Cipramil 40mg/Ml Oral Drops
PACKAGE LEAFLET: INFORMATION FOR THE USER
CIPRAMIL® 40MG/ML ORAL DROPS
(citalopram hydrochloride)
Your medicine is available using the name Cipramil 40mg/ml Oral Drops, but will be referred to as Cipramil throughout the Leaflet.
Read all of this leaflet carefully before you start taking this medicine
■ Keep this leaflet. You may need to read it again.
■ If you have further questions, please ask your doctor or pharmacist.
■ This medicine has been prescribed for you. Do not pass it on to others. It may harm them, even if their symptoms are the same as yours.
■ If any of the side effects are troubling, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.
In this leaflet:
1. What Cipramil is and what it is used for
2. Before you take Cipramil
3. How to take Cipramil
4. Possible side effects
5. How to store Cipramil
6. Further information
1. What Cipramil is and what it is used for
How does Cipramil work?
Cipramil is a Selective Serotonin Reuptake Inhibitor (SSRI) and belongs to a group of medicines known as antidepressants.
These medicines help to correct certain chemical imbalances in the brain that are causing the symptoms of your illness.
What is Cipramil used for?
Cipramil contains citalopram and is used for the treatment of depression and, when you feel better, to help prevent these symptoms recurring. Cipramil is also used for long-term treatment to prevent the occurrence of new episodes of depression or if you have recurrent depression.
Cipramil is also beneficial in relieving symptoms if you tend to suffer from panic attacks.
2. Before you take Cipramil
Do not take Cipramil
■ If you are allergic (hypersensitive) to citalopram, or any of the other ingredients of Cipramil (see What Cipramil contain, section 6). Consult your doctor if you think you might be.
■ If you are also taking a medicine containing pimozide. Talk to your doctor.
■ 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 Cipramil. One day must elapse after you have finished taking moclobemide. After stopping Cipramil 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. Also refer to the section "Taking other medicines".
Take special care with Cipramil
Please tell your doctor if you have any medical problems, especially if you have:
■ Liver disease
■ Kidney disease
■ Diabetes (you may need an adjustment of your antidiabetic therapy)
■ Epilepsy or a history of seizures or fits
■ If you are receiving electroconvulsive treatment
■ A bleeding disorder or have ever suffered from bleeding in the stomach or intestine
■ Mania or panic disorder
■ Low blood levels of sodium
■ ECT (electroconvulsive therapy)
■ Problems with your eyes, such as certain kinds of glaucoma
■ 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 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.
Please consult your doctor, even if these statements were applicable to you at any time in the past.
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 Cipramil treatment it may take several weeks before you experience any improvement. In the beginning 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 Cipramil 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 for patients under 18 because he/she decides that this is in their best interests. If your doctor has prescribed Cipramil 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 Cipramil. Also, the long-term safety effects concerning growth, maturation and cognitive and behavioural development of Cipramil in this age group have not yet been demonstrated.
Taking other medicines
Medicines may affect the action of other medicines and this can sometimes cause serious adverse reactions.
Please tell your doctor or pharmacist if you are taking or have taken any other medicines (including those purchased without prescription) during the last 14 days. This includes other medicines for depression (see Do not take Cipramil above).
■ The herbal remedy St John's wort (Hypericum perforatum). This should not be taken at the same time as Cipramil.
■ Monoamine oxidase inhibitors (MAOIs). These should not be taken at the same time as Cipramil (see Do not take Cipramil above).
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 Cipramil you should see your doctor.
■ Lithium (used to prevent and treat mania) and tryptophan (an anti-depressant).
■ Pimozide (a neuroleptic). This should not be taken at the same time as Cipramil (see Do not take Cipramil above).
■ Imipramine and desipramine (used to treat depression).
■ Medicines containing selegiline (used to treat Parkinson's disease).
■ Cimetidine (used to treat stomach ulcers).
■ 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 Cipramil 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. fentiazine derivatives, pimozide, haloperidol), tricyclic antidepressants, certain antimicrobial agents (e.g. sparfloxacin, moxifloxacin, erythromycin IV, pentamidine, anti-malarian treatment particularly halofantrine), certain antihistamines (astemizole, mizolastine). If you have any further questions about this you should speak to your doctor.
