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What you need to know before you take Citalopram Tablets

Do not take Citalopram Tablets • if you are allergic to citalopram or to any of the other ingredients of this medicine (listed in section 6). • if you are taking pimozide (an antipsychotic medicine). • at the same time as taking medication known as monoamine oxidase inhibitors (MAOIs). MAOIs include medicines such as phenelzine, iproniazid, isocarboxazid, nialamide, tranylcypromine and moclobemide (used for the treatment of depression), selegiline (used in the treatment of Parkinson’s disease) and linezolid (an antibiotic). Even if you have finished taking one of the following MAOIs: phenelzine, iproniazid, isocarboxazid, nialamide or tranylcypromine you will need to wait 2 weeks before you start taking your Citalopram Tablets. One day must elapse after you have finished taking moclobemide. After stopping Citalopram Tablets, you must allow 1 week before taking any MAOI. • if you are born with or have had an episode of abnormal heart rhythm (seen at ECG; an examination to evaluate how the heart is functioning). • if you take medicines for heart rhythm problems or that may affect the heart’s rhythm (see section “Other medicines and Citalopram”). Warnings and precautions Talk to your doctor or pharmacist before taking Citalopram Tablets • if you suffer from any mental illnesses • if you have diabetes, because the dosage of your anti-diabetic medicine may have to be changed • if you have epilepsy or a history of seizures or fits • if you are having ECT (electroconvulsive therapy) • if you have mania or panic disorder • if you have or have ever had a bleeding disorder, or have ever suffered from bleeding in the stomach or intestines, or if you are pregnant (see section 2 `Pregnancy, breast-feeding, and fertility’) • if you have liver disease • if you have kidney disease • if you suffer or have suffered from heart problems or have recently had a heart attack • if you have a low resting heart-rate and/or you know that you may have salt depletion as a result of prolonged severe diarrhoea and vomiting (being sick) or usage of diuretics (water tablets) • if you experience a fast or irregular heartbeat, fainting, collapse, or dizziness on standing up which may indicate abnormal functioning of the heart rate • if you have low blood sodium levels • if you experience fever, confusion, abnormal movements, shivering, muscle spasms, agitation, and progress to coma or loss of consciousness, restlessness, sweating, exaggeration of reflexes, muscle cramps, or rapid heart rate which may be a sign of a condition known as ‘serotonin syndrome’ • if you have or have previously had eye problems, such as certain kinds of glaucoma (increased pressure in the eye). Medicines like Citalopram Tablets (so called SSRI’s) may cause symptoms of sexual dysfunction (see section 4). In some cases, these symptoms have continued after stopping treatment. Please consult your doctor, even if these statements were applicable to you at any time in the past. Please note: Some patients with manic-depressive illness may enter into a manic phase. This is characterized by unusual and rapidly changing ideas, inappropriate happiness and excessive physical activity. If you experience this, contact your doctor. Symptoms such as restlessness or difficulty in sitting or standing still can also occur during the first weeks of the treatment. Tell your doctor immediately if you experience these symptoms. Special information relating to your disease As with other medicines used to treat depression or related diseases, the improvement is not achieved immediately. After the start of Citalopram Tablets treatment, it may take several weeks before you experience any improvement. At the start of the treatment, certain patients may experience increased anxiety, which will disappear during continued treatment. Therefore, it is very important that you follow exactly your doctor’s orders and do not stop the treatment or change the dose without consulting your doctor. Thoughts of suicide and worsening of your depression or anxiety disorder If you are depressed and/or have anxiety disorders, you can sometimes have thoughts of harming or killing yourself. These may be increased when first starting antidepressants, since these medicines all take time to work, usually about two weeks but sometimes longer. You may be more likely to think like this: • if you have previously had thoughts about killing or harming yourself; • if you are a young adult. Information from clinical trials has shown an increased risk of suicidal behaviour in adults aged less than 25 years with psychiatric conditions who were treated with an antidepressant. If you have thoughts of harming or killing yourself at any time, contact your doctor or go to a hospital straight away. You may find it helpful to tell a relative or close friend that you are depressed or have an anxiety disorder, and ask them to read this leaflet. You might ask them to tell you if they think your depression or anxiety is getting worse, or if they are worried about changes in your behaviour. Use in children and adolescents under 18 years of age Citalopram Tablets should normally not be used for children and adolescents under 18 years. Also, you should know that patients under 18 have an increased risk of side effects such as suicide attempt, suicidal thoughts, and hostility (predominantly aggression, oppositional behaviour and anger) when they take this class of medicines. Despite this, your doctor may prescribe Citalopram Tablets for patients under 18 because he/she decides that this is in their best interest. If your doctor has prescribed Citalopram Tablets for a patient under 18 and you want to discuss this, please go back to your doctor. You should inform your doctor if any of the symptoms listed above develop or