The following provides information on contraindications to the use of citalopram in general, pregnancy, breastfeeding and children. Please note that the contraindications may vary depending on the dosage form of a drug (eg tablet, syringe, ointment).
When should citalopram not be used?
The active substance must not be used with
- Hypersensitivity to citalopram
- severely impaired kidney function (creatinine clearance below 20 milliliters per minute)
- concurrent treatment with the neuroleptic pimozide
- Cardiac arrhythmias such as QT prolongation or congenital Long QT syndrome; it is also prohibited to use it concurrently with other agents known to prolong the QT interval
- concomitant treatment with antidepressants from the drug class of MAO inhibitors, as this can trigger the life-threatening serotonin syndrome with confusion, shaking, sweating, fever and drop in blood pressure to coma. Citalopram must be given no earlier than two weeks after cessation of treatment with irreversible MAO inhibitors and not earlier than one day after stopping moclobemide or selegiline.
Because citalopram is predominantly excreted via the liver, the drug should not be used in patients with severe hepatic impairment. In patients with severe hepatic impairment, if you are taking citalopram, the doctor must adjust the dose and carefully monitor liver function. Citalopram should only be used after careful consideration of the benefit and risk by the physician and under his control.
- Patients with seizures (for example, epilepsy)
- History of a history of coagulation
- Diabetics because citalopram, like some other selective serotonin reuptake inhibitors, affects sugar metabolism and requires re-dosing of antidiabetics
- heart failure
- a recent heart attack
- morbidly slowed heartbeat
- a predilection for lack of potassium or magnesium in the blood due to comorbidities or other medications. There is an increased risk of cardiac arrhythmias.
What should you watch out for during pregnancy and lactation?
There are no adequate studies on the use of citalopram in pregnant women. Therefore, citalopram should be given during pregnancy only after careful medical consideration of benefit and risk.
Selective serotonin reuptake inhibitors such as citalopram may cause neonatal withdrawal symptoms in the last three months of pregnancy. Signs include excitability, tremors, high blood pressure (including in the lungs), increased muscle tension, including nerve-related behavioral problems such as continued crying and difficulty sucking or sleeping.
Citalopram passes into breast milk in small amounts and may cause harm to the infant. Therefore, the drug should not be taken during breast-feeding.
In studies on animals, citalopram reduced the quality of the semen. In theory, this could affect fertility, but so far no impact on human fertility has been observed.
What should be considered in children?
Use in children and adolescents under the age of 18 is not allowed due to possible behavioral problems or even suicidal thoughts.
Warnings and Precautions
- Low risk of suicide should be encouraged at the beginning of treatment.
- If seizures occur in patients, the drug should be discontinued.
- In diabetics, sugar levels may change during treatment with the drug. Regular medical checks on blood glucose levels are therefore necessary.
- Treatment with this medicine should not be stopped suddenly to avoid withdrawal symptoms.
- Wounds can bleed for longer by taking the drug, so check the blood clotting regularly with a doctor.
- Severe Depressed and adolescent adults under the age of 30, despite the treatment, are at an increased risk of suicide and must therefore be monitored carefully.
- The drug is not suitable for the treatment of children and adolescents under the age of 18 years.
- The medicine may increase the risk of bone fractures.
- The maximum daily dose of the drug is 40 milligrams.
- The drug can change your ability to react so much that driving a car or operating machinery is dangerous. This applies even more in combination with alcohol.
Sometimes medications release allergic reactions.
If you notice any signs of allergic reaction, tell your doctor or pharmacist immediately.