Contains the active ingredient citalopram (as citalopram hydrobromide)
Consumer Medicine Information
What is in this leaflet
This leaflet answers some common questions about this medicine. It does not contain
all the available information. It does not take the place of talking to your doctor
All medicines have risks and benefits. Your doctor has weighed the risks of you taking
this medicine against the benefits they expect it will have for you.
If you have any concerns about taking this medicine, ask your doctor or pharmacist.
Keep this leaflet with the medicine.
You may need to read it again.
What this medicine is used for
APO-Citalopram contains the active ingredient citalopram (as citalopram hydrobromide).
It is used to treat depression.
Citalopram belongs to a group of antidepressant medicines called Selective Serotonin
Reuptake Inhibitors (SSRIs). Citalopram and other SSRIs are thought to help by increasing
the amount of serotonin in your brain.
Depression is longer lasting and/or more severe than the 'low moods' everyone has
from time to time due to the stress of everyday life. It is thought to be caused by
a chemical imbalance in parts of the brain. This imbalance affects your whole body
and can cause emotional and physical symptoms such as feeling low in spirit, loss
of interest in activities, being unable to enjoy life, poor appetite or overeating,
disturbed sleep, often waking up early, loss of sex drive, lack of energy and feeling
guilty over nothing.
Citalopram corrects this chemical imbalance and may help relieve the symptoms of depression.
Ask your doctor if you have any questions about why this medicine has been prescribed
Your doctor may have prescribed this medicine for another reason.
There is no evidence that this medicine is addictive.
However, if you suddenly stop taking it, you may get side effects.
This medicine is available only with a doctor's prescription.
Do not give this medicine to a child or adolescent.
The benefit and safety of citalopram use in children and adolescents below 18 years
of age has not been proven.
Before you take this medicine
When you must not take it
Do not take this medicine if you have an allergy to:
any medicine containing citalopram
any of the ingredients listed at the end of this leaflet
Some of the symptoms of an allergic reaction may include:
shortness of breath
wheezing or difficulty breathing
swelling of the face, lips, tongue or other parts of the body
rash, itching or hives on the skin
Do not take this medicine if you are taking the following medicines:
pimozide, used to treat disorders which affect the way you think, feel or act
Monoamine Oxidase Inhibitors (MAOIs), used to treat depression (phenelzine, tranylcypromine,
moclobemide), Parkinson's Disease (selegiline) or infections (linezolid).
Do not take citalopram until 14 days after stopping most MAOIs. The exception is the
MAOI, moclobemide, where you may take citalopram one whole day after finishing taking
Taking citalopram with MAOIs may cause a serious reaction with signs such as a sudden
increase in body temperature, very high blood pressure, rigid muscles, nausea/vomiting
and/or fits (convulsions). Your doctor will know when it is safe to start citalopram
after the MAOI has been stopped.
linezolid, used in some serious bacterial infections
Do not take this medicine if you have or have had any of the following medical conditions:
Congenital Long QT Syndrome, where your heart beats unusually, and you may feel short
of breath, dizzy or faint. Your doctor will tell you if you have this.
The expiry date (EXP) printed on the pack has passed.
The packaging is torn, shows signs of tampering or it does not look quite right.
If you are not sure whether you should start taking this medicine, talk to your doctor.
Before you start to take it
Tell your doctor if you have allergies to any other medicines, foods, preservatives
Tell your doctor if you have or have had any of the following medical conditions:
mania, hypomania, bipolar disorder or any other conditions which affect the way you
think, feel or act
epilepsy or convulsions, fits or seizures (you should avoid taking citalopram if your
epilepsy is not properly controlled; if it is properly controlled your doctor will
wish to watch you carefully if you take citalopram)
problems with blood clotting or abnormal bleeding, or bruise easily
thoughts or actions relating to self-harm or suicide
lactose or galactose intolerance, Lapp lactase insufficiency, glucose or galactose
(These tablets contain lactose)
a decreased level of sodium or potassium in your blood, which may be due to certain
medicines (e.g. certain diuretics [water tablets] and antibiotics), or to certain
medical conditions (e.g. kidney problems, dehydration, excess sweating or vomiting
or diarrhoea). Your doctor will test you for this before you start taking citalopram.
restlessness and/or a need to move often (akathisia)
raised intraocular pressure (fluid pressure in the eye), or if you are at risk of
Tell your doctor if you are pregnant or plan to become pregnant.
There have been reports that babies exposed to certain antidepressants during the
third trimester of pregnancy may develop complications after birth.
Do not take this medicine whilst pregnant until you and your doctor have discussed
the risks and benefits involved.
