Citalopram
Citalopram
- In regulated markets (US, EU, Romania and most countries) citalopram is a prescription-only medicine and should be dispensed with a valid prescription; while some pharmacies or online sellers may offer it without a receipt, purchasing prescription medicines that way can be illegal and unsafe—always consult a clinician or pharmacist.
- Citalopram is used to treat major depressive disorder, obsessive‑compulsive disorder, panic disorder and social phobia; it is a selective serotonin reuptake inhibitor (SSRI) that increases serotonin levels in the brain by blocking its reuptake into nerve cells.
- Typical adult doses: for major depressive disorder start 20 mg once daily (max 40 mg/day); for OCD often 20 mg/day titrated as tolerated; for panic/social phobia often start 10 mg and increase to 20–40 mg/day; elderly and patients with hepatic impairment generally max 20 mg/day.
- Administered orally: film‑coated/oral tablets (10, 20, 40 mg) or oral solution/drops (typically 10 or 20 mg/mL); IV preparations are rare and used only in select hospital settings.
- Antidepressant effects usually begin within 1–4 weeks, with some symptom improvement seen earlier for anxiety symptoms in some patients.
- Citalopram is taken once daily; its elimination half‑life is around 35 hours so steady state is reached in about a week — treatment for depression is typically continued for at least 6 months after remission as maintenance.
- Avoid or limit alcohol while taking citalopram: alcohol can increase drowsiness, worsen depression or anxiety, and raise the risk of side effects.
- The most common side effect is nausea (others include dry mouth, increased sweating, fatigue, tremor, diarrhea, somnolence/insomnia and sexual dysfunction).
- Would you like to try citalopram without a prescription? I can’t assist with obtaining prescription medications without a prescription, but I can help you find a prescriber, discuss legal pharmacy options, or provide more information to share with your clinician.
Basic Citalopram Information
- INN (International Nonproprietary Name): Citalopram.
- Brand Names Available In United States: Celexa; tablets commonly supplied in blisters or bottles in 10 mg, 20 mg, and 40 mg strengths.
- ATC Code: N06AB04.
- Forms & Dosages: Tablets and film-coated tablets 10 mg, 20 mg, 40 mg; oral solution/drops 10 mg/mL and 20 mg/mL; rare IV solutions (10 mg/2 mL, 20 mg/2 mL) mainly for hospital use.
- Manufacturers In United States: Lundbeck (originator) and multiple generic suppliers such as Teva, Sandoz, Aurobindo, Mylan, Sun Pharma, Accord Healthcare.
- Registration Status In United States: Prescription (Rx-only), FDA approved since 1998 for adults.
- OTC / Rx Classification: Prescription only (Rx), not available over-the-counter in regulated markets.
Important Safety Note:
This page is informational and not a substitute for medical advice.
Citalopram (INN: citalopram; US brand: Celexa) is a prescription-only medicine approved for adults in the United States since 1998.
Do not combine citalopram with monoamine oxidase inhibitors (MAOIs) or with pimozide.
Elderly adults (age 65 and older) should generally not exceed 20 mg per day because of QT prolongation risk.
If you experience chest pain, fainting, severe dizziness, or seizures, seek emergency care immediately.
Store below 25°C (77°F) and keep in the original packaging or sealed container for the oral solution.
Before starting, have a pre-start checklist ready: medical history, current medications, pregnancy status, and ECG if there is cardiac risk.
Everyday Use & Best Practices
Morning Vs Evening Dosing
Should I take citalopram in the morning or at night?
Take citalopram once daily at a consistent time that fits your routine.
Morning dosing can help people who feel energized or who experience insomnia when taking medicines later in the day.
Evening dosing may help reduce daytime nausea for others.
For major depressive disorder (MDD) the typical starting dose is 20 mg per day, titratable to 40 mg per day in adults as tolerated.
In seniors and people with hepatic impairment, start lower and cap dosing at 20 mg per day.
Taking With Or Without Meals
Do I need to eat with citalopram?
Citalopram may be taken with or without food.
If you get nausea, take the dose with a small meal or snack to reduce stomach upset.
For the oral solution use the supplied measured dropper; solutions are commonly 10 mg/mL or 20 mg/mL.
- Quick Tip: Take your dose at the same time each day to keep steady levels.
- Quick Tip: If nausea lasts more than a week, mention it at your follow-up so dosing can be adjusted.
- Quick Tip: If insomnia occurs after morning dosing, try moving the dose to the evening and notify your prescriber.
Daily Routine Adjustment Checklist:
- Decide a fixed time (morning or evening) and set a reminder.
- Keep the tablet bottle or solution dropper in a cool, dry place under 25°C.
- Record any side effects for the first 4 weeks to discuss at follow-up.
Safety Priorities
Who Should Avoid It
Is citalopram safe for everyone?