Taking Cipramil with food and drink
Cipramil can be taken with or without food (see section 3 "How to take Cipramil").
As with all antidepressants, it is sensible to avoid drinking alcohol whilst receiving treatment although Cipramil has not been shown to increase the effects of alcohol.
Pregnancy
Ask your doctor or pharmacist for advice before taking any medicine.
If you are pregnant, think you might be pregnant, or are trying to become pregnant, tell your doctor. Do not take Cipramil if you are pregnant unless you and your doctor have discussed the risks and benefits involved.
Make sure your midwife and/or doctor know you are on Cipramil. When taken during pregnancy, particularly in the last 3 months of pregnancy, medicines like Cipramil 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. Also, if you take Cipramil 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.
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 Cipramil because small amounts of the medicine can pass into the breast milk.
Driving and using machines
Cipramil does 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.
Important information about some of the ingredients of Cipramil
This medicinal product contains small amounts of ethanol (alcohol), less than 100mg in all doses. These drops also contain the preservatives E216 and E218, which may cause allergic reactions (possibly delayed).
3. How to take Cipramil
How much to take
It is important to take your drops as instructed by your doctor.
The label will tell you how many to take and how often. If it does not, or you are not sure, ask your doctor or pharmacist.
Adults
Depression
The usual dose is 16mg (8 drops) per day. This may be increased by your doctor to a maximum of 32mg (16 drops) per day.
Panic disorder
The starting dose is 8mg (4 drops) per day for the first week before increasing the dose to between 16-24mg (8-12 drops) per day. The dose may be increased by your doctor to a maximum of 32mg (16 drops) per day.
Elderly patients (above 65 years of age)
The starting dose should be decreased to half of the recommended dose e.g. 8-16mg per day.
Elderly patients should not usually receive more than 16mg (8 drops) per day.
Children and adolescents (< 18 years)
Cipramil should not be given to children or adolescents under 18 years of age. For further information, please see section 2,
Before you take Cipramil.
Patients with special risks
Patients with liver complaints should not receive more than 16mg (8 drops) per day.
If you have previously taken Cipramil tablets, you will find that the dose of your medicine in mg given as drops is a bit lower than that of tablets. This is because your body more easily absorbs the drops than the tablets, so you do not need as many mg to have the same effect.
The doses of tablets correspond to doses of drops as follows:
|
Tablets |
Drops |
|
10mg |
8mg (4 drops) |
|
20mg |
16mg (8 drops) |
|
30mg |
24mg (12 drops) |
|
40mg |
32mg (16 drops) |
How and when to take Cipramil
The drops are for oral use and can be taken in a drink of water, or orange or apple juice.
Cipramil is taken every day as one dose at any time of the day.
Duration of treatment
Like other medicines for depression and panic disorder these drops may take a few weeks before you feel any improvement. Continue to take Cipramil even if it takes some time before you feel any improvement in your condition.
The duration of treatment is individual, usually at least 6 months. Continue to take the drops for as long as your doctor recommends. Do not stop taking them even if you begin to feel better, unless you are told to do so by your doctor. The underlying illness may persist for a long time and if you stop your treatment too soon your symptoms may return.
Patients who have recurrent depression benefit from continued treatment, sometimes for several years, to prevent the occurrence of new depressive episodes.
Never change the dose of the medicine without talking to your doctor first.
If you take more Cipramil than you should
If you think that you or anyone else may have taken too many Cipramil, contact your doctor or nearest hospital emergency department immediately. Do this even if there are no signs of discomfort or poisoning. Take the Cipramil box/container with you if you go to a doctor or hospital. Some of the signs of an overdosage could be life-threatening.
Symptoms of overdosage may include:
■ Irregular heart beat
■ Seizures
■ Changes in heart rhythm
■ Feeling sick (nausea)
■ Vomiting
■ Sweating
■ Drowsiness
■ Unconsciousness
■ Fast heart beats
■ Tremor
■ Changes in blood pressure
■ Serotonin syndrome (see Section 4)
■ Agitation
■ Dizziness
■ Enlarged eye pupils
■ Bluish skin
■ Breathing too quickly
If you forget to take Cipramil
If you forget to take a dose, take the next dose at the usual time. Do not take a double dose.
