CITALOPRAM SANDOZ 20 mg FILM-COATED TABLETS

Introduction

Prospective: Information for the User

Citalopram Sandoz 20 mg film-coated tablets EFG

Citalopram Sandoz 30 mg film-coated tablets EFG

Read the entire prospectus carefully before starting to take this medication, as it contains important information for you.

• Keep this prospectus, as you may need to read it again.
• If you have any doubts, consult your doctor or pharmacist.
• This medication has been prescribed to you only, and you should not give it to others, even if they have the same symptoms as you, as it may harm them.
• If you experience adverse effects, consult your doctor or pharmacist, even if they are not listed in this prospectus. See section 4.

Contents of the Prospectus:

1. What Citalopram Sandoz is and what it is used for.
2. What you need to know before taking Citalopram Sandoz.
3. How to take Citalopram Sandoz.
4. Possible adverse effects.
5. Storage of Citalopram Sandoz.
6. Package contents and additional information.

1. What Citalopram Sandoz is and what it is used for

Citalopram is a selective serotonin reuptake inhibitor (SSRI) and belongs to the group of medications known as antidepressants. These medications help correct certain chemical imbalances in the brain that cause the symptoms of your illness.

Citalopram is indicated for the treatment of:

• Depression and prevention of relapses and recurrences.
• Anxiety disorder with or without agoraphobia.
• Obsessive-compulsive disorder (OCD).

Your doctor may prescribe citalopram for any other purpose. Ask your doctor if you have any doubts about why you have been prescribed citalopram.

2. What you need to know before taking Citalopram Sandoz

Do not take Citalopram Sandoz

• If you are allergic to citalopram or any of the other components of this medication (listed in section 6),
• If you are taking other medications that belong to a group called monoamine oxidase inhibitors (MAOIs). MAOIs include medications such as phenelzine, iproniazid, isocarboxazid, nialamide, tranylcypromine, selegiline (for the treatment of Parkinson's disease), moclobemide (for the treatment of depression), and linezolid (an antibiotic).
• If you have had any heart rhythm disorders since birth or have ever had any episodes of this type (as observed with an electrocardiogram, a test used to evaluate heart function).
• If you are taking medications for a condition that affects heart rhythm.
• If you are taking medications that may affect heart rhythm.
  • Also, consult the section "Other medications and Citalopram Sandoz" below.

Even if you have finished treatment with MAOIs, you need to wait 2 weeks before starting treatment with citalopram.

You must wait one day after taking moclobemide.

After finishing citalopram, you must wait one week before taking any MAOI.

Warnings and precautions

Consult your doctor or pharmacist before starting to take Citalopram Sandoz.

Please inform your doctor if you have any other condition or illness, as your doctor may need to take it into consideration. In particular, inform your doctor:

• If you have manic episodes or anxiety disorder.
• If you have liver or kidney failure. Your doctor may need to adjust the dose.
• If you have diabetes. Treatment with citalopram may alter blood sugar control. You may need an adjustment of insulin and/or oral hypoglycemic doses.
• If you have epilepsy. Treatment with citalopram should be discontinued if seizures occur or if there is an increase in the frequency of seizures (see also section 4 "Possible adverse effects").
• If you have a history of bleeding disorders, if you develop unusual bruises, or if you are pregnant (see "Pregnancy, breastfeeding, and fertility").
• If you have low sodium levels in the blood.
• If you are receiving electroconvulsive therapy.
• If you have or have had any heart problems or have recently had a heart attack.
• If your heart beats slowly when you are at rest (known as bradycardia) and/or you think your body may be losing salt, for example, because you have had intense diarrhea and vomiting for several days or because you have used diuretics (medications to urinate).
• If you have noticed that your heartbeats are fast or irregular or if you have fainted or felt dizzy when getting up from a sitting or lying position. This could indicate that you have a heart rhythm disorder.
• If you have a problem with dilation of the eye pupils (mydriasis).