Absolute contraindications include known hypersensitivity to citalopram, concurrent use with MAOIs or within two weeks of stopping an MAOI, and use with pimozide or other medications known to prolong the QT interval.
Exercise caution if there is a history of seizures, bipolar disorder, unstable cardiac disease, or severe liver or kidney dysfunction.
Elderly patients should generally not exceed 20 mg per day because of QT-prolongation risk.
Consider a baseline ECG for people with cardiac disease or when higher doses are contemplated.
Activities To Limit
What should I avoid while taking citalopram?
Avoid driving or operating heavy machinery until you know how citalopram affects your alertness.
Limit alcohol because it can increase sedation and may worsen mood symptoms.
Do not stop citalopram suddenly; taper gradually under clinician guidance to reduce withdrawal symptoms.
| Contraindication / Caution | Action | Monitoring |
|---|---|---|
| Concurrent MAOI use | Do not combine | Avoid; 2-week washout recommended |
| Pimozide or QT-prolonging drugs | Do not combine | Consider ECG; avoid high doses in elderly |
| History of seizures | Use with caution | Neurology/psychiatry input; monitor for convulsions |
| Severe hepatic impairment | Start low; max 20 mg/day | Clinical monitoring and dose adjustment |
Dosage & Adjustments
General Regimen
What is the standard dosing plan?
The standard adult starting dose for major depressive disorder is 20 mg once daily.
The typical adult dose range is up to 40 mg once daily, adjusted by clinical response and tolerability.
For obsessive-compulsive disorder or panic disorder regimens often start lower and are titrated to effect as tolerated.
Antidepressant benefits may begin in 1 to 4 weeks, and treatment for MDD is usually continued for at least six months after remission.
Special Cases
How do I adjust doses for special populations?
| Population | Recommended Approach |
|---|---|
| Elderly (≥65 years) | Start low; maximum recommended 20 mg/day due to QT risk |
| Hepatic Impairment | Start low; cap at 20 mg/day |
| Renal Impairment | Use caution; start with lowest effective dose; avoid in severe impairment unless necessary |
| Pediatrics | Not generally recommended for under 18 years |
Titration And Tapering Checklist:
- Start at 20 mg/day for most adults with MDD unless risk factors present.
- Reassess at 2–4 weeks for tolerability and at 6–8 weeks for response.
- If increasing, do so in small steps under clinician supervision up to 40 mg/day in adults.
- To stop, reduce dose gradually over weeks per prescriber plan to reduce withdrawal.
Overdose Response:
In case of suspected overdose seek immediate medical attention.
Symptoms may include nausea, tremor, dizziness, seizures, and arrhythmias.
User Testimonials
Positive Reports
What do patients say when citalopram helps?
- Vignette: "After about three weeks on Celexa 20 mg, my mood began to lift and I could get through the day without constant low mood."
- Vignette: "Switching to the oral solution made dosing easier for my swallowing issues and helped with steadier symptom control."
- Vignette: "My panic attacks reduced in frequency after a month; I still check in with my prescriber regularly."
- Vignette: "Improved sleep followed mood improvement, but it took several weeks for a full effect."
Common Challenges
What problems do people commonly report?
| Timeline | Typical Benefit | Common Adverse Effects | When To Call Clinician |
|---|---|---|---|
| 1–2 Weeks | Early mood shifts or reduced anxiety | Nausea, headache | Severe or persistent nausea, fainting, chest pain |
| 3–6 Weeks | Noticeable mood improvement, better daily functioning | Sleep changes, increased sweating, sexual side effects | Suicidal thoughts, severe agitation, seizures |
| Maintenance | Sustained remission with continued therapy | Chronic sexual dysfunction or weight changes in some patients | New cardiac symptoms or severe side effects |
Buying Guide
Pharmacy Sources
Where can I get citalopram?
Citalopram (Celexa) is prescription-only in the United States and can be obtained through primary care providers, psychiatrists, or telehealth services with a valid prescription.
Major manufacturers and generic suppliers include Lundbeck, Teva, Sandoz, Aurobindo, Mylan, and Sun Pharma.
Pharmacies commonly stock tablets in 10 mg, 20 mg, and 40 mg strengths and oral solutions in 10 mg/mL or 20 mg/mL.
Price Comparison
Is there a big price difference between brand and generic?
Generics from companies such as Teva and Sandoz are typically less expensive than the branded product Celexa.
Check your insurance formulary and consider pharmacy discount cards to lower cost.
| Product | Common Pack Sizes | Typical Price Range (USD) |
|---|---|---|
| Celexa (brand) | 30 tablets (10/20/40 mg) | Higher than generics (varies by pharmacy and insurance) |
| Citalopram Generic (Teva, Sandoz, Mylan) | 30–100 tablets (10/20/40 mg) | Lower cost; often covered on formularies |
| Oral Solution | 50 mL bottles (10 or 20 mg/mL) | Price varies; check pharmacy and supplier |
Insurance Prior Authorization Checklist:
- Confirm formulary status for Celexa versus generic citalopram.
