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Apo-Citalopram

(citalopram)

In this factsheet:
• How does Apo-Citalopram work? What will it do for me?
• How should I use Apo-Citalopram?
• What form(s) does Apo-Citalopram come in?
• Who should NOT take Apo-Citalopram?
• What side effects are possible with Apo-Citalopram?
• Are there any other precautions or warnings for Apo-Citalopram?
• What other drugs could interact with Apo-Citalopram?

DIN (Drug Identification Number)

What side effects are possible with Apo-Citalopram?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent. The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

abdominal pain agitation anxiety diarrhea dizziness drowsiness dry mouth fatigue fever heartburn increased sweating

increased yawning loss of appetite nausea painful periods sexual difficulties shakiness sore throat stuffy or runny nose trouble sleeping vomiting

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

behaviour similar to drunkenness bleeding gums blurred vision confusion dizziness or fainting increase in frequency of urination or amount of urine produced, or trouble holding or releasing urine irregular heartbeat lack of emotion loss of memory menstrual changes

mood or mental changes nervousness nosebleed purple or red spots on skin severe agitation severe migraine skin rash or itching slow or irregular heartbeat (less than 50 beats per minute) sore throat, fever, and chills trouble breathing unusual or sudden body or facial movements or postures

Stop taking the medication and seek immediate medical attention if any of the following occur:

• chest pain
• seizure or convulsions
• serotonin syndrome (signs include agitation, confusion, diarrhea, fever, overactive reflexes, poor coordination, restlessness, shivering, sweating, talking or acting with excitement you cannot control, trembling or shaking, twitching)
• thoughts of suicide or hurting yourself

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for Apo-Citalopram?

Before you begin taking a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Abnormal heart rhythm: Citalopram may cause an abnormal heart rhythm, especially at higher doses. Your doctor may occasionally monitor your heart rate and rhythm with a test called an electrocardiogram. People with a history of a heart rhythm disturbance called QT prolongation should not take this medication. If you have congestive heart failure, slow heart rhythm, are at risk of low potassium or magnesium levels because of certain illnesses or medications, or you are taking certain medications that can affect the heart rhythm (e.g., amiodarone, sotalol), you should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Bleeding disorders: Citalopram may increase bruising and bleeding from cuts that may take longer to stop. People with bleeding disorders or a history of bleeding problems should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Diabetes: Citalopram may lower blood sugar levels (hypoglycemia). People with diabetes should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Drowsiness/reduced alertness: Citalopram may cause drowsiness for some who take it. Avoid activities that require mental alertness, judgment, and physical coordination (such as driving a car or performing hazardous tasks) until you establish that citalopram does not affect you in this way.

Heart disease: Citalopram may cause decreased heart rate for some people. People with heart disease should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Kidney function: People with severely reduced kidney function should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function: People with reduced liver function should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Mania or hypomania: Citalopram may cause activation of mania or hypomania. People with a history of mania or bipolar disorder should be closely monitored by their doctor while taking this medication.

Seizures: People with a history of seizures should be closely monitored by their doctor when taking citalopram. If you develop seizures, contact your doctor or seek medical attention immediately.

Stopping the medication: Stopping this medication suddenly may lead to side effects. If you are thinking of stopping the medication, check with your doctor first.

Suicidal or agitated behaviour: People taking this medication may feel agitated (restless, anxious, aggressive, emotional, and feeling not like themselves) or they may want to hurt themselves or others. These symptoms may occur within several weeks after people start taking this medication. People should be closely monitored by their doctor for emotional and behavioural changes. If you experience any of these symptoms while taking this medication, contact your doctor immediately.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking citalopram, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children and is not indicated for use in children under the age of 18. There have been reports that using this and similar medications in children under 18 years old may cause behavioural and emotional changes such as suicidal thoughts and behaviour.

Seniors: Because this medication is removed from the body by the kidney and liver, seniors may be at increased risk of side effects if they use this medication. If you are over 65, discuss with your doctor whether any special monitoring is required.

What other drugs could interact with Apo-Citalopram?