Consult your doctor, even if any of the above circumstances have occurred to you in the past.

Some patients with manic-depressive illness may enter a manic phase. This is characterized by a change in ideas that is uncommon and rapid, disproportionate joy, and excessive physical activity. If you experience this, contact your doctor.

Symptoms such as restlessness or difficulty sitting or standing (akathisia) may also occur during the first few weeks of treatment. Inform your doctor immediately if you experience these symptoms.

Some medications in the same group as citalopram (called SSRIs/SNRIs) may cause symptoms of sexual dysfunction (see section 4). In some cases, these symptoms persist after treatment is discontinued.

Special information related to your illness

Like other medications for the treatment of depression or related illnesses, improvement is not immediate. After starting treatment with citalopram, it may take several weeks before you experience any improvement.

In the treatment of anxiety disorder, it usually takes 2 to 4 weeks before any improvement is observed.

At the start of treatment, some patients may experience an increase in anxiety, which disappears with continued treatment. Therefore, it is very important that you follow your doctor's instructions exactly and do not interrupt treatment or change the dose without consulting your doctor.

Suicidal thoughts and worsening of your depression or anxiety disorder

If you are depressed and/or suffer from an anxiety disorder, you may occasionally have thoughts of harming yourself or taking your own life. These may increase when taking antidepressants for the first time, as all these medications require time to start working, usually around two weeks, although in some cases it may be longer.

You would be more likely to have these types of thoughts:

• If you have previously had thoughts of taking your own life or harming yourself.
• If you are a young adult. Clinical trial information has shown an increased risk of suicidal behavior in young adults (under 25 years) with psychiatric illnesses who were treated with an antidepressant.

If at any time you have thoughts of harming yourself or taking your own life, contact your doctor or go directly to a hospital.

It may be helpful for you to tell a relative or close friendthat you are depressed or have an anxiety disorder and ask them to read this prospectus. You can ask them if they think your depression or anxiety disorder has worsened or if they are concerned about changes in your attitude.

Children and adolescents

Citalopram should not normally be used in the treatment of children and adolescents under 18 years of age. At the same time, you should be aware that in patients under 18 years of age, there is a greater risk of adverse effects such as suicidal attempts, suicidal ideas, and hostility (predominantly aggression, confrontational behavior, and irritability) when taking this class of medications.

However, your doctor may prescribe citalopram to patients under 18 years of age when they decide what is most convenient for the patient. If your doctor has prescribed citalopram and you are a patient under 18 years of age and wish to discuss this decision, please return to your doctor. You must inform your doctor if any of the symptoms mentioned above progress or if you experience complications when patients under 18 years of age are taking this citalopram. At the same time, the long-term effects on safety and related to growth, maturity, and cognitive and behavioral development of this citalopram in this age group have not yet been demonstrated.

Other medications and Citalopram Sandoz

Tell your doctor or pharmacist if you are taking, have recently taken, or may need to take any other medication.

Some medications can affect the action of others and may sometimes cause serious adverse reactions.

Tell your doctor if you are using any of the following medications:

• Non-selective monoamine oxidase inhibitors (MAOIs) that contain phenelzine, iproniazid, isocarboxazid, nialamide, and tranylcypromine as active substances. If you have taken any of these medications, you must wait 14 days before starting to take citalopram. After finishing treatment with citalopram, you must wait 7 days before taking any of these medications.
• Reversible MAO-A inhibitors that contain moclobemide (for the treatment of depression).
• The antibiotic linezolid.
• Lithium (for prophylaxis and treatment of manic-depressive disorder) and tryptophan.
• Imipramine and desipramine (for the treatment of depression).
• Irreversible MAO-B inhibitors that contain selegiline (for the treatment of Parkinson's disease); these increase the risk of adverse effects. The dose of selegiline should not exceed 10 mg per day.
• Metoprolol (for the treatment of high blood pressure and/or heart disease); blood levels of metoprolol increase, but no signs of increased effect or adverse effects of metoprolol have been observed.
• Sumatriptan and similar medications (for the treatment of migraine) and opioids such as tramadol and buprenorphine (for the treatment of severe pain) increase the risk of adverse effects; if you experience any unusual symptoms using this combination, you should see your doctor.
• Cimetidine, lansoprazole, and omeprazole (used for the treatment of stomach ulcers), fluconazole (used for the treatment of fungal infections), fluvoxamine (antidepressant), and ticlopidine (used to reduce the risk of stroke). These may increase citalopram blood levels, but no increase in citalopram adverse effects has been reported.
• Medications that affect platelet function (e.g., some antipsychotic medications, acetylsalicylic acid (for pain treatment), non-steroidal anti-inflammatory medications (for arthritis treatment)); these slightly increase the risk of bleeding disorders.
• St. John's Wort (Hypericum perforatum) (a herbal remedy used for depression); concomitant administration with citalopram may increase the risk of adverse effects.
• Mefloquine (for the treatment of malaria), bupropion (for the treatment of depression), and tramadol (for the treatment of severe pain) due to a possible risk of lowering the seizure threshold.
• Neuroleptics (medications for the treatment of schizophrenia, psychosis) due to a possible risk of lowering the seizure threshold, and antidepressants.
• Antiarrhythmic drugs class IA and III, antipsychotics (e.g., phenothiazine derivatives, pimozide, haloperidol), tricyclic antidepressants, certain antimicrobial medications (sparfloxacin, moxifloxacin, erythromycin IV, pentamidine, medications against malaria, particularly halofantrine), and certain antihistamines (astemizole, mizolastine).
• Medications that decrease potassium or magnesium levels in the blood, as they increase the risk of life-threatening heart rhythm disorders. Do not take citalopram if you are taking medications because you have a condition that affects heart rhythm or if you are taking medications that may affect heart rhythm. If you have doubts about this, consult your doctor.

Taking Citalopram Sandoz with food, drinks, and alcohol

Citalopram can be taken with or without food (see section 3. "How to take Citalopram Sandoz").

It has been observed that citalopram does not increase the effects of alcohol. However, it is advisable to avoid consuming alcohol during treatment with citalopram.

Pregnancy, breastfeeding, and fertility

If you are pregnant or breastfeeding, think you may be pregnant, or plan to become pregnant, consult your doctor or pharmacist before using this medication.

Pregnant women should not normally take citalopram, nor should breastfeeding mothers, unless their doctor has analyzed the risks and benefits involved.

If you take citalopram during the last 3 months of your pregnancy and until the date of birth, be aware that the following effects may be observed in the newborn: respiratory difficulty, blue skin, seizures, changes in body temperature, feeding difficulties, vomiting, low blood sugar, muscle stiffness or floppiness, intense reflexes, tremors, restlessness, irritability, lethargy, constant crying, and difficulty sleeping. If your newborn has any of these symptoms, please contact your doctor immediately.

If you take citalopram in the final stage of pregnancy, there may be a greater risk of abundant vaginal bleeding shortly after delivery, especially if you have a history of bleeding disorders. Your doctor or midwife should know that you are taking citalopram to advise you.

Citalopram passes into breast milk in small amounts. There is a risk of effects on the child. If you are taking citalopram, inform your doctor before starting breastfeeding.

Make sure your midwife and/or doctor are informed that you are being treated with citalopram.

During pregnancy, particularly in the last 3 months, medications like citalopram may increase the risk of a serious disease in newborns called persistent pulmonary hypertension (PPHN), in which the baby breathes rapidly and turns blue. These symptoms usually start within the first 24 hours after birth. If they appear in your baby, you should contact your midwife and/or doctor immediately.

Citalopram has been shown to reduce sperm quality in animal models. This effect could theoretically affect fertility, but to date, no impact on human fertility has been observed.