Effects when treatment with Cipramil is stopped
Stopping this medicine quickly may cause symptoms such as dizziness, nausea and numbness or tingling in hands or feet, sleep disturbances (vivid dreams, nightmares, inability to sleep), feeling anxious, headaches, feeling or being sick, sweating, feeling restless or agitated, tremor, feeling confused or disorientated, feeling emotional or irritable, diarrhoea (loose stools), visual disturbances, fluttering or pounding heartbeat (palpitations).
These are usually non-serious and disappear within a few days. When you have completed your course of treatment, the dose of Cipramil is usually reduced gradually over a couple of weeks.
If you have any further questions on the use of this product, ask your doctor or pharmacist.
4. Possible side effects
Like all medicines, Cipramil can have side effects and some people may experience unwanted effects (side effects) whilst taking Cipramil. Several of the effects listed below can also be symptoms of your illness and may disappear as you start to get better.
Serious side effects
Stop taking Cipramil and seek medical advice immediately if you have any of the following allergic reactions:
■ Difficulty in breathing.
■ Swelling of the face, lips, tongue or throat that causes difficulty in swallowing or breathing.
■ Severe itching of the skin (with raised lumps).
■ Fast irregular heart beat, fainting which could be symptoms of a life threatening condition known as torsades de pointes.
If you notice any of the following you should contact your doctor immediately as your dose may need to be reduced or stopped:
■ You start having fits for the first time or fits that you have suffered from in the past before become more frequent.
■ Your behaviour changes because you feel elated or over excited.
■ You experience high fever, agitation, confusion, and trembling or abrupt contractions of muscles. These may be signs of a rare condition called serotonin syndrome.
■ Tiredness, confusion and twitching of your muscles. These may be signs of a low blood level of sodium.
If you have thoughts of harming or killing yourself at any time, contact your doctor or go to a hospital straight away.
The following side effects are often mild and usually disappear after a few days' treatment.
Very common side effects (likely to affect more than 1 in 10 people)
■ Sleepiness
■ Difficulty in sleeping
■ Increased sweating
■ Dry mouth (a dry mouth increases the risk of tooth decay, so be sure to clean your teeth more often than usual)
■ Feeling sick (nausea)
Common side effects (likely to affect up to 1 in 10 people)
■ Lack of appetite
■ Agitation
■ Decreased sex drive
■ Anxiety
■ Nervousness
■ Confusion
■ Abnormal dreams
■ Tremor
■ Tingling or numbness in the hands or feet
■ Ringing in the ears (tinnitus)
■ Yawning
■ Diarrhoea
■ Vomiting
■ Constipation
■ Itching
■ Pain in muscles and joints
■ For men, problems with ejaculation and erection
■ For females, failing to reach an orgasm
■ Tiredness
■ Prickling of the skin
■ Loss of weight
Uncommon (likely to affect up to 1 in every 100 people)
■ Bruising easily
■ Increased appetite
■ Aggression
■ Reduced emotions, indifference
■ Hallucinations
■ Mania
■ Fainting
■ Large pupils (the dark centre of the eye)
■ Fast heart beat
■ Slow heart beat
■ Nettle rash
■ Loss of hair
■ Rash
■ Sensitivity to sunlight
■ Difficulties urinating
■ Vaginal bleeding
■ Swelling of the arms or legs
■ Increased weight
Rare (likely to affect up to 1 in every 1000 people)
■ Convulsions
■ Involuntary movements
■ Taste disturbances
■ Bleeding
■ Hepatitis
Some patients have reported (frequency not known)
■ Thoughts of harming or killing themselves
■ An increase in bleeding or bruising caused by a decrease in blood platelets
■ Rash (hypersensitivity)
■ Low potassium levels in the blood (hypokalaemia), which can cause muscle weakness, twitching or abnormal heart rhythms
■ Panic attack
■ Grinding teeth
■ Restlessness
■ Unusual muscle movements or stiffness
■ Involuntary movements of the muscles (akathisia)
■ Low blood pressure
■ Nosebleed
■ Bleeding disorders including skin and mucosal bleeding (ecchymosis)
■ Sudden swelling of skin or mucosa
■ In men, painful erections
■ Flow of breast milk in men or in women who are not breastfeeding (galactorrhoea)
■ Abnormal liver function tests
■ An increased risk of bone fractures has been observed in
patients taking this type of medicines
SSRIs can, very rarely, increase the risk of bleeding, including stomach or intestinal bleeding. Let your doctor know if you vomit blood or develop black or blood stained stools.
