Citalex 10 mg and 20 mg film-coated tablets – citalopram for depression and panic disorder

Citalex contains citalopram, an antidepressant from the group of selective serotonin reuptake inhibitors (SSRIs). These medicines help correct certain chemical imbalances in the brain that cause the symptoms of depression and anxiety disorders.

In Serbia it is authorised as Citalex 10 mg and Citalex 20 mg film-coated tablets (packs of 20 and 50 tablets) and is a prescription-only medicine. Improvement is usually not felt immediately but after several weeks of regular use.

What is Citalex used for and how should it be taken?

Key facts about the medicine

What is Citalex used for?

• treatment of depression (major depressive episodes) and, once you feel better, prevention of the return of symptoms;
• long-term treatment to prevent new episodes in recurrent depression;
• relief of the symptoms of panic disorder (a tendency to panic attacks).

Your doctor decides whether the medicine is suitable for you.

How is it taken and dosed?

Citalex is taken once a day, at any time of day, with or without food. Swallow the tablets with enough water and do not chew them (they taste bitter).

• Improvement usually begins after the first week and becomes noticeable after the second week or later – keep taking it even if you do not feel better straight away.
• Treatment of depression usually lasts at least 6 months; in recurrent depression your doctor may recommend treatment for several years.
• When treatment is ended, the dose is reduced gradually over one to two weeks or longer.

This is the general dosage from the official documentation – your doctor determines your dose.

Special patient groups

• Children and adolescents under 18: should usually not take the medicine; a higher risk of suicidal behaviour and aggression has been reported, and long-term safety regarding growth and development has not been established.
• Over 65 years: lower dose, maximum 20 mg a day.
• Impaired liver function: maximum 20 mg a day; special caution in severe impairment.
• Impaired kidney function: no dose adjustment in mild to moderate impairment; no data for severe impairment (creatinine clearance below 20 mL/min).

Contraindications – when the medicine must not be used

• allergy (hypersensitivity) to citalopram or any of the excipients
• concomitant use of MAO inhibitors (phenelzine, iproniazid, isocarboxazid, nialamide, tranylcypromine, moclobemide, selegiline above 10 mg a day, linezolid); wait 2 weeks after irreversible MAOIs, at least 1 day after moclobemide, and at least one week after stopping Citalex before taking an MAOI
• congenital or acquired heart rhythm disorder (prolonged QT interval)
• concomitant use of medicines that prolong the QT interval or treat heart rhythm disorders

Warnings and precautions

• bleeding disorders or previous bleeding in the stomach or intestine; pregnancy
• liver or kidney disease; diabetes (diabetes treatment may need adjustment)
• epilepsy or previous seizures; electroconvulsive therapy
• mania or panic disorder; in manic-depressive illness a manic phase may occur
• low blood sodium; low potassium or magnesium (e.g. after severe diarrhoea, vomiting or with diuretics)
• heart disease, recent heart attack, slow heart rate, episodes of fast or irregular heartbeat, fainting or dizziness on standing
• glaucoma or other eye problems
• restlessness and inability to sit or stand still in the first weeks – contact your doctor
• sexual dysfunction, which in some cases continues after stopping treatment

Interactions with other medicines, food and drink

• St John’s wort (Hypericum perforatum) and MAO inhibitors – do not use at the same time
• linezolid; sumatriptan, tramadol, buprenorphine and similar medicines; lithium and tryptophan – risk of serotonin syndrome
• pimozide – do not use at the same time; medicines affecting heart rhythm (class IA and III antiarrhythmics, phenothiazines, haloperidol, tricyclic antidepressants, sparfloxacin, moxifloxacin, IV erythromycin, pentamidine, halofantrine, astemizole, mizolastine) – do not combine
• imipramine, desipramine, selegiline, mefloquine, bupropion, metoprolol, neuroleptics – tell your doctor
• cimetidine, lansoprazole, omeprazole, fluconazole, fluvoxamine and ticlopidine can increase citalopram levels
• anticoagulants, aspirin, NSAIDs (ibuprofen, diclofenac) and other medicines affecting platelets – higher risk of bleeding
• alcohol – it is sensible to avoid it during treatment

Pregnancy and breast-feeding

Citalex should not be taken in pregnancy unless you have discussed the risks and benefits with your doctor. Use in the last 3 months of pregnancy may increase the risk of persistent pulmonary hypertension in the newborn (rapid breathing, bluish skin) and other symptoms in the baby (e.g. seizures, feeding problems, trembling, irritability), and near the end of pregnancy the risk of heavy bleeding after delivery. You should not breast-feed during treatment, as small amounts pass into breast milk. In animal studies citalopram reduced sperm quality.

