How does it work?
Cipramil tablets and drops contain the active ingredient citalopram hydrochloride, which is a type of antidepressant known as a selective serotonin re-uptake inhibitor (SSRI). Citalopram is also available without a brand name, ie as the generic medicine.
Antidepressant medicines act on nerve cells in the brain. In the brain there are numerous different chemical compounds called neurotransmitters. These act as chemical messengers between the nerve cells. Serotonin is one such neurotransmitter and has various functions.
When serotonin is released from nerve cells in the brain it acts to lighten mood. When it is reabsorbed into the nerve cells, it no longer has an effect on mood. It is thought that when depression occurs, there may be a decreased amount of serotonin released from nerve cells in the brain.
SSRIs work by preventing serotonin from being reabsorbed back into the nerve cells in the brain. This helps prolong the mood lightening effect of any released serotonin. In this way, citalopram helps relieve depression, panic and fear.
It may take between two to four weeks for the benefits of this medicine to appear, so it is very important that you keep taking it, even if it doesn't seem to make much difference at first. If you feel your depression or anxiety has got worse, or if you have any distressing thoughts or feelings in these first few weeks, then you should talk to your doctor.
What is it used for?
- Depressive illness.
- Panic disorder with or without agoraphobia.
How do I take it?
- Citalopram is taken once a day. Your dose can be taken at any time of day and can be taken either with or without food.
- Cipramil drops should be mixed with water, apple juice or orange juice.
- Do not exceed the dose prescribed by your doctor.
- You should not suddenly stop taking this medicine, as this can cause withdrawal symptoms such as dizziness, sleep disturbances (including intense dreams), nausea, headache, a feeling of weakness, pins and needles and anxiety. Withdrawal symptoms are temporary and are not due to addiction or dependence on the medicine. They can usually be avoided by stopping the medicine gradually, usually over a period of weeks or months, depending on your individual situation. Follow the instructions given by your doctor when it is time to stop treatment with this medicine. On very rare occasions some people have experienced withdrawal symptoms after accidentally missing a dose of this medicine.
- This medicine may reduce your ability to drive or operate machinery safely. Do not drive or operate machinery until you know how this medicine affects you and you are sure it won't affect your performance.
- It is recommended that you avoid drinking alcohol while taking this medicine.
- Depression and other psychiatric illnesses are associated with an increased risk of suicidal thoughts, self-harm, and suicide. You should be aware that this medicine may not start to make you feel better for at least two to four weeks. However, it is important that you keep taking it in order for it to work properly and for you to feel better. If you feel your depression or anxiety has got worse, or if you have any distressing thoughts, or feelings about suicide or harming yourself in these first few weeks, or indeed at any point during treatment or after stopping treatment, then it is very important to talk to your doctor.
- SSRI antidepressants have been associated with the development of unpleasant or distressing restlessness and the need to move, often accompanied by an inability to sit or stand still. This is most likely to occur within the first few weeks of treatment. If you experience these symptoms you should consult your doctor.
- Antidepressants may cause the amount of sodium in the blood to drop - a condition called hyponatraemia. This can cause symptoms such as drowsiness, confusion, muscle twitching or convulsions. Elderly people may be particularly susceptible to this effect. You should consult your doctor if you develop any of these symptoms while taking this medicine, so that your blood sodium level can be checked if necessary.
- If you experience seizures (convulsions or fits) while taking this medicine, consult your doctor immediately, as you will need to stop treatment with this medicine. This also applies if you suffer from epilepsy and experience more seizures than normal after starting this medicine.
- Following a review of the safety and efficacy of SSRIs to treat depression in children under 18 years of age (unlicensed use), the Committee on Safety of Medicines (CSM) has concluded that the risks of citalopram outweigh the benefits for treating depressive illness in this age group. Citalopram is not licensed and not recommended for any uses in children and adolescents under 18 years of age. However, some specialists may still prescribe it if they feel it is essential. If your child is prescribed citalopram it is very important that they are encouraged to report any distressing feelings, thoughts about suicide or self-harm, irritability, aggressive behaviour, mood changes or other unusual change in behaviour that they may experience while taking the medicine. If you notice a change in your child's behaviour or are worried about them at any point it is important to talk to your doctor immediately.