Also let your doctor know if you continue to have other symptoms associated with your depression. This might include hallucinations, anxiety, mania or confusion.
Any side effects that do occur will usually disappear after a few days. If they are troublesome or persistent, or if you develop any other unusual side effects while taking Cipramil, please tell your doctor.
If you notice any other side effects not mentioned in this leaflet please tell your doctor or pharmacist.
5. How to store Cipramil
■ Keep out of the reach and sight of children.
■ Do not store above 25°C.
■ After first opening use within 16 weeks.
■ If your doctor tells you to stop taking your medicine, return any left-over medicine to the pharmacist, unless the doctor tells you to keep it at home.
■ If your medicine appears to be discoloured, damaged or shows any other signs of deterioration, please return it to your pharmacist who will advise you.
■ Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.
6. Further information
What Cipramil contains
Each ml of the solution contains 40mg of citalopram (as hydrochloride) as the active ingredient.
The other ingredients are: methyl parahydroxybenzoate, propyl parahydroxybenzoate, ethanol, hydroxyethylcellulose and purified water.
What Cipramil looks like and contents of the pack
Cipramil is a colourless solution which is available in an amber glass bottle with a child resistant screw cap and a polyethylene dropper.
Cipramil is available in a pack size of 15ml.
Manufacturer
Cipramil is manufactured by: H. Lundbeck A/S, Ottiliavej 9, Valby, Copenhagen, DK-2500, Denmark.
Procured from within the EU and repackaged by: Doncaster Pharmaceuticals Group Ltd., Kirk Sandall, Doncaster, DN3 1QR.
Product Licence holder: Landmark Pharma Ltd., 7 Regents Drive, Prudhoe, Northumberland, NE42 6PX.
PL No: 21828/0361 POM
Leaflet revision and issue date: 28.12.12
Cipramil® is a registered trademark of H. Lundbeck A/S.
PACKAGE LEAFLET: INFORMATION FOR THE USER
CITALOPRAM 40MG/ML ORAL DROPS
Your medicine is available using the name Citalopram 40mg/ml Oral Drops, but will be referred to as Citalopram Drops throughout the Leaflet.
Read all of this leaflet carefully before you start taking this medicine
■ Keep this leaflet. You may need to read it again.
■ If you have further questions, please ask your doctor or pharmacist.
■ This medicine has been prescribed for you. Do not pass it on to others. It may harm them, even if their symptoms are the same as yours.
■ If any of the side effects are troubling, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.
In this leaflet:
1. What Citalopram Drops are and what they are used for
2. Before you take Citalopram Drops
3. How to take Citalopram Drops
4. Possible side effects
5. How to store Citalopram Drops
6. Further information
1. What Citalopram Drops are and what it they are used for
How do Citalopram Drops work?
Citalopram Drops are a Selective Serotonin Reuptake Inhibitor (SSRI) and belongs to a group of medicines known as antidepressants.
These medicines help to correct certain chemical imbalances in the brain that are causing the symptoms of your illness.
What are Citalopram Drops used for?
Citalopram Drops contain citalopram and is used for the treatment of depression and, when you feel better, to help prevent these symptoms recurring. Citalopram Drops are also used for longterm treatment to prevent the occurrence of new episodes of depression or if you have recurrent depression.
Citalopram Drops are also beneficial in relieving symptoms if you tend to suffer from panic attacks.
2. Before you take Citalopram Drops
Do not take Citalopram Drops
■ If you are allergic (hypersensitive) to citalopram, or any of the other ingredients of Citalopram Drops (see What Citalopram Drops contain, section 6). Consult your doctor if you think you might be.
■ If you are also taking a medicine containing pimozide. Talk to your doctor.
■ 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 Citalopram Drops. One day must elapse after you have finished taking moclobemide. After stopping Citalopram Drops 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. Also refer to the section "Taking other medicines".
Take special care with Citalopram Drops
Please tell your doctor if you have any medical problems, especially if you have:
■ Liver disease
■ Kidney disease
■ Diabetes (you may need an adjustment of your antidiabetic therapy)
■ Epilepsy or a history of seizures or fits
■ If you are receiving electroconvulsive treatment
■ A bleeding disorder or have ever suffered from bleeding in the stomach or intestine
■ Mania or panic disorder
■ Low blood levels of sodium
■ ECT (electroconvulsive therapy)
■ Problems with your eyes, such as certain kinds of glaucoma
■ 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 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.
