Citalopram HBr is an antidepressant from the family of drugs known as selective serotonin reuptake inhibitors or SSRIs. Citalopram HBr helps restore the brain’s chemical balance by increasing the supply of a chemical messenger in the brain called serotonin. Citalopram HBr appears to relieve depression by increasing serotonin with minimal effect on many of the other chemicals in the brain.

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Suicidality in Children and Adolescents

Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with Major Depressive Disorder (MDD) and other psychiatric disorders. Anyone considering the use of Citalopram or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Citalopram is not approved for use in pediatric patients. (See Warnings and Precautions: Pediatric Use)

Pooled analyses of short-term (4 to 16 weeks) placebo-controlled trials of 9 antidepressant drugs (SSRIs and others) in children and adolescents with major depressive disorder (MDD), obsessive compulsive disorder (OCD), or other psychiatric disorders (a total of 24 trials involving over 4400 patients) have revealed a greater risk of adverse events representing suicidal thinking or behavior (suicidality) during the first few months of treatment in those receiving antidepressants. The average risk of such events in patients receiving antidepressants was 4%, twice the placebo risk of 2%. No suicides occurred in these trials.

Adults with Major Depressive Disorder may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality), whether or not they are taking antidepressant medications, and this risk may persist until significant remission occurs. Patients being treated with antidepressants should be observed closely for clinical worsening and suicidality, especially at the beginning of a course of drug therapy, or at the time of dose changes, either increases or decreases. Citalopram is contraindicated in patients taking monoamine oxidase inhibitors (MAOIs), pimozide (see DRUG INTERACTIONS), or in patients with a hypersensitivity to citalopram hydrobromide. As with other SSRIs, caution is indicated in the coadministration of tricyclic antidepressants (TCAs) with Citalopram. As with other psychotropic drugs that interfere with serotonin reuptake, patients should be cautioned regarding the risk of bleeding associated with the concomitant use of Citalopram with NSAIDs, aspirin, or other drugs that affect coagulation. The most frequent adverse events reported with Citalopram vs placebo in clinical trials were nausea (21% vs 14%), dry mouth (20% vs 14%), somnolence (18% vs 10%), insomnia (15% vs 14%), increased sweating (11% vs 9%), tremor (8% vs 6%), diarrhea (8% vs 5%), and ejaculation disorder (6% vs 1%).