Citalopram has also been shown to reduce the quality of sperm in animal studies, which
may affect fertility. If you are intending to start a family, ask your doctor for
Tell your doctor if you are breastfeeding or plan to breastfeed.
It is not recommended that you breast-feed while taking this medicine because citalopram
passes into breast milk and may affect your baby.
Do not take this medicine whilst breast-feeding until you and your doctor have discussed
the risks and benefits involved.
Tell your doctor if you are receiving electroconvulsive treatment (ECT).
If you have not told your doctor about any of the above, tell them before you start
taking this medicine.
Taking other medicines
Tell your doctor or pharmacist if you are taking any other medicines, including any
that you get without a prescription from your pharmacy, supermarket or health food
Some combinations of medicines may increase the risk of serious side effects and are
Therefore some medicines must not be taken with citalopram. These include:
monoamine oxidase inhibitors, such as moclobemide, phenelzine, tranylcypromine, selegiline
Some other medicines may interact with citalopram. These include:
tryptophan, contained in some multivitamin and herbal preparations
tramadol, a strong pain killer
sumatriptan and similar medicines used to treat migraines and cluster headaches
St John's Wort (Hypericum perforatum), a herbal remedy
other medicines used to treat depression
lithium, used to treat mood swings and some types of depression
any other medicines used to treat anxiety, obsessive-compulsive disorder or pre-menstrual
antipsychotics, medicines used to treat psychoses, schizophrenia and other conditions
which affect the way you think, feel or act (e.g. olanzapine, risperidone)
prochlorperazine, used to prevent or treat severe nausea and vomiting
antiarrhythmics, medicines used to treat an irregular heart beat e.g. dipyridamole
medicines known to prolong bleeding e.g. aspirin or other non-steroidal anti-inflammatory
drugs (NSAIDs) and anti-coagulants (such as warfarin and ticlopidine), which can thin
beta-blockers such as metoprolol, used to treat high blood pressure and other heart
fluconazole, ketoconazole and itraconazole, medicines used to treat fungal infections
macrolide antibiotics, such as erythromycin and clarithromycin
certain other antibiotics which may lower your potassium or magnesium levels (e.g.
carbamazepine and other medicines used to control epilepsy (fits).
cimetidine and medicines called proton pump inhibitors (e.g. omeprazole) used to treat
reflux and stomach ulcers
certain diuretics (water tablets)
If you are taking any of these you may need a different dose or you may need to take
If you take medicines which affect the heart rhythm whilst taking citalopram then
your doctor will do regular tests on your heart (ECG). Citalopram may also cause changes
to your heart rhythm.
Other medicines not listed above may also interact with citalopram.
Your doctor and pharmacist have more information on medicines to be careful with or
avoid while taking this medicine.
How to take this medicine
Follow all directions given to you by your doctor or pharmacist carefully.
They may differ from the information contained in this leaflet.
If you do not understand the directions, ask your doctor or pharmacist for help.
How much to take
Your doctor or pharmacist will tell you how much of this medicine you should take.
This will depend on your condition and whether you are taking any other medicines.
The usual starting dose for adults is 20 mg per day.
Your doctor may increase your dose slowly in stages of 10 mg depending on how you
respond to this medicine. The maximum dose is 40 mg a day.
Elderly people have a starting dose of 10 mg per day, which may be increased slowly
to a maximum dose of 20 mg a day.
People who take cimetidine or other medicines which affect the blood levels of citalopram
(called CYP 2C19 inhibitors), or people who have liver problems should not take more
than 20 mg of citalopram per day.
Do not stop taking your medicine or change your dosage without first checking with
How to take it
Swallow the tablets whole with a full glass of water. Do not chew them.
When to take it
Take it as a single dose, either in the morning or in the evening, at about the same
time each day.
Taking it at the same time each day will have the best effect and will also help you
remember when to take it.
It does not matter if you take it before, with or after food.
How long to take it for
Continue taking your medicine for as long as your doctor tells you, even if it takes
some time before you feel any improvement in your condition.
Make sure you have enough to last over weekends and holidays.
As with other medicines for the treatment of these conditions, it may take a few weeks
before you feel any improvement.
Individuals will vary greatly in their response to this medicine.
Your doctor will check your progress at regular intervals.
The length of treatment may vary for each individual, but is usually at least 6 months.
In some cases your doctor may decide that longer treatment is necessary.
The underlying illness may last for a long time and if you stop your medicine too
soon, your symptoms may return.