Please consult your doctor, even if these statements were applicable to you at any time in the past.
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 Drops treatment it may take several weeks before you experience any improvement. In the beginning 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 Drops 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 Drops for patients under 18 because he/she decides that this is in their best interests. If your doctor has prescribed Citalopram Drops 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 Drops. Also, the longterm safety effects concerning growth, maturation and cognitive and behavioural development of Citalopram Drops in this age group have not yet been demonstrated.
Taking other medicines
Medicines may affect the action of other medicines and this can sometimes cause serious adverse reactions.
Please tell your doctor or pharmacist if you are taking or have taken any other medicines (including those purchased without prescription) during the last 14 days. This includes other medicines for depression (see Do not take Citalopram Drops above).
■ The herbal remedy St John's wort (Hypericum perforatum). This should not be taken at the same time as Citalopram Drops.
■ Monoamine oxidase inhibitors (MAOIs). These should not be taken at the same time as Citalopram Drops (see Do not take Citalopram Drops above).
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 Drops you should see your doctor.
■ Lithium (used to prevent and treat mania) and tryptophan (an anti-depressant).
■ Pimozide (a neuroleptic). This should not be taken at the same time as Citalopram Drops (see Do not take Citalopram Drops above).
■ Imipramine and desipramine (used to treat depression).
■ Medicines containing selegiline (used to treat Parkinson's disease).
■ Cimetidine (used to treat stomach ulcers).
■ 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 Drops 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. fentiazine derivatives, pimozide, haloperidol), tricyclic antidepressants, certain antimicrobial agents (e.g. sparfloxacin, moxifloxacin, erythromycin IV, pentamidine, anti-malarian treatment particularly halofantrine), certain antihistamines (astemizole, mizolastine). If you have any further questions about this you should speak to your doctor.
Taking Citalopram Drops with food and drink
Citalopram Drops can be taken with or without food (see section 3 "How to take Citalopram Drops").
As with all antidepressants, it is sensible to avoid drinking alcohol whilst receiving treatment although Citalopram Drops has not been shown to increase the effects of alcohol.
Pregnancy
Ask your doctor or pharmacist for advice before taking any medicine.
If you are pregnant, think you might be pregnant, or are trying to become pregnant, tell your doctor. Do not take Citalopram Drops if you are pregnant unless you and your doctor have discussed the risks and benefits involved.
Make sure your midwife and/or doctor know you are on Citalopram Drops. When taken during pregnancy, particularly in the last 3 months of pregnancy, medicines like Citalopram Drops 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. Also, if you take Citalopram Drops 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.
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 Drops because small amounts of the medicine can pass into the breast milk.
Driving and using machines
Citalopram Drops 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.
Important information about some of the ingredients of Citalopram Drops
This medicinal product contains small amounts of ethanol (alcohol), less than 100mg in all doses. These drops also contain the preservatives E216 and E218, which may cause allergic reactions (possibly delayed).
3. How to take Citalopram Drops
How much to take
It is important to take your drops as instructed by your doctor.
The label will tell you how many to take and how often. If it does not, or you are not sure, ask your doctor or pharmacist.
Adults
Depression
The usual dose is 16mg (8 drops) per day. This may be increased by your doctor to a maximum of 32mg (16 drops) per day.
Panic disorder
The starting dose is 8mg (4 drops) per day for the first week before increasing the dose to between 16-24mg (8-12 drops) per day. The dose may be increased by your doctor to a maximum of 32mg (16 drops) per day.
Elderly patients (above 65 years of age)
The starting dose should be decreased to half of the recommended dose e.g. 8-16mg per day.
Elderly patients should not usually receive more than 16mg (8 drops) per day.
Children and adolescents (< 18 years)
Citalopram Drops should not be given to children or adolescents under 18 years of age. For further information, please see section 2, Before you take Citalopram Drops.
Patients with special risks
Patients with liver complaints should not receive more than 16mg (8 drops) per day.
