Side Effects of Citalopram
Citalopram is generally well-tolerated with primarily mild-to-moderate gastrointestinal and neuropsychiatric side effects that are mostly transient, though cardiovascular monitoring is essential due to potential QT prolongation.
Most Common Side Effects
The most frequently reported adverse effects include:
- Nausea is the most common side effect, occurring in approximately 20% of patients, typically mild-to-moderate and transient 1, 2
- Dry mouth affects 15-18% of patients and is consistently reported across studies 1, 2
- Somnolence occurs frequently, though citalopram is relatively non-sedating compared to tricyclic antidepressants 1, 3
- Increased sweating is experienced by 15-18% of patients 1, 2
- Tremor affects 15-18% of patients 1, 2
- Insomnia occurs in 15-18% of patients despite the drug's non-sedating profile 2, 3
Gastrointestinal Effects
Taking citalopram with food may help reduce nausea and other gastrointestinal symptoms, particularly during the first 1-2 weeks of treatment 4:
- Gastrointestinal side effects are the most common adverse effects of SSRIs and the primary cause of treatment discontinuation 4
- Additional GI effects include increased saliva, flatulence (frequent), and gastritis, gastroenteritis, eructation (infrequent) 1
- Monitor gastrointestinal symptoms especially during the first 1-2 weeks of treatment 4
- In patients with gut-brain interaction disorders (such as irritable bowel syndrome), GI effects may be more pronounced 4
Cardiovascular Effects
QT prolongation is a serious concern that requires monitoring 1:
- Frequent cardiovascular effects include tachycardia, postural hypotension, and hypotension 1
- Infrequent but serious effects include hypertension, bradycardia, angina pectoris, myocardial infarction, and cerebrovascular accident 1
- Rare but life-threatening: ventricular arrhythmia, torsade de pointes, cardiac arrest, and bundle branch block 1
- Only a small, clinically unimportant reduction in heart rate is typically observed 5
Neuropsychiatric Effects
- Frequent: paresthesia, migraine, impaired concentration, amnesia, apathy 1
- Infrequent: hyperkinesia, vertigo, hypertonia, extrapyramidal disorder, leg cramps, involuntary muscle contractions 1
- Psychiatric effects include aggravated depression, suicide attempt, confusion, and rarely hallucination, psychosis, or delusion 1
- Low potential for convulsions and extrapyramidal effects based on monitoring of 10,000 patients 6
Sexual Dysfunction
- Ejaculation failure occurs significantly more frequently than placebo 6
- Female reproductive effects include amenorrhea (frequent), galactorrhea, breast pain, and vaginal hemorrhage (infrequent) 1
Serious but Rare Adverse Events
Monitor for serotonin syndrome, especially with multiple serotonergic medications or dose increases 4:
- Serotonin syndrome can arise within 24-48 hours and includes mental status changes, autonomic instability (tachycardia, labile blood pressure, hyperthermia), and neuromuscular symptoms (tremor, rigidity, myoclonus, hyperreflexia) 4
- Postmarketing reports include acute renal failure, akathisia, anaphylaxis, angioedema, angle closure glaucoma, gastrointestinal hemorrhage, grand mal convulsions, hemolytic anemia, hepatic necrosis, pancreatitis, priapism, rhabdomyolysis, and thrombocytopenia 1
Discontinuation and Withdrawal
- No evidence of significant withdrawal phenomena on abrupt discontinuation based on clinical trial data 6
- Withdrawal syndrome has been reported in postmarketing surveillance 1
Safety Profile Advantages
- Minimal anticholinergic effects compared to tricyclic antidepressants 2
- Not cardiotoxic in therapeutic doses 2
- Relatively wide margin of safety in overdose when taken alone 6
- No clinically relevant effects on laboratory parameters 5, 6
- Little to no effect on psychomotor function 6
- Low discontinuation rate of only 15% for adverse events in clinical trials 3