There may be an interaction between citalopram and any of the following:

alcohol anticoagulants (e.g.,warfarin) anti-HIV medications (e.g., indinavir, lopinavir, ritonavir) antiplatelets (e.g., acetylsalicylic acid (ASA), clopidogrel) atypical antipsychotic medications (e.g., risperidone, ziprasidone) "azole" antifungals (e.g., fluconazole, itraconazole,ketoconazole) beta-blockers (e.g., propranolol, metoprolol) bromocriptine carbamazepine cimetidine ciprofloxacin clozapine desipramine dextromethorphan imipramine isoniazid linezolid

lithium l-tryptophan macrolide antibiotics (e.g., clarithromycin, erythromycin) MAO inhibitors (e.g., selegiline, phenelzine, tranylcypromine) metoclopramide NSAIDs (e.g., ibuprofen, indomethacin) omeprazole opioid pain relievers (i.e., fentanyl, morphine, pentazocine) other SSRIs (e.g., fluoxetine, sertraline) SNRIs (e.g., venlafaxine, duloxetine) phenytoin pimozide quinine selegiline sibutramine St. John's wort tramadol trazodone triptans (e.g., sumatriptan)

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

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Depression Symptom Checker Tool

The Depression Symptom Checker tool can help you learn about depression. Use this tool to create a list of your symptoms and rate how much the symptoms impact your life on a daily basis. The checklist is divided into 6 symptom categories that are associated with depression. You can also learn more about symptoms of depression here.

For each statement choose a number from 0 to 4 that describes the impact on your daily life, where 4 has the highest impact and 0 has no impact:

• 0 = no impact on daily life/no symptoms
• 1 = mild impact on daily life
• 2 = moderate impact on daily life
• 3 = severe impact on daily life
• 4 = debilitating impact on daily life

It is important to remember that this is not a “score” but a way to help you communicate how much you feel the symptom impacts your daily life. When you finish you will be able to print out your symptoms and share this information with your doctor. Use the Doctor Discussion Guide to prepare for your doctor’s visit.

Rate how much the following symptoms apply to you.

1. Emotions

Depression can affect anyone at any age, although it most commonly appears between 15 and 45 years of age.

I feel a sense of sadness and/or hopelessness

No Impact Mild Moderate Severe Debilitating

0 1 2 3 4

I feel restless and/or irritable

No Impact Mild Moderate Severe Debilitating

0 1 2 3 4

I have lost interest in hobbies and activities I once enjoyed

No Impact Mild Moderate Severe Debilitating

0 1 2 3 4

I have thoughts of self-harm, death, or suicide (if you have these thoughts, please seek medical help immediately)

No Impact Mild Moderate Severe Debilitating

0 1 2 3 4

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2. Fatigue

Serious depression affects about 11% of Canadians at some time in their lives, and about 4% during any given year

I do not have the energy to do the things I need or want to do

No Impact Mild Moderate Severe Debilitating

0 1 2 3 4

I think the lack of energy could be related to depression instead of another health issue

Yes Possibly No

Yes Possibly No

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3. Sleep

During depression treatment, sleep and appetite often improve before your mood improves.(

I am sleeping too much

No Impact Mild Moderate Severe Debilitating

0 1 2 3 4

I am having trouble getting enough sleep

No Impact Mild Moderate Severe Debilitating

0 1 2 3 4

I have other sleep problems that are impacting my life

No Impact Mild Moderate Severe Debilitating

0 1 2 3 4

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4. Weight

Weight loss is considered significant if you gain or lose more than 5% of your body weight within a month.

I have been losing weight recently without trying

No Impact Mild Moderate Severe Debilitating

0 1 2 3 4

I have been gaining weight recently without trying

No Impact Mild Moderate Severe Debilitating

0 1 2 3 4

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5. Thinking and concentrating

Having a close relative with depression, experiencing childhood trauma or the death of a loved one, or worrying a lot about problems may increase the likelihood of experiencing an episode of depression

I have difficulty concentrating

No Impact Mild Moderate Severe Debilitating

0 1 2 3 4

I have difficulty thinking clearly

No Impact Mild Moderate Severe Debilitating

0 1 2 3 4

I have trouble making decisions

No Impact Mild Moderate Severe Debilitating

0 1 2 3 4

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6. Unexplained Aches and Pains

Up to 76% of people with depression also experience physical symptoms, such as headache, stomach pain, and back pain

I am bothered by unexplained aches and pains (headache, stomach pain, other pains)

No Impact Mild Moderate Severe Debilitating

0 1 2 3 4

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