POM
If you have previously taken Citalopram tablets, you will find that the dose of your medicine in mg given as drops is a bit lower than that of tablets. This is because your body more easily absorbs the drops than the tablets, so you do not need as many mg to have the same effect.
The doses of tablets correspond to doses of drops as follows:
|
Tablets |
Drops |
|
10mg |
8mg (4 drops) |
|
20mg |
16mg (8 drops) |
|
30mg |
24mg (12 drops) |
|
40mg |
32mg (16 drops) |
How and when to take Citalopram Drops
The drops are for oral use and can be taken in a drink of water, or orange or apple juice.
Citalopram Drops are taken every day as one dose at any time of the day.
Duration of treatment
Like other medicines for depression and panic disorder these drops may take a few weeks before you feel any improvement. Continue to take Citalopram Drops even if it takes some time before you feel any improvement in your condition.
The duration of treatment is individual, usually at least 6 months. Continue to take the drops for as long as your doctor recommends. Do not stop taking them even if you begin to feel better, unless you are told to do so by your doctor. The underlying illness may persist for a long time and if you stop your treatment too soon your symptoms may return.
Patients who have recurrent depression benefit from continued treatment, sometimes for several years, to prevent the occurrence of new depressive episodes.
Never change the dose of the medicine without talking to your doctor first.
If you take more Citalopram Drops than you should
If you think that you or anyone else may have taken too many Citalopram Drops, contact your doctor or nearest hospital emergency department immediately. Do this even if there are no signs of discomfort or poisoning. Take the Citalopram Drops box/container with you if you go to a doctor or hospital. Some of the signs of an overdosage could be life-threatening.
Symptoms of overdosage may include:
■ Irregular heart beat
■ Seizures
■ Changes in heart rhythm
■ Feeling sick (nausea)
■ Vomiting
■ Sweating
■ Drowsiness
■ Unconsciousness
■ Fast heart beats
■ Tremor
■ Changes in blood pressure
■ Serotonin syndrome (see Section 4)
■ Agitation
■ Dizziness
■ Enlarged eye pupils
■ Bluish skin
■ Breathing too quickly
If you forget to take Citalopram Drops
If you forget to take a dose, take the next dose at the usual time. Do not take a double dose.
Effects when treatment with Citalopram Drops is stopped
Stopping this medicine quickly may cause symptoms such as dizziness, nausea and numbness or tingling in hands or feet, sleep disturbances (vivid dreams, nightmares, inability to sleep), feeling anxious, headaches, feeling or being sick, sweating, feeling restless or agitated, tremor, feeling confused or disorientated, feeling emotional or irritable, diarrhoea (loose stools), visual disturbances, fluttering or pounding heartbeat (palpitations).
These are usually non-serious and disappear within a few days. When you have completed your course of treatment, the dose of Citalopram Drops is usually reduced gradually over a couple of weeks.
If you have any further questions on the use of this product, ask your doctor or pharmacist.
4. Possible side effects
Like all medicines, Citalopram Drops can have side effects and some people may experience unwanted effects (side effects) whilst taking Citalopram Drops. Several of the effects listed below can also be symptoms of your illness and may disappear as you start to get better.
Serious side effects
Stop taking Citalopram Drops and seek medical advice immediately if you have any of the following allergic reactions:
■ Difficulty in breathing.
■ Swelling of the face, lips, tongue or throat that causes difficulty in swallowing or breathing.
■ Severe itching of the skin (with raised lumps).
■ Fast irregular heart beat, fainting which could be symptoms of a life threatening condition known as torsades de pointes.
If you notice any of the following you should contact your doctor immediately as your dose may need to be reduced or stopped:
■ You start having fits for the first time or fits that you have suffered from in the past before become more frequent.
■ Your behaviour changes because you feel elated or over excited.
■ You experience high fever, agitation, confusion, and trembling or abrupt contractions of muscles. These may be signs of a rare condition called serotonin syndrome.
■ Tiredness, confusion and twitching of your muscles. These may be signs of a low blood level of sodium.
If you have thoughts of harming or killing yourself at any time, contact your doctor or go to a hospital straight away.
The following side effects are often mild and usually disappear after a few days' treatment.