Driving and using machines

Generally, citalopram does not cause drowsiness; however, if you feel dizzy or drowsy when you start taking this medication, do not drive or use tools or machinery until these effects disappear.

Citalopram Sandoz contains lactose and sodium

If your doctor has told you that you have an intolerance to certain sugars, consult with them before taking this medication.

This medication contains less than 1 mmol of sodium (23 mg) per film-coated tablet; that is, it is essentially "sodium-free".

3. How to take Citalopram Sandoz

Follow the administration instructions for this medication exactly as indicated by your doctor. In case of doubt, consult your doctor or pharmacist again.

Adults

Depression

The usual dose is 20 mg per day. If necessary, your doctor may increase this dose up to a maximum of 40 mg per day.

Anxiety Disorder

The initial dose is 10 mg per day for the first week before increasing it to 20 or 30 mg per day. Your doctor, if necessary, may increase this dose up to a maximum of 40 mg per day.

Obsessive-Compulsive Disorder (OCD)

The initial dose is 20 mg per day. Your doctor, if necessary, may increase this dose up to a maximum of 40 mg per day.

Advanced Age (over 65 years)

In elderly patients, treatment should be started with half the recommended dose, for example, 10 or 20 mg per day.

In general, elderly patients should not take more than 20 mg per day.

Patients with Special Risks

Patients with liver disease should not take more than 20 mg per day.

Use in Children and Adolescents

Citalopram should not be administered to children or adolescents. For additional information, see section 2 "What you need to know before taking Citalopram Sandoz".

How and When to Take Citalopram Sandoz

Citalopram is taken every day as a single daily dose.

The tablets can be taken at any time of day, regardless of meals.

The tablets should be swallowed with a glass of water. Do not chew them (they have a bitter taste).

Duration of Treatment

Like other medications for depression, anxiety disorder, and obsessive-compulsive disorder, it may take several weeks before you notice any improvement. Continue taking citalopram even if it takes some time before you feel any improvement in your condition.

Never change the dose of the medication without talking to your doctor first.

The duration of treatment is individual, generally at least 6 months. Continue taking the tablets for the time recommended by your doctor. Do not stop taking them even if you feel better, unless your doctor has indicated so. The underlying disease may persist for a long period, and if you interrupt your treatment too early, your symptoms may reappear.

Patient with recurrent depression benefit from continued treatment, sometimes for several years, to prevent the appearance of new depressive episodes.

If You Take More Citalopram Sandoz Than You Should

If you have taken more Citalopram Sandoz than you should, consult your doctor, pharmacist, or call the Toxicology Information Service, phone: 91 562 04 20, indicating the medication and the amount used. Do this even when you do not observe discomfort or signs of intoxication. Bring the package of Citalopram Sandoz with you to the doctor or hospital.

Some symptoms of an overdose may include irregular heartbeats with life risk, convulsions, changes in heart rhythm, drowsiness, coma, vomiting, tremors, decrease in blood pressure, increase in blood pressure, nausea (feeling dizzy), serotonin syndrome (see section 4 "Possible side effects"), agitation, dizziness, dilated pupils, sweating, bluish skin, hyperventilation (increased respiratory rate).

If You Forget to Take Citalopram Sandoz

If you forget to take a dose, take the next dose at the usual time.

Do not take a double dose to make up for forgotten doses.

If You Stop Taking Citalopram Sandoz

Do not stop taking Citalopram Sandoz until your doctor tells you to do so. When you have completed your treatment, it is generally recommended that the dose of citalopram be gradually reduced over several weeks.

Sudden withdrawal of the medication can cause some mild or transient disorders such as dizziness, tingling sensation, sleep disturbances (intense dreams, nightmares, inability to sleep), feeling of anxiety, headache, feeling of dizziness (nausea), vomiting, sweating, feeling of restlessness or agitation, tremors, feeling of confusion or disorientation, feelings of emotion or irritation, diarrhea (loose stools), visual disturbances, rapid pulse or palpitations.