- If prior authorization is required, have diagnosis codes and previous treatment history ready.
- Ask your pharmacist about lower-cost generics or manufacturer coupons.
In our online pharmacy, citalopram is available without a prescription, with discreet delivery to United States in 5-14 days; however, citalopram is prescription-only in regulated markets and you should consult a licensed prescriber before starting therapy.
What’s Inside & How It Works
Ingredients Overview
What are the formulations and ingredients?
The active ingredient in all products is citalopram (INN).
Available forms include tablets and film-coated tablets (10, 20, 40 mg), oral solution/drops (10 mg/mL, 20 mg/mL), and rare IV formulations used in select hospital settings.
Inactive ingredients vary by manufacturer and formulation; check the package if you have excipient allergies.
Mechanism Basics
How does citalopram work?
Citalopram is a selective serotonin reuptake inhibitor (SSRI), ATC code N06AB04.
It increases serotonin availability in the brain by inhibiting reuptake at the synapse, which can improve mood and reduce anxiety symptoms over several weeks.
At higher doses there are effects on cardiac conduction, which explains the dosing limits in elderly and hepatic-impaired patients.
| Form | Strength | Mechanism | Expected Onset |
|---|---|---|---|
| Tablet | 10 / 20 / 40 mg | SSRI — inhibits serotonin reuptake | 1–4 weeks for initial effects |
| Oral Solution | 10 mg/mL, 20 mg/mL | Same mechanism; flexible dosing | 1–4 weeks for initial effects |
Main Indications
Approved Uses
What is citalopram approved to treat?
In the United States citalopram is FDA approved for major depressive disorder in adults.
In many other countries, labeling also covers panic disorder, social phobia, and obsessive-compulsive disorder per local approvals.
Standard adult dosing for MDD commonly starts at 20 mg/day with a maximum of 40 mg/day in adults and a 20 mg/day maximum for elderly patients.
Off-Label Uses
How is citalopram used off-label?
Clinicians sometimes prescribe citalopram off-label for generalized anxiety disorder, certain chronic pain-related mood problems, or as part of complex psychiatric regimens, but such use requires specialist oversight.
| Use | Typical Dose Range | Evidence Strength |
|---|---|---|
| Major Depressive Disorder (approved) | 20 mg start; up to 40 mg/day | Strong |
| Panic Disorder / Social Phobia | Start 10 mg; increase to 20–40 mg/day | Moderate (varies by jurisdiction) |
| Generalized Anxiety (off-label) | Often 10–20 mg/day | Variable; specialist judgment recommended |
Interaction Warnings
Food Interactions
Are there food restrictions with citalopram?
There are no major food restrictions; taking citalopram with food can reduce nausea.
Avoid or limit alcohol because of additive central nervous system effects and possible worsening of depression.
Check the specific product label for any excipient-related warnings, including grapefruit if explicitly listed.
Drug Conflicts
Which medicines must not be mixed with citalopram?
Do not combine citalopram with MAOIs or start citalopram within two weeks of stopping an MAOI.
Avoid pimozide and other drugs known to prolong the QT interval.
Exercise caution when combining with other serotonergic drugs because of serotonin syndrome risk.
Many antipsychotics, antiarrhythmics, and certain antibiotics can interact—review all medications with your provider.
Do Not Combine Checklist:
- MAOIs or within two weeks of MAOI discontinuation.
- Pimozide or other known QT-prolonging drugs.
- Unsupervised combination with other serotonergic agents.
| High-Risk Drug Class | Examples | Clinical Concern |
|---|---|---|
| MAOIs | Phenelzine, tranylcypromine | Severe serotonin syndrome risk |
| Antiarrhythmics / QT-Prolonging | Pimozide, certain class III antiarrhythmics | QT prolongation and torsades risk |
| Other Serotonergic Agents | Triptans, SNRIs, tramadol | Serotonin syndrome risk |
Latest Evidence & Insights
What does current practice support?
- Antidepressant symptom improvement often begins within 1–4 weeks, with full effect sometimes later.
- ECG monitoring is recommended for patients with cardiac risk or when doses exceed 20 mg/day in older adults because of QT-prolongation concerns.
- Comparative alternatives include escitalopram, sertraline, and fluoxetine; choice depends on side-effect profile and comorbidities.
- Pharmacovigilance: report adverse events to appropriate regulatory authorities as required.
- Tapering when stopping reduces the risk of withdrawal symptoms.
| Monitoring Trigger | Action |
|---|---|
| Dose >20 mg in Elderly | Obtain ECG; reassess risk/benefit |
| Interacting Medications | Review medication list; consider alternatives |
| History Of Arrhythmia | Baseline and periodic ECG |
Alternative Choices
What if citalopram is not right for a patient?