Occasionally the symptoms of depression or other psychiatric conditions may include
thoughts of harming yourself or committing suicide. It is possible that these symptoms
may continue or increase until the full anti-depressant effect of your medicine becomes
You or anyone close to you or caring for you should watch for these symptoms and tell
your doctor immediately or go to the nearest hospital if you have any distressing
thoughts or experiences during this initial period or at any other time.
Also contact your doctor if you experience any worsening of your depression or other
symptoms at any time during your treatment.
Do not stop taking this medicine even if you begin to feel better.
Your doctor may decide that you should continue to take it for some time, even when
you have overcome your problem. For best effect, this medicine must be taken regularly.
Do not stop taking your medicine suddenly.
If you suddenly stop taking your medicine, you may experience mild, but usually temporary,
symptoms such as dizziness, feelings like pins and needles, sleeping problems (vivid
dreams, nightmares, inability to sleep), feeling anxious, headaches, feeling sick
(nausea), vomiting, sweating, feeling restless or agitated, tremor, feeling confused
or disorientated, feeling emotional or irritable, diarrhoea (loose stools), visual
disturbances, or fast or irregular heartbeats.
When you have completed your course of treatment, it is better that your dose is gradually
reduced over a couple of weeks, rather than stopped abruptly.
Your doctor will tell you how to reduce the dosage so that you help avoid getting
any unwanted effects.
If you forget to take it
If you are less than 12 hours late in taking your dose, take the missed dose as soon
as you remember and then go back to taking your dose as you normally would.
If you are more than 12 hours late, then skip the dose you missed and take your next
dose when you are meant to.
Do not take a double dose to make up for missed doses.
This may increase the chance of you experiencing side effects.
If you are not sure what to do, ask your doctor or pharmacist.
If you have trouble remembering to take your medicine, ask your pharmacist for some
hints to help you remember.
If you take too much (overdose)
If you think that you or anyone else may have taken too much of this medicine, immediately
telephone your doctor or the Poisons Information Centre (Tel: 13 11 26 in Australia)
for advice. Alternatively go to the Accident and Emergency Department at your nearest
Do this even if there are no signs of discomfort or poisoning. You may need urgent
If you take too much citalopram you may get symptoms of nausea (feeling sick), vomiting,
dizziness, fast or slow heart beat or change in heart rhythm, decreased or increased
blood pressure, tremor (shaking), agitation, dilated pupils of the eyes, drowsiness
or sleepiness. Convulsions, coma, and rarely, temporary paralysis or weakness of muscles
A condition called serotonin syndrome may occur, with high fever, agitation, confusion,
trembling and abrupt contraction of muscles.
While you are taking this medicine
Things you must do
Persons taking citalopram may be more likely to think about killing themselves or
actually trying to do so, especially when citalopram is first started or the dose
is changed. Tell your doctor immediately if you have thoughts about killing yourself
or if you are close to or care for someone using citalopram who talks about or shows
signs of killing him or herself.
All mentions of suicide or violence must be taken seriously.
Occasionally, the symptoms of depression may include thoughts of suicide or self-harm.
It is possible that these symptoms continue or get worse until the full antidepressant
effect of the medicine becomes apparent. This is more likely to occur if you are a
young adult, i.e. 18 to 24 years of age, and you have not used antidepressant medicines
If you or someone you know or care for is showing any of the following warning signs
of suicide-related behaviour while taking this medicine, contact your doctor or even
go to the nearest hospital for treatment:
thoughts or talk of death or suicide
thoughts or talk of self-harm or harm to others
any recent attempts of self-harm
increase in aggressive behaviour, irritability or agitation
worsening of depression.
Follow your doctor's instructions. Do not stop taking this medicine or change the
dose without consulting your doctor, even if you experience increased anxiety at the
beginning of treatment.
At the beginning of treatment certain patients may experience increased anxiety, which
will disappear during continued treatment.
Tell your doctor immediately if you experience symptoms such as restlessness or difficulty
in sitting or standing still.
These symptoms can also occur during the first weeks of treatment.
Contact your doctor immediately if you suddenly experience an episode of mania.
Some people with manic depression (bipolar disorder) may enter a manic phase. Symptoms
of mania include lots of rapidly changing thoughts or ideas, exaggerated gaiety, being
much more physically active and much more restless.
Sometimes you may not know that you are manic, so it may be helpful to have a friend
or relative watch over you for any possible signs of change in your behaviour.
Visit your doctor regularly so they can check on your progress.
Tell your doctor immediately if you become pregnant.
If you are a woman of child-bearing age, you should avoid becoming pregnant while
Make sure your midwife and/or doctor know you are taking citalopram. 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 newborn (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.
