CITALOPRAM VIATRIS 20 mg FILM-COATED TABLETS

2. What you need to know before you take Citalopram Viatris

Do not take Citalopram Viatris

• If you are allergic to citalopram or any of the other ingredients of this medicine (listed in section 6).
• If you are taking other medicines that belong to a group called monoamine oxidase inhibitors (MAOIs). MAOIs include medicines such as phenelzine, iproniazide, isocarboxazide, nialamide, tranylcypromine, selegiline (used in the treatment of Parkinson's disease), moclobemide (used for the treatment of depression) and linezolid (an antibiotic).
• If you have been born with or have had a heart rhythm disorder or have experienced any episode of this type (this is observed with an electrocardiogram, a test used to evaluate how the heart works).
• If you are taking medicines because you have a disease that affects heart rhythm.
• If you are taking medicines that may affect heart rhythm.

Also, consult the section "Other medicines and Citalopram Viatris" below.

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

A day must have passed since you took moclobemide.

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

Warnings and precautions

Consult your doctor or pharmacist before starting to take Citalopram Viatris

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

• If you have had 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 glucose control. You may need an adjustment of the dose of insulin and/or oral hypoglycemics.
• 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 side effects").
• If you have a history of bleeding disorders or if you develop unusual bruising, 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 (this is 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 (medicines 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 some heart rhythm disorder.
• If you have a problem with the dilation of the pupils (mydriasis).

Consult your doctor, even if any of the above circumstances have occurred to you at some point.

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 weeks of treatment. Inform your doctor immediately if you experience these symptoms.

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

Angle-Closure Glaucoma

SSRIs, including citalopram, may have an effect on pupil size, leading to mydriasis. This mydriatic effect has the potential to reduce the angle of the eye, leading to an increase in intraocular pressure and angle-closure glaucoma, especially in patients who are predisposed. Citalopram, therefore, should be used with caution in patients with angle-closure glaucoma or a history of glaucoma.

Special information related to your disease

Like other medicines used to treat depression or related diseases, improvement is not achieved immediately. After starting treatment with citalopram, it may take several weeks before you experience any improvement.

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

At the start of treatment, some patients may experience an increase in anxiety, which will disappear 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, on some occasions, have thoughts in which you harm or kill yourself. These may increase when taking antidepressants for the first time, as all these medicines require time to start taking effect, usually around two weeks, although in some cases it may be longer.

You would be more likely to have these thoughts:

• If you have previously had thoughts in which you kill or harm yourself.
• If you are a young adult. Information from clinical trials has shown an increased risk of suicidal behavior in young adults (under 25 years) with psychiatric diseases who were treated with an antidepressant.

If at any time you have thoughts in which you harm or kill yourself, contact your doctor or go directly to a hospital.

It may be helpful to tell a relative or close friendthat you are depressed or that you have an anxiety disorder and ask them to read this leaflet. 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. At the same time, you should know that in patients under 18 years, 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 medicines. Nevertheless, the doctor may prescribe citalopram to patients under 18 years when they decide it is most convenient for the patient. If the doctor has prescribed citalopram to a patient under 18 years and you want to discuss this decision, please go back to your doctor. You must inform your doctor if any of the symptoms described above progress or if you experience complications when patients under 18 years are taking citalopram. At the same time, the long-term effects on safety and related to growth, maturity, and cognitive and behavioral development of citalopram in this age group have not yet been demonstrated.

Other medicines and Citalopram Viatris

Tell your doctor or pharmacist if you are taking, have recently taken, or might take any other medicines.

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

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

• Non-selective monoamine oxidase inhibitors (MAOIs), containing phenelzine, iproniazide, isocarboxazide, nialamide, and tranylcypromine as active substances. If you have taken any of these medicines, 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 medicines.
• Reversible MAO-A inhibitors, containing moclobemide (used for the treatment of depression).
• The antibiotic linezolid.
• Lithium (used for the prophylaxis and treatment of manic-depressive disorder), tryptophan, opioids (e.g., buprenorphine). These medicines may interact with citalopram, and you may experience symptoms such as involuntary muscle contractions, including the muscles that control eye movement, agitation, hallucinations, coma, excessive sweating, tremors, exaggerated reflexes, increased muscle tension, body temperature above 38°C. Contact your doctor when you experience these symptoms.
• Imipramine and desipramine (both used to treat depression).
• Irreversible MAO-B inhibitors, containing selegiline (used 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 (used for high blood pressure and/or heart disease); the blood levels of metoprolol are increased, but no signs of increased effect or adverse effects of metoprolol have been observed.
• Sumatriptan and similar medicines (used to treat migraine) and tramadol (used for 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 to treat stomach ulcers), fluconazole (used to treat fungal infections), fluvoxamine (antidepressant), and ticlopidine (used to reduce the risk of stroke). The levels of citalopram in the blood may be increased, but no increase in adverse effects of citalopram has been reported.
• Medicines that affect platelet function, for example, some antipsychotic drugs, acetylsalicylic acid (used for pain), non-steroidal anti-inflammatory drugs (used for arthritis); 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 (used to treat malaria), bupropion (used to treat depression), and tramadol (used to treat severe pain), due to a possible risk of reducing the threshold for seizures.
• Neuroleptics (medicines for treating schizophrenia, psychosis), due to a possible risk of reducing the threshold for seizures, and antidepressants.
• Antiarrhythmic drugs class IA and III, antipsychotics (e.g., phenothiazine derivatives, pimozide, haloperidol), antidepressants, certain antimicrobials (sparfloxacin, moxifloxacin, erythromycin IV, pentamidine, antimalarial drugs, particularly halofantrine), certain antihistamines (astemizole, mizolastine).
• Medicines that decrease potassium or magnesium levels, due to a possible risk of malignant arrhythmias.