Use with caution in
- Elderly people.
- Young adults (under 25 years of age).
- People with a history of suicidal behaviour or thoughts.
- People with a history of mania or hypomania.
- People also receiving electroconvulsive therapy (ECT).
- People taking antipsychotic medicines.
- Decreased liver function.
- Severely decreased kidney function.
- People with heart disease such as heart failure, a recent heart attack or a slow or irregular heartbeat (your doctor may want you to have an electrocardiogram (ECG) to monitor your heartbeat before treatment is started because this medicine can potentially affect your heart rhythm).
- People with a low level of potassium or magnesium in their blood (hypokalaemia or hypomagnesaemia - this should be corrected before treatment is started).
- People with a history of bleeding disorders.
- People taking medicine that affects blood clotting (eg anticoagulants such as warfarin - for more information go to the 'how can this medicine affect other medicines' section at the end of this page).
Not to be used in
- Children and adolescents under 18 years of age (but see warning above).
- Manic episodes of manic depression (bipolar affective disorder).
- Uncontrolled epilepsy.
- People with an abnormal heart rhythm seen on a heart monitoring trace (ECG) as a 'prolonged QT interval'.
- People taking medicines that can cause a 'prolonged QT interval' (your doctor will know, but go to the 'how can this medicine affect other medicines' section at the end of this page for some examples).
- People taking the antipsychotic medicine pimozide.
- People who have taken a type of medicine called a monoamine-oxidase inhibitor (MAOI) in the last 14 days (see end of factsheet for more information).
- Cipramil tablets contain lactose and are not suitable for people with rare hereditary problems of galactose intolerance, the Lapp deficiency or glucose-galactose malabsorption.
This medicine should not be used if you are allergic to any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.
If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
Pregnancy and breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
- The safety of this medicine in pregnancy has not been established. It should therefore be used with caution during pregnancy, and only if the benefits to the mother outweigh any risks to the foetus. This is particularly important in the first and third trimesters where the medicine could have harmful effects on the baby. Symptoms that resemble side effects or withdrawal symptoms of citalopram have been seen in new-born babies whose mothers took citalopram in the third trimester. It is important to seek medical advice from your doctor if you think you could be pregnant or plan to have a baby while taking this medicine. If you get pregnant and decide to stop taking citalopram you should not do so suddenly see the warning above about withdrawal symptoms.
- This medicine passes into breast milk, however the effect of this on the nursing infant is unknown. Mothers who need to take this medicine should discuss the risks and benefits of breastfeeding with their doctor.
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.
Very common (affect more than 1 in 10 people)
- Dry mouth.
- Increased sweating.
- Feeling sick.
- Feeling weak.
- Difficulty sleeping (insomnia).
Common (affect between 1 in 10 and 1 in 100 people)
- Decreased appetite and weight.
- Shaking, usually of the hands (tremor).
- Pins and needles sensations.
- Agitation, anxiety or nervousness.
- Confusion or problems with attention.
- Abnormal dreams.
- Sensation of ringing or other noise in the ears (tinnitus).
- Diarrhoea or constipation.
- Decreased sex drive.
- Abnormal female orgasm.
- Impotence or problems with ejaculation.
- Pain in the muscles or joints (myalgia or arthralgia).
Uncommon (affect between 1 in 100 and 1 in 1000 people)
- Increased appetite and weight.
- Skin reactions, such as rash, hives, hair loss, increased sensitivity to sunlight, bleeding in the skin (purpura).
- Fluid retention, resulting in swelling (oedema).
- Heavy menstrual bleeding (menorrhagia).
- Dilated pupils.
- Increased or decreased heart rate (tachycardia or bradycardia).
- Difficulty passing urine.