Low Potassium or Sodium
Some people (especially older people or those taking diuretics/water tablets or people
who are dehydrated, have diarrhoea or vomiting or take certain antibiotics) may experience
a lack of sodium or potassium in the blood when taking this medicine. Tell your doctor
if you get a headache or start to feel dizzy, confused, forgetful, weak or fatigued,
unsteady or unable to concentrate or if you get muscle weakness or spasms or abnormal
heart beats or have problems breathing.
If you are about to be started on any new medicine, remind your doctor and pharmacist
that you are taking this medicine.
Tell any other doctors, dentists, and pharmacists who treat you that you are taking
If you are going to have surgery, tell the surgeon or anaesthetist that you are taking
If you start to breastfeed or are planning to breastfeed while taking this medicine,
tell your doctor immediately.
If you are about to have any blood tests, tell your doctor that you are taking this
Your doctor may occasionally do tests to make sure the medicine is working and to
prevent side effects. If you are taking certain other medicines or have heart problems
you doctor will monitor you closely.
Keep all your doctor's appointments so that your progress can be checked.
Tell your doctor if, for any reason, you have not taken your medicine exactly as prescribed.
Otherwise your doctor may think that it was not effective and change your treatment
Tell your doctor if you feel this medicine is not helping your condition.
If you are being treated for depression, be sure to discuss with your doctor any problems
you may have and how you feel, especially any feelings of severe sadness, thoughts
of suicide, bursts of unusual energy, anger or aggression, or if you become particularly
agitated or restless.
Tell your doctor immediately if your heart beats unusually, and/or you feel short
of breath, dizzy or faint.
Make sure you have enough tablets to last over weekends and holidays.
Things you must not do
Do not take this medicine to treat any other complaints unless your doctor tells you
Do not give your medicine to anyone else, even if they have the same condition as
Do not stop taking your medicine or change the dosage without checking with your doctor.
If you stop taking it suddenly, your condition may worsen, or you may have unwanted
Your doctor will tell you how to gradually reduce the dose of your medicine. This
is usually done slowly, over 1 to 2 weeks, before stopping completely.
Things to be careful of
Be careful when driving or operating machinery until you know how this medicine affects
This medicine may cause nausea, fatigue, dizziness, visual disturbances or drowsiness
in some people. If you have any of these symptoms, do not drive, operate machinery
or do anything else that could be dangerous.
Avoid alcohol while you are taking this medicine.
It is best not to drink alcohol while you are being treated for depression.
You should be aware that people over 50 years of age who take antidepressants have
an increased risk of having a bone fracture.
Tell your doctor or pharmacist as soon as possible if you do not feel well while you
are taking this medicine.
All medicines can have side effects. Sometimes they are serious but most of the time
they are not.
Do not be alarmed by the following lists of side effects. You may not experience any
Ask your doctor or pharmacist to answer any questions you may have.
Tell your doctor or pharmacist if you notice any of the following and they worry you:
feeling tired and weak (fatigued), hot flushes, fever, feeling unwell, shaking or
tremors, migraine, headache, dizziness or giddiness
muscle, back, bone, nerve or joint pain, stiffness, weakness or cramps, decrease or
loss of touch or other senses
increased or decreased sensitivity to outside stimuli
feeling or being sick, reflux, diarrhoea or loose bowel motions, constipation, indigestion,
stomach pain or discomfort, wind
increased saliva or dry mouth, taste disturbance
burping, hiccups, problems swallowing, sore mouth, tongue or throat, haemorrhoids
sleepiness, drowsiness, sleeping difficulties, strange dreams
sexual disturbances (decreased sexual drive, problems with orgasm; problems with ejaculation
frightening or unusual dreams, yawning, teeth grinding or clenching, increased or
decreased appetite, impaired concentration
excessive and/or abnormal movements
increased muscle tension, muscle twitching
problems with eyes or eyesight
feeling faint or dizzy when you stand up due to low blood pressure
unable to tolerate alcohol
menstrual irregularities, breast pain, unusual vaginal bleeding
loss of bladder control
unusual hair loss or thinning
tingling or numbness of the hands or feet
breast enlargement or the unusual secretion of breast milk in men or women
increased sensitivity of the skin to sun
mild rash, or itching or prickling of the skin
acne, eczema, dermatitis, dry skin, psoriasis or other skin problem
ringing or other persistent noise in the ears
increased or decreased sweating
bruises or skin discolouration
weight decrease or weight increase
flu-like symptoms, runny or blocked nose, sneezing, facial pressure or pain, coughing
or sore throat
a sense of indifference to everything.
Some of these side effects may occur within the first two weeks of treatment and disappear
after a short period of time.