Driving and using machines

Citalex usually does not affect everyday activities. If you feel dizzy or drowsy at the start of treatment, take care when driving or using machines until these effects pass.

Possible side effects

• Very common: drowsiness, difficulty falling asleep, headache, changes in sleep pattern, weakness, increased sweating, dry mouth, nausea.
• Common: reduced appetite, agitation, reduced libido, anxiety, nervousness, confusion, abnormal dreams, apathy, trembling, tingling or numbness of hands and feet, dizziness, concentration problems, migraine, memory loss, ringing in the ears, palpitations, yawning, runny or blocked nose, diarrhoea, vomiting, constipation, stomach pain, wind, increased salivation, itching, muscle and joint pain, ejaculation and erection problems, inability to reach orgasm in women, tiredness, prickling skin, weight loss.
• Uncommon: easy bruising, increased appetite, aggression, hallucinations, mania, fainting, dilated pupils, fast or slow heart rate, hives, hair loss, rash, sensitivity to sunlight, difficulty urinating, heavy periods, swelling of hands and feet, weight gain.
• Rare: increased libido, seizures, involuntary movements, taste disturbances, bleeding, cough, hepatitis.
• Frequency not known: bleeding after delivery, thoughts of self-harm, low platelet count, low blood potassium or sodium, panic attacks, teeth grinding, akathisia, low blood pressure, nosebleeds, painful erection, milk discharge, irregular periods, increased risk of bone fractures, irregular heart rhythm.

Many milder side effects disappear after a few days of treatment. Report suspected side effects to your doctor, pharmacist or ALIMS.

Overdose, missed dose and stopping treatment

• Overdose: contact your doctor or emergency service immediately, even without symptoms, and take the pack with you. Possible signs include irregular or fast heartbeat, seizures, nausea, vomiting, sweating, drowsiness, unconsciousness, trembling, changes in blood pressure, serotonin syndrome, dilated pupils, bluish skin and rapid breathing.
• Missed dose: take the next dose at the usual time; do not take a double dose.
• Stopping treatment: stopping suddenly can cause dizziness, nausea, tingling, sleep disturbances, agitation, headache, sweating, trembling, confusion, irritability, diarrhoea, visual disturbances and palpitations – so your doctor reduces the dose gradually.

Related information

If you have questions about your treatment or about combining it with other medicines and supplements, ask your doctor or pharmacist – no supplement replaces a prescribed antidepressant.

Composition, pack and manufacturer

• Active substance: citalopram – 10 mg or 20 mg per film-coated tablet (as citalopram hydrobromide).
• Excipients – core: microcrystalline cellulose; mannitol; magnesium stearate; colloidal anhydrous silica. Coating: hypromellose; macrogol 6000; titanium dioxide (E171).
• Pack: carton with 2 or 5 PVC/PVDC-Al blisters of 10 film-coated tablets (20 or 50 tablets).
• Marketing authorisation holder: ACTAVIS D.O.O. BEOGRAD, Đorđa Stanojevića 12, Belgrade. Manufacturer (according to the ALIMS renewal list 2023): Balkanpharma-Dupnitsa AD, Dupnitsa, Bulgaria.

Storage

• This medicine does not require any special storage conditions.
• Keep out of the sight and reach of children.
• Do not use after the expiry date (shelf life: 4 years).

Frequently asked questions

When does Citalex start to work?

Improvement usually begins after the first week and becomes noticeable after the second week or later. At the start some patients may experience increased anxiety, which passes as treatment continues.

How long should Citalex be taken?

Treatment of depression usually lasts at least 6 months, and longer in recurrent depression. Your doctor decides the duration.

Can I stop taking Citalex suddenly?

No. Stopping suddenly can cause withdrawal symptoms (dizziness, tingling, sleep disturbances, agitation). Your doctor reduces the dose gradually over one to two weeks or longer.

Can I take St John’s wort with Citalex?

No – according to the leaflet, St John’s wort should not be used at the same time as Citalex.

Sources

• ALIMS – Summary of Product Characteristics Citalex®, 10 mg and 20 mg, film-coated tablets (August 2023, Serbian)
• ALIMS – Patient leaflet Citalex®, 10 mg and 20 mg, film-coated tablets (August 2023, Serbian)
• ALIMS – Summary of Product Characteristics Citalex®, 20 mg (document for the 20 mg authorisation, Serbian)
• ALIMS – Patient leaflet Citalex®, 20 mg (document for the 20 mg authorisation, Serbian)

Sources checked on: 24 October 2026.