Rare (affect between 1 in 1000 and 1 in 10,000 people)
- Inflammation of the liver (hepatitis).
- Low blood sodium level (hyponatraemia).
Frequency not known
- Visual disturbances.
- Decrease in the number of platelets in the blood (thrombocytopenia).
- Persistent painful erection of the penis (priapism).
- Bruising under the skin causing red patches (ecchymosis).
- Low level of potassium in the blood (hypokalaemia).
- Abnormal heart rhythm seen as a 'prolonged QT interval' on an ECG.
The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.
For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
How can this medicine affect other medicines?
It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to ensure that the combination is safe.
Citalopram should not be taken at the same time as monoamine oxidase inhibitor medicines (MAOIs). These include monoamine-oxidase inhibitor antidepressants such as phenelzine, tranylcypromine, isocarboxazid and moclobemide, the antibiotic linezolid and the anti-Parkinson's medicines selegiline (in doses above 10mg per day) and rasagiline.
Citalopram should not be started until at least a day after stopping moclobemide or linezolid, and until at least two weeks after stopping other monoamine oxidase inhibitors. Similarly, treatment with any MAOIs should not be started until at least one week after citalopram has been stopped.
There may be an increased chance of an abnormal heart rhythm, seen as a 'prolonged QT interval' on an ECG, if this medicine is taken in combination with other medicines that can have this side effect, such as those listed below. The manufacturer states that these medicines should not be used in combination with citalopram:
- medicines to treat abnormal heart rhythms (anti-arrhythmics), eg amiodarone, procainamide, quinidine, disopyramide
- certain antidepressants, eg maprotiline, amitriptyline, clomipramine, imipramine
- the antihistamines terfenadine or mizolastine
- certain antimalarials, eg halofantrine, chloroquine, quinine, Riamet, mefloquine
- certain antimicrobials, eg erythromycin given by injection, clarithromycin, levofloxacin, moxifloxacin, voriconazole or pentamidine
- certain antipsychotics, eg amisulpride, thioridazine, chlorpromazine, sertindole, haloperidol, pimozide, zuclopenthixol, sulpiride
- arsenic trioxide
The medicines listed below can sometimes cause the amount of potassium in the blood to drop too low. If this happens in someone taking citalopram it could increase the risk of irregular heartbeats. Your doctor may want to check your potassium levels regularly if you are taking one of these medicines in combination with citalopram:
- beta-2-agonists for asthma, eg salbutamol
- corticosteroids by mouth or injection, such as prednisolone
- diuretics such as furosemide, bendroflumethiazide, acetazolamide
- intravenous amphotericin
- stimulant laxatives, eg senna
If you have diabetes, treatment with citalopram may alter the control of your blood sugar. As a result, you may need an adjustment in your dose of insulin or antidiabetic tablets. If you have diabetes you should discuss this with your doctor.
As SSRIs have been associated with bleeding abnormalities, the following medicines, which are known to affect the ability of the blood to clot, should be used with caution in combination with citalopram:
- anticoagulant medicines such as warfarin
- antiplatelet medicines such as aspirin, clopidogrel or dipyridamole
- non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac
- some antipsychotic medicines
- some antisickness medicines, eg prochlorperazine
- tricyclic antidepressants, eg amitriptyline.
There may be an increased risk of side effects if citalopram is taken with the following, which also enhance the activity of serotonin in the brain:
- the herbal remedy St John's wort (Hypericum perforatum) - this should not be taken in combination with citalopram
- triptans for migraine, eg sumatriptan
The following medicines may prevent the breakdown of citalopram in the body and so could potentially increase the chance of its side effects. If you are taking any of these medicines with citalopram you should tell your doctor if you get any new or increased side effects:
There may be an increased risk of seizures if citalopram is used in combination with the following medicines:
- tricyclic antidepressant medicines
- antipsychotic medicines
Other medicines containing the same active ingredient
Citalopram tablets and drops are also available without a brand name, ie as the generic medicine.