Very common side effects (likely to affect more than 1 in 10 people)
■ Sleepiness
■ Difficulty in sleeping
■ Increased sweating
■ Dry mouth (a dry mouth increases the risk of tooth decay, so be sure to clean your teeth more often than usual)
■ Feeling sick (nausea)
Common side effects (likely to affect up to 1 in 10 people)
■ Lack of appetite
■ Agitation
■ Decreased sex drive
■ Anxiety
■ Nervousness
■ Confusion
■ Abnormal dreams
■ Tremor
■ Tingling or numbness in the hands or feet
■ Ringing in the ears (tinnitus)
■ Yawning
■ Diarrhoea
■ Vomiting
■ Constipation
■ Itching
■ Pain in muscles and joints
■ For men, problems with ejaculation and erection
■ For females, failing to reach an orgasm
■ Tiredness
■ Prickling of the skin
■ Loss of weight
Uncommon (likely to affect up to 1 in every 100 people)
■ Bruising easily
■ Increased appetite
■ Aggression
■ Reduced emotions, indifference
■ Hallucinations
■ Mania
■ Fainting
■ Large pupils (the dark centre of the eye)
■ Fast heart beat
■ Slow heart beat
■ Nettle rash
■ Loss of hair
■ Rash
■ Sensitivity to sunlight
■ Difficulties urinating
■ Vaginal bleeding
■ Swelling of the arms or legs
■ Increased weight
Rare (likely to affect up to 1 in every 1000 people)
■ Convulsions
■ Involuntary movements
■ Taste disturbances
■ Bleeding
■ Hepatitis
Some patients have reported (frequency not known)
■ Thoughts of harming or killing themselves
■ An increase in bleeding or bruising caused by a decrease in blood platelets
■ Rash (hypersensitivity)
■ Low potassium levels in the blood (hypokalaemia), which can cause muscle weakness, twitching or abnormal heart rhythms
■ Panic attack
■ Grinding teeth
■ Restlessness
■ Unusual muscle movements or stiffness
■ Involuntary movements of the muscles (akathisia)
■ Low blood pressure
■ Nosebleed
■ Bleeding disorders including skin and mucosal bleeding (ecchymosis)
■ Sudden swelling of skin or mucosa
■ In men, painful erections
■ Flow of breast milk in men or in women who are not breastfeeding (galactorrhoea)
■ Abnormal liver function tests
■ An increased risk of bone fractures has been observed in
patients taking this type of medicines
SSRIs can, very rarely, increase the risk of bleeding, including stomach or intestinal bleeding. Let your doctor know if you vomit blood or develop black or blood stained stools.
Also let your doctor know if you continue to have other symptoms associated with your depression. This might include hallucinations, anxiety, mania or confusion.
Any side effects that do occur will usually disappear after a few days. If they are troublesome or persistent, or if you develop any other unusual side effects while taking Citalopram Drops, please tell your doctor.
If you notice any other side effects not mentioned in this leaflet please tell your doctor or pharmacist.
5. How to store Citalopram Drops
■ Keep out of the reach and sight of children.
■ Do not store above 25°C.
■ After first opening use within 16 weeks.
■ If your doctor tells you to stop taking your medicine return any left-over medicine to the pharmacist, unless the doctor tells you to keep it at home.
■ If your medicine appears to be discoloured, damaged or shows any other signs of deterioration, please return it to your pharmacist who will advise you.
■ Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.
6. Further information
What Citalopram Drops contain
Each ml of the solution contains 40mg of citalopram (as hydrochloride) as the active ingredient.
The other ingredients are: methyl parahydroxybenzoate, propyl parahydroxybenzoate, ethanol, hydroxyethylcellulose and purified water.
What Citalopram Drops look like and contents of the pack
Citalopram Drops are a colourless solution which is available in an amber glass bottle with a child resistant screw cap and a polyethylene dropper.
Citalopram Drops are available in a pack size of 15ml.
Manufacturer
Citalopram Drops are manufactured by: H. Lundbeck A/S, Ottiliavej 9, Valby, Copenhagen, DK-2500, Denmark.
Procured from within the EU and repackaged by: Doncaster Pharmaceuticals Group Ltd., Kirk Sandall, Doncaster, DN3 1QR.
Product Licence holder: Landmark Pharma Ltd., 7 Regents Drive, Prudhoe, Northumberland, NE42 6PX.
PL No: 21828/0361
Leaflet revision and issue date: 28.12.12
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