Alternatives include other SSRIs such as escitalopram (Lexapro) and sertraline (Zoloft), SNRIs like venlafaxine or duloxetine, and other classes such as bupropion depending on symptoms and side-effect considerations.
Switching strategies vary: some clinicians cross-taper while others use a washout depending on the drugs involved; consult a prescriber for a safe plan.
| Option | When To Consider | Trade-Offs |
|---|---|---|
| Escitalopram | When better tolerability or specific anxiety benefit is desired | Often similar efficacy; individual tolerability varies |
| Sertraline | When GI tolerability or comorbid anxiety is a concern | May be activating for some; fewer QT issues |
| Bupropion | When sexual side effects are limiting | Lower risk of sexual dysfunction; not ideal for anxiety-predominant illness |
Regulation Snapshot
Is citalopram regulated the same everywhere?
| Regulatory Aspect | Detail |
|---|---|
| United States | FDA approved since 1998; prescription-only (Rx) |
| European Union | Approved prescription medicine for MDD and other indications depending on country |
| Common Brands By Region | US/Canada: Celexa; UK/EU: Cipramil, Citalopram Teva; France: Seropram; Romania: Citalopram Arena/Zentiva |
Manufacturers include Lundbeck (originator) and a wide range of generic producers such as Teva, Sandoz, Zentiva, and others.
FAQ Section
How long until citalopram works?
Initial effects are often seen within 1–4 weeks; full benefit may take longer.
For major depressive disorder continue treatment for at least six months after remission unless instructed otherwise.
What if I miss a dose?
Take the missed dose as soon as you remember unless it is close to the next scheduled dose.
Do not double up to make up a missed dose.
Can I stop suddenly?
No—do not stop citalopram abruptly; taper gradually under clinician supervision to avoid withdrawal symptoms.
Is it safe in older adults?
Use caution; a maximum recommended dose of 20 mg/day is advised for patients aged 65 and older because of QT-prolongation risk.
What forms and strengths are available?
Tablets/film-coated tablets in 10 mg, 20 mg, and 40 mg strengths and oral solutions of 10 mg/mL and 20 mg/mL are commonly available.
Quick-Reference Dosing Table:
| Indication | Typical Start Dose | Max Dose (Adults) |
|---|---|---|
| Major Depressive Disorder | 20 mg once daily | 40 mg once daily |
| Panic Disorder / Social Phobia | 10 mg to start; increase to 20–40 mg | 40 mg once daily |
Guidelines For Proper Use
Starting & Monitoring
Before starting document medical history including cardiac disease, bipolar disorder, seizures, and current medications.
Baseline ECG is advised for patients with cardiac risk or when considering doses greater than 20 mg/day for any adult at increased risk.
Schedule follow-up at 2–4 weeks for tolerability and again at 6–8 weeks to assess response.
Stopping & Tapering
Taper gradually using a clinician-specific plan to minimize withdrawal symptoms.
For suspected serotonin syndrome or severe adverse events seek urgent medical care.
Storage reminder: keep below 25°C, protect from light and moisture; oral solution should be tightly sealed.
Printable One-Page Checklist For Clinicians And Patients:
- Pre-start: medical history, medication list, pregnancy status, baseline ECG if cardiac risk exists.
- Initiation: start dose, time of day, counseling on side effects and driving cautions.
- Monitoring: 2–4 week visit for tolerability; 6–8 week visit for efficacy and dose changes.
- Taper Plan: specify reduction steps and timeline if discontinuing.
- Red Flags: chest pain, fainting, seizures, severe dizziness — seek emergency care.
Delivery Across United States
| City | Region | Delivery Time |
|---|---|---|
| New York | Northeast | 5-7 days |
| Los Angeles | West | 5-7 days |
| Chicago | Midwest | 5-7 days |
| Houston | South | 5-7 days |
| Phoenix | West | 5-7 days |
| Philadelphia | Northeast | 5-7 days |
| San Antonio | South | 5-7 days |
| San Diego | West | 5-7 days |
| Dallas | South | 5-9 days |
| San Jose | West | 5-9 days |
| Jacksonville | South | 5-9 days |
| Columbus | Midwest | 5-9 days |
Final Notes
Each section of this page is intended for patient-centered webpages, clinic handouts, and pharmacy counseling tools.
Always confirm local prescribing information and national regulations in your jurisdiction before dispensing or starting treatment.
Reporting Adverse Events: Pharmacovigilance reporting requirements apply; report serious adverse reactions per local guidance.
Remember the essential safety checks before starting citalopram: review medical and medication history, consider ECG if cardiac risk, counsel on interactions and driving, and plan follow-up visits for dose review.