worsen when patients under 18 are taking Citalopram Tablets. Also, the long-term safety effects concerning growth, maturation, cognitive, and behavioural development of Citalopram Tablets in this age group have not yet been demonstrated. Other medicines and Citalopram Tablets Tell your doctor or pharmacist if you are taking, have recently taken, or might take any other medicines, including medicines obtained without a prescription and herbal remedies. This includes other medicines for depression (see Do not take Citalopram Tablets). This is especially important if you are taking • The herbal remedy St John’s wort (Hypericum perforatum). This should not be taken at the same time as Citalopram Tablets. • Monoamine oxidase inhibitors (MAOIs). These should not be taken at the same time as Citalopram Tablets (see Do not take Citalopram Tablets). Tell your doctor if you are taking any of the following medicines: • Linezolid (an antibiotic). • Sumatriptan (used to treat migraine) or tramadol (a pain killer). If you feel unwell when using these medicines with Citalopram Tablets you should see your doctor. • Lithium (used to prevent and treat mania) and tryptophan (an antidepressant). • Pimozide (a neuroleptic). This should not be taken at the same time as Citalopram Tablets. • Imipramine and desipramine (used to treat depression). • Medicines containing selegiline (used to treat Parkinson’s disease). • Cimetidine, lansoprazole, and omeprazole (used to treat stomach ulcers), fluconazole (used to treat fungal infections), fluvoxamine (antidepressant), and ticlopidine (used to reduce the risk of stroke). These may cause increased blood levels of citalopram. • Mefloquine (used to treat malaria). • Bupropion (used to treat depression). • Medicines known to affect the blood platelets (e.g. anticoagulant drugs used to treat or prevent blood clots; aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and diclofenac used as painkillers and some antipsychotic drugs and tricyclic antidepressants). • Metoprolol, a beta blocker used to treat migraine, some heart conditions and high blood pressure. The effects of either drug could be increased, decreased, or altered. • Neuroleptics (used in the treatment of schizophrenia). Do not take Citalopram Tablets if you take medicines for heart rhythm problems or medicines that may affect the heart’s rhythm, e.g. such as Class IA and III antiarrhythmics, antipsychotics (e.g. phenothiazine derivatives, pimozide, haloperidol), tricyclic antidepressants, certain antimicrobial agents (e.g. sparfloxacin, moxifloxacin, erythromycin IV, pentamidine, anti-malarial treatment particularly halofantrine), certain antihistamines (astemizole, mizolastine). If you have any further questions about this, you should speak to your doctor. Taking Citalopram Tablets with food, drink, and alcohol Citalopram Tablets can be taken with or without food (see section 3 “How to take Citalopram Tablets”). As with all antidepressants, it is sensible to avoid drinking alcohol whilst receiving treatment although Citalopram Tablets have not been shown to increase the effects of alcohol. Pregnancy, breast-feeding, and fertility If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor for advice before taking this medicine. Do not take Citalopram Tablets if you are pregnant or breast-feeding unless you have discussed the risks and benefits involved. Pregnancy Make sure your midwife and/or doctor know you are on Citalopram Tablets. When taken during pregnancy, particularly in the last 3 months of pregnancy, medicines like citalopram may increase the risk of a serious condition in babies, called persistent pulmonary hypertension of the new born (PPHN), making the baby breathe faster and appear bluish. These symptoms usually begin during the first 24 hours after the baby is born. If this happens to your baby, you should contact your midwife and/or doctor immediately. Also, if you take Citalopram Tablets during the last 3 months of your pregnancy and until the date of birth you should be aware that the following effects may be seen in your newborn: fits, being too hot or cold, feeding difficulties, vomiting, low blood sugar, stiff or floppy muscles, overactive reflexes, tremor, jitteriness, irritability, lethargy, constant crying, sleepiness or sleeping difficulties. If your newborn baby gets any of these symptoms, please contact your midwife and/or doctor immediately. If you take Citalopram Tablets near the end of your pregnancy there may be an increased risk of heavy vaginal bleeding shortly after birth, especially if you have a history of bleeding disorders. Your doctor or midwife should be aware that you are taking Citalopram Tablets so they can advise you. Breast-feeding Ask your doctor or pharmacist for advice before taking any medicine. If you are breast-feeding, ask your doctor for advice. You should not breast-feed your baby when taking Citalopram Tablets because small amounts of the medicine can pass into the breast milk. Fertility Citalopram has been shown to reduce the quality of sperm in animal studies. Theoretically, this could affect fertility, but impact on human fertility has not been observed as yet. Ask your doctor or pharmacist for advice before taking any medicine. Driving and using machines Citalopram Tablets do not usually affect the ability to carry out normal daily activities. However, if you feel dizzy or sleepy when you start to take this medicine, you should be careful when driving, operating machinery or performing jobs that need you to be alert until these effects wear off. Citalopram Tablets contain lactose and sodium Citalopram Tablets contains lactose. If you have been told that you cannot digest or tolerate some sugars, contact your doctor before taking this medicinal product. This medicine contains less than 1 mmol sodium (23 mg) per tablet, that is to say essentially `sodium-free’