Do not take citalopram if you are taking medicines because you already have a disease that affects heart rhythm or if you are taking medicines that may affect heart rhythm.

If you have doubts about this, consult your doctor.

Taking Citalopram Viatris with food and alcohol

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

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 medicine. Pregnant women should not normally take citalopram, nor should breastfeeding mothers, unless you and your doctor have analyzed the risks and benefits involved.

If you take citalopram during the last 3 months of your pregnancy and up to the date of birth, be aware that the following effects may be observed in the newborn baby: breathing difficulties, blue skin, seizures, changes in body temperature, feeding difficulties, vomiting, low blood sugar, muscle stiffness or floppiness, exaggerated reflexes, tremors, restlessness, irritability, lethargy, constant crying, and difficulty sleeping. If your newborn baby 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 heavy 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 be able to advise you.

Citalopram passes into breast milk in small amounts. There is a risk of effects in 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, medicines 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 during the first 24 hours after birth. If they appear in your baby, you should contact your midwife and/or doctor immediately.

Animal studies have shown that citalopram reduces sperm quality. This could theoretically affect fertility, but the impact on human fertility has not been observed yet.

Driving and using machines

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

Citalopram Viatris contains lactose

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

3. How to Take Citalopram Viatris

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 20-30 mg per day.

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

Elderly Patients (over 65 years old)

In elderly patients, treatment should be started with half the recommended dose, for example, 10-20 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, please see section 2 "What you need to know before taking Citalopram Viatris".

.

How and When to Take Citalopram

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.

The score line is only for breaking the tablet if you find it difficult to swallow it whole.

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, usually 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 told you to do so. The underlying disease may persist for a long period, and if you interrupt your treatment too early, your symptoms may reappear.

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

If You Take More Citalopram Viatris Than You Should

If you think you or someone else has taken more citalopram than you should, contact your doctor or pharmacist immediately, go to the emergency department of the nearest hospital, or call the Toxicology Information Service, phone 91 562 04 20, indicating the medication and the amount taken.

Do this even if you do not observe discomfort or signs of intoxication.

Take the citalopram packaging with you if you go to the doctor or hospital.

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

If You Forget to Take Citalopram Viatris

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 missed doses.

If You Stop Taking Citalopram Viatris

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

Abrupt 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 or pounding heartbeat.

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

If you have any other questions 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 everyone will experience them.

Side effects usually disappear after a few weeks of treatment. Please note that many of the effects can also be symptoms of your disease and will therefore improve as you start to feel better.

Some patients have reported the following serious side effects.

If you experience 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 combined 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(may affect up to 1 in 1,000 people)

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

• Hyponatremia: low sodium levels in the blood, which can cause fatigue, confusion, and muscle contractions.
• Rapid and irregular heartbeats or feeling of fainting, as they could be symptoms of a serious heart problem known as torsades 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 as you start to feel better.

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

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

Very Common (may affect more than 1 in 10 people)

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

• Common(may affect up to 1 in 10 people) 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).
• Yawning.
• Diarrhea.
• Vomiting.
• Constipation.
• Rash.
• Muscle and joint pain.
• Men may experience problems with ejaculation and erection.
• Women may experience difficulty reaching orgasm.
• Fatigue.
• Itching of the skin.
• Weight loss.

Uncommon(may affect up to 1 in 1,000 people)

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

Rare(may affect up to 1 in 1,000 people)

• 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 blood, which increases the risk of bleeding or bruising (hematoma).
• Hypersensitivity (rash).
• Severe allergic reaction that causes difficulty breathing or dizziness.
• Increased urine production.
• Hypokalemia: low potassium levels 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 bleeding of skin and mucous membranes (ecchymosis).
• Heavy vaginal bleeding shortly after childbirth (postpartum hemorrhage), see 'Pregnancy, Breastfeeding, and Fertility' in section 2 for more information.
• 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.
• Abnormal 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.

Reporting Side Effects:

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

5. Storage of Citalopram Viatris

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 stated on the packaging after CAD or EXP. The expiration date is the last day of the month indicated.

Medications should not be disposed of through wastewater or household waste. Deposit the packaging and medications you no longer need at the SIGRE collection point in your pharmacy. If in doubt, ask your pharmacist how to dispose of the packaging and medications you no longer need. This will help protect the environment.

6. Package Contents and Additional Information

Composition of Citalopram Viatris

• The active ingredient is citalopram (hydrobromide). Each 20 mg citalopram tablet.
• The other ingredients (excipients) are lactose monohydrate, microcrystalline cellulose, cornstarch, povidone K30, crospovidone, magnesium stearate, hypromellose, lactose monohydrate, macrogol 4000, titanium dioxide, purified water.

Appearance of the Product and Package Contents

Citalopram Viatris 20 mg is presented in the form of white, oval, convex, scored, and film-coated tablets marked with "CM/20" on one side and "G" on the other.

It is presented in packs of 14, 28, or 56 tablets packaged in blisters.

Only some pack sizes may be marketed.

Marketing Authorization Holder and Manufacturer

Marketing Authorization Holder:

Viatris Pharmaceuticals, S.L.U.

C/ General Aranaz, 86

28027 - Madrid

Spain

Manufacturer:

Mylan Hungary Kft

H-2900 Komárom

Mylan utca 1

Hungary

Date of Last Revision of this Leaflet:January 2024

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