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Precautions and Warnings With Citalopram

Specific Citalopram Warnings and Precautions

Some precautions and warnings to be aware of prior to taking citalopram include the following:
  • Antidepressants (including citalopram) may increase the risk of suicidal thinking or behavior (see Depression and Suicide). Therefore, if you notice any changes in symptoms or new symptoms, talk to your healthcare provider immediately. Signs may include:
    • Anxiety
    • Hostility
    • Agitation
    • Panic
    • Restlessness
    • Hallucinations
    • Extreme hyperactivity
    • Suicidal thinking or behavior (see Celexa and Suicide for more information).
  • Before prescribing citalopram, your healthcare provider should make sure that you do not have bipolar disorder instead of depression. Sometimes, the symptoms of both conditions are very similar, and citalopram can cause problems in people with bipolar disorder.


  • Antidepressants can cause a group of dangerous symptoms known as serotonin syndrome. Taking citalopram with other medications that affect serotonin can increase this risk. This includes other antidepressants, triptans (migraine medications), and several other medications (see Drug Interactions With Citalopram). Contact your healthcare provider immediately if you have any possible signs of serotonin syndrome, including:
    • Confusion
    • Seeing or hearing things that are not really there (hallucinations)
    • Fast heartbeat (tachycardia)
    • Feeling faint
    • Fever
    • Sweating
    • Muscle spasms
    • Difficulty walking
    • Diarrhea.
  • If you have a seizure disorder, it is possible that citalopram could cause seizures. Talk to your healthcare professional before taking this medication.


  • Citalopram can cause a potentially dangerous change in the heart rhythm known as QT prolongation. Combining it with other QT-prolonging medications increase this risk, as does taking high doses of citalopram (more than 40 mg a day). People with low blood potassium levels, low blood magnesium levels, congestive heart failure, or certain arrhythmias have a higher risk for this problem. People with congenital long QT syndrome should avoid this medication if possible.


  • If you are stopping citalopram, you should be monitored by a healthcare professional for withdrawal symptoms. If you do develop such problems, such as irritability, anxiety, confusion, headache, lethargy, or insomnia, your healthcare provider may slow down the rate at which the drug is stopped (see Citalopram Withdrawal).
  • This medication may cause bleeding in the stomach or intestines. This risk is increased in those taking aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. Symptoms of gastrointestinal bleeding may include:
    • Bright red blood coating the stool
    • Dark blood mixed with the stool
    • Black or tarry stool
    • Bright red blood in vomit
    • Vomit that has the appearance of coffee grounds.
If you experience any of these problems, call your healthcare provider.
  • If you are elderly or taking a diuretic, citalopram could cause low salt levels in the blood (hyponatremia). This generally returns to normal when you stop using the medication.
  • If you have liver or kidney problems, you may need a lower citalopram dosage since the liver and kidneys help remove it from the blood.
  • This medicine may affect your ability to perform complex tasks requiring mental and motor skills. Therefore, it is recommended that you become accustomed to its effect on you before becoming involved in activities requiring mental or motor concentration, such as driving a car or operating machinery.
  • Citalopram can react with certain medications (see Drug Interactions With Citalopram).
  • This product is a considered a pregnancy Category C medication. This means that it may not be safe to use during pregnancy. Talk to your healthcare provider about the risks and benefits of using citalopram when pregnant (see Celexa and Pregnancy).
  • Citalopram passes through breast milk. Therefore, if you are breastfeeding or plan to start, discuss this issue with your healthcare provider (see Celexa and Breastfeeding).
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