Tell your doctor as soon as possible if you notice any of the following:
nervousness, confusion, problems with concentration, loss of memory
feeling restless or unable to sit still
stomach pain with nausea and vomiting of blood, or blood in the bowel movements
anxiety, agitation, aggression, worsening of depression
general swelling or swollen hands, ankles, feet or face or eye area due to fluid build-up
feelings of not being part of your body, or in a daze
feeling sick or unwell with weak muscles or feeling confused (these symptoms may be
signs of a rare condition as a result of low levels of sodium in the blood, which
may be caused by antidepressants, especially in elderly female patients)
feeling fatigued with muscle weakness or spasms or abnormal heart beats or problems
breathing. This may be due to low potassium levels in your blood.
increased tendency to develop bruises or broken bones
passing more or less urine than normal, or problems when urinating
agitation, anxiety, feeling tense and restless, tired, drowsy, lack of energy, irritable,
problems sleeping, headache, nausea and tingling or numbness of the hands and feet
after stopping citalopram.
The above list includes serious side effects that may require medical attention. Serious
side effects are rare.
If any of the following happen, tell your doctor immediately or go to Accident and
Emergency at your nearest hospital:
convulsions (fits or seizures)
a collection of symptoms including weight gain (despite loss of appetite), feeling
and being sick, muscle weakness and irritability
severe rash, with blisters and/ or excessive peeling of skin
a sudden increase in body temperature, very high blood pressure, rigid muscles, nausea/vomiting
and/or fits (convulsions). These symptoms may be signs of a rare condition called
Neuroleptic Malignant Syndrome (a serious reaction to some medicines with a sudden
increase in body temperature, extremely high blood pressure and severe convulsions)
fast, slow or irregular heartbeat, high blood pressure
palpitations, fainting or chest pain
kidney pain, difficulty in passing urine or blood in the urine
severe blisters and bleeding in the lips, eyes, mouth, nose and genitals
fever, sore throat, swollen glands, mouth ulcers, unusual bleeding or bruising under
mood of excitement, over-activity and uninhibited behaviour or aggression
hearing, seeing or feeling things that are not there (hallucinations)
thoughts of suicide or attempting suicide or self-harm
sudden, severe breathing problems
feeling paranoid, panicky, or "high" or having mood swings or feeling more depressed
or in a trance
tremors, movement disorders such as involuntary movements of the muscles or being
jaundice (yellowing of the skin and/or eyes) , with or without other signs of hepatitis
or liver problems (loss of appetite, tiredness, feeling or being sick, dark urine,
stomach pain or swelling, confusion, unconsciousness).
sudden weakness or numbness of the face, arms or legs, especially on one side, slurred
symptoms of an allergic reaction including cough, shortness of breath, wheezing or
difficulty breathing; swelling of the face, lips, tongue, throat or other parts of
the body; rash, itching or hives on the skin
The above list includes very serious side effects. You may need urgent medical attention
or hospitalisation. These side effects are very rare.
Tell your doctor or pharmacist if you notice anything that is making you feel unwell.
Other side effects not listed above may also occur in some people.
Storage and disposal
Keep your medicine in its original packaging until it is time to take it.
If you take your medicine out of its original packaging it may not keep well.
Keep your medicine in a cool dry place where the temperature will stay below 25°C.
Do not store your medicine, or any other medicine, in the bathroom or near a sink.
Do not leave it on a windowsill or in the car.
Heat and dampness can destroy some medicines.
Keep this medicine where children cannot reach it.
A locked cupboard at least one-and-a-half metres above the ground is a good place
to store medicines.
If your doctor or pharmacist tells you to stop taking this medicine or it has passed
its expiry date, your pharmacist can dispose of the remaining medicine safely.
What APO-Citalopram look like
APO-Citalopram 20 mg Tablets
White to off-white, oval, biconvex, film-coated tablets, with BL embossed on one side
and '20' on the other. AUST R 226578. AUST R 233166.
APO-Citalopram 40 mg Tablets
White to off-white, oval, biconvex, film coated tablets with '40' embossed on one
and 'BL' embossed on the other side. AUST R 226579. AUST R 233165.
Available in bottles or blister packs of 28 tablets.
* Not all strengths, pack types and/or pack sizes may be available.
Each tablet contains 20 mg or 40 mg of citalopram (as citalopram hydrobromide) as
the active ingredient.
It also contains the following inactive ingredients:
This medicine is gluten-free, sucrose-free, tartrazine-free and free of other azo
Apotex Pty Ltd
16 Giffnock Avenue,
Macquarie Park NSW 2113
APO is registered trademarks of Apotex Inc.
This leaflet was last updated in July 2020.