When you have finished the treatment period, it is generally recommended that the dose of citalopram be gradually reduced over a couple of weeks instead of being stopped abruptly.

If you have any other doubts about the use of this medication, ask your doctor or pharmacist.

4. Possible Side Effects

Like all medications, this medication can cause side effects, although not all people suffer from them.

Side effects usually disappear after a few weeks of treatment. Note that many of the effects can also be symptoms of your disease and will therefore improve when you start feeling better.

Some patients have reported the following serious side effects. If you have any of the following symptoms, you should stop taking citalopram and see your doctor immediately.

• High fever, agitation, confusion, tremors, and sudden muscle contractions; may be signs of a rare condition called serotonin syndrome, which has been reported with the use of antidepressants.
• If you notice swelling of the skin, tongue, lips, or face, or have difficulty breathing or swallowing (allergic reaction).
• Unusual bleeding, including gastrointestinal bleeding.

Rare but Serious Side Effects (may affect up to 1 in 1,000 patients):

If you have any of the following symptoms, you should stop taking citalopram and see your doctor immediately.

• Hyponatremia: low sodium level in the blood, which can cause fatigue, confusion, and muscle contraction.
• Rapid and irregular heartbeats or feeling of fainting, as they could be symptoms of a serious heart problem known as torsade de pointes.

The following side effects are generally mild and usually disappear after a few days of treatment. Please be aware that several of the effects mentioned below can be symptoms of your disease and will therefore improve when you start feeling better.

If the side effects are bothersome or last more than a few days, consult your doctor.

Dry mouth increases the risk of caries. Therefore, you should brush your teeth more often than usual.

Very Common Side Effects (may affect more than 1 in 10 patients):

• Drowsiness.
• Difficulty sleeping.
• Increased sweating.
• Dry mouth.
• Nausea (feeling dizzy).
• Headache.

Common Side Effects (may affect up to 1 in 10 patients):

• Decreased appetite.
• Agitation.
• Decreased sexual behavior.
• Anxiety.
• Nervousness.
• Confusional state.
• Abnormal dreams.
• Tremors.
• Tingling or numbness of hands or feet.
• Dizziness.
• Attention disturbance.
• Ringing in the ears (tinnitus).
• Diarrhea.
• Vomiting.
• Constipation.
• Rash.
• Muscle and joint pain.
• Men may experience problems with ejaculation and erection.
• Women may experience difficulty reaching orgasm.
• Fatigue.
• Fever.
• Itching of the skin.
• Weight loss.

Uncommon Side Effects (may affect up to 1 in 100 patients):

• Bleeding disorders (easy bruising).
• Increased appetite.
• Aggressiveness.
• Depersonalization.
• Hallucinations.
• Mania.
• Fainting.
• Dilated pupils.
• Rapid heartbeats.
• Slow heartbeats.
• Hives.
• Hair loss.
• Skin rash.
• Sensitivity to light.
• Difficulty urinating.
• Excessive menstrual bleeding.
• Swelling of arms and legs.
• Weight gain.

Rare Side Effects (may affect up to 1 in 1,000 patients):

• Seizures.
• Involuntary movements.
• Taste disturbances.
• Bleeding.
• Hepatitis.
• Fever.

Frequency Not Known (cannot be estimated from the available data):

