cases of hyponatremia have been reported following treatment with a selective serotonin reuptake inhibitor (SSRI). Risk factors for the development of SSRI-associated hyponatremia including advanced age, female gender, concomitant use of diuretics, low body weight, and lower baseline serum sodium levels have been identified. Hyponatremia tends to develop within the first few weeks of treatment (range 3 to 120 days) and typically resolves within 2 weeks (range 48 hours to 6 weeks) after therapy has been discontinued with some patients requiring treatment. The proposed mechanism for the development of hyponatremia involves the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) via release of antidiuretic hormone.

Metabolic and nutritional side effects including weight increase or decrease have been reported frequently. Increased hepatic enzymes, thirst, dry eyes, increased alkaline phosphatase, and abnormal glucose tolerance have been reported infrequently. Bilirubinemia, hypokalemia, hyponatremia, obesity, hypoglycemia, hepatitis, and dehydration have rarely been reported. An increase in serum cholesterol has been reported following use of citalopram.

Dermatologic

Dermatologic side effects including rash and pruritus have been reported frequently. Photosensitivity reaction, urticaria, acne, skin discoloration, eczema, alopecia, dermatitis, dry skin, and psoriasis have been reported infrequently. Hypertrichosis, decreased sweating, melanosis, keratitis, cellulitis, and pruritus ani have rarely been reported. Ecchymosis has been reported to be temporally associated with the use of citalopram (the active ingredient contained in Celexa) One case of escitalopram-induced cutaneous leukocytoclastic vasculitis has been reported.

One case of cutaneous leukocytoclastic vasculitis has been reported in a patient receiving escitalopram (dose not stated). The lesions disappeared one week following discontinuation of escitalopram and reappeared upon rechallenge. A similar reaction occurred when the patient was switched to paroxetine.

Ocular

The ocular side effect of abnormal accommodation has been reported frequently. Conjunctivitis, and eye pain have been reported infrequently. Mydriasis, photophobia, diplopia, abnormal lacrimation and cataract have been reported infrequently. Epidermal necrolysis and erythema multiforme have been reported rarely. Nystagmus has been reported to be temporally associated with citalopram (the active ingredient contained in Celexa) treatment.

Other

Several side effects on senses have been reported. Taste perversion has been reported frequently. Tinnitus has been reported infrequently. Taste loss has rarely been reported.

Hepatic

Hepatic side effects including necrosis have been reported rarely.

Renal

Renal side effects including acute renal failure have been reported.

Hypersensitivity

Hypersensitivity side effects including anaphylaxis and allergic reaction have been reported.