• Thoughts of self-harm or thoughts of suicide, see also the section "Warnings and Precautions".
• Decreased platelet count in the blood, which increases the risk of bleeding or bruising (hematoma).
• Hypersensitivity (rash).
• Severe allergic reaction that causes difficulty breathing or dizziness.
• Increased amount of urine excreted.
• Hypokalemia: low potassium level in the blood, which can cause muscle weakness, contractions, or abnormal heart rhythm.
• Panic attack.
• Teeth grinding.
• Restlessness.
• Abnormal muscle movements or stiffness.
• Akathisia (involuntary muscle movements).
• Visual disturbances.
• Low blood pressure.
• Nosebleeds.
• Bleeding disorders, including skin and mucous membrane bleeding (ecchymosis).
• Sudden swelling of the skin or mucous membranes.
• Painful erections.
• Increased levels of prolactin hormone in the blood.
• Milk flow in men and in women who are not breastfeeding.
• Irregular menstrual period.
• Excessive vaginal bleeding shortly after childbirth (postpartum hemorrhage), see "Pregnancy, Breastfeeding, and Fertility" in section 2 for more information.
• Altered liver function tests.
• Orthostatic hypotension (significant drop in blood pressure that occurs when an individual stands up).
• An increased risk of bone fractures has been observed in patients treated with this type of medication.
• Abnormal heart rhythm.

If you experience side effects, consult your doctor or pharmacist, even if it is a side effect that does not appear in this leaflet.

Reporting Side Effects

If you experience any type of side effect, consult your doctor or pharmacist, even if it is a possible side effect that does not appear in this leaflet. You can also report them directly through the Spanish Medication Surveillance System for Human Use: https://www.notificaram.es. By reporting side effects, you can contribute to providing more information on the safety of this medication.

5. Storage of Citalopram Sandoz

Keep this medication out of sight and reach of children.

No special storage conditions are required.

Do not use this medication after the expiration date that appears on the package after CAD/EXP. The expiration date is the last day of the month indicated.

Medications should not be thrown away through wastewater or household waste. Deposit the packages and medications you no longer need in the SIGRE Point of the pharmacy. In case of doubt, ask your pharmacist how to dispose of the packages and medications you no longer need. This way, you will help protect the environment.

6. Package Contents and Additional Information

Composition of Citalopram Sandoz 20 mg film-coated tablets:

• The active ingredient is citalopram. Each tablet contains 24.99 mg of citalopram hydrobromide (equivalent to 20 mg of citalopram).

The other components (excipients) are: cornstarch, lactose monohydrate, povidone K64, glycerol 85% (E-422), microcrystalline cellulose, magnesium stearate, sodium carboxymethylcellulose (type A) (derived from potato starch), hypromellose, titanium dioxide (E 171), macrogol 6000, and talc.

Composition of Citalopram Sandoz 30 mg film-coated tablets

• The active ingredient is citalopram. Each tablet contains 37.48 mg of citalopram hydrobromide (equivalent to 30 mg of citalopram).
• The other components (excipients) are: cornstarch, lactose monohydrate, povidone K64, glycerol 85% (E-422), microcrystalline cellulose, magnesium stearate, sodium carboxymethylcellulose (type A) (derived from potato starch), hypromellose, titanium dioxide (E 171), macrogol 6000, and talc.

Appearance of the Product and Package Contents

Citalopram Sandoz 20 mg are film-coated tablets, white, oblong, biconvex, scored on one side, and marked with "C20" on the other. They are packaged in PVC/Aluminum or Aluminum/PVC/PVDC blisters within packages of 14, 28, or 56 tablets.

Citalopram Sandoz 30 mg are film-coated tablets, white, oblong, biconvex, scored on one side, and marked with "C30" on the other.

They are packaged in PVC/Aluminum or Aluminum/PVC/PVDC blisters within packages of 28 or 56 tablets.

Only some package sizes may be marketed.

Marketing Authorization Holder and Manufacturer

Marketing Authorization Holder

Sandoz Farmacéutica, S.A.

Centro Empresarial Parque Norte

Edificio Roble

C/ Serrano Galvache, 56

28033 Madrid

Spain

Manufacturer

Salutas Pharma GmbH

Otto-von-Guericke Allee 1

Barleben 39179

Germany

LEK, S.A.

Ul Domaniewska 50 C,

Warzawa, PL 02-672

Poland

Date of the Last Revision of this Leaflet: July 2024

Detailed information about this medication is available on the website of the Spanish Agency for Medicines and Health Products (AEMPS) http://www.aemps.gob.es/