This page shows what was measured, who it was measured in, and what that does not settle.
What Citalopram does in the body
Citalopram blocks that transporter, so serotonin lingers in the gap between cells.
Nerve cells that signal with serotonin recapture most of it through a transporter protein straight after releasing it. It does this very selectively — the label records essentially no affinity for the dozen other receptors that give older antidepressants their side effects. At higher blood levels it also slows one of the potassium currents that resets the heart’s electrical rhythm, which is why its dose has a hard ceiling.
Why people take it. Depression
What happened in people
Individually corrected QTc rising 8.5 msec at 20 mg and 18.5 msec at 60 mg against placebo in 119 healthy subjects
✎ Source-linked record
Where this came from
A person wrote this into the record with the study named beside it. No reviewer has signed it off.
The recorded finding that sits closest to something a person would notice. Written into the record, not signed off, and it carries no population or interval.
Citalopram United States prescribing information — Dosage and Administration 2.1 to 2.5, Warnings and Precautions 5.1 to 5.10, Clinical Pharmacology 12.2 Car… · a recorded source, not a stored snapshot
Sequenced Treatment Alternatives to Relieve Depression (STAR*D) registry record (NCT00021528) · a recorded source, not a stored snapshot
The limit that matters most
That 20 mg daily is an effective antidepressant dose in patients over 60, in hepatic impairment or in CYP2C19 poor metabolisers — the groups the label caps there, and a dose its pivotal trial found had no clear effect
Where it acts
Serotonin transporter on presynaptic terminals in the central nervous system; the dose-limiting effect is on the cardiac potassium channel that shapes ventricular repolarisation
Kind of result
The kind of result is not recorded
Supervision
Professional supervision is normally required. A regulator classifies this substance in a way that restricts how it is supplied.
What the registries record it as
The substance registry classes this as chemical.
FDA substance registry · I1E9D14F36 · read 2026-08-29
Its recorded molecular formula is C20H22BrFN2O, weighing 405.35.
US prescribing information · 0dfb11d9-f48d-56ee-e063-6294a90ad256 · read 2026-08-30
Where each sentence above came from
A person wrote this explanation into the record, with the studies named in the path below.
The recorded use, written for a reader without medical training. Not signed off.
A limit recorded against this substance. Not signed off as a reviewed claim.
The four opening statements run to 104 words.
Words this page uses
Four words worth knowing first
Chosen from what this page shows, with each one explained before the word it depends on.
Placebo
A placebo is a dummy treatment given so the real one can be compared with it.
A picture of it, and where the picture fails
A placebo is like a blank control in an experiment.
Where that stops being true. A blank does nothing. People given a placebo often do get better.
What people get wrong. A placebo effect is read as imaginary. The improvement is measured and real.
An inactive intervention matched in appearance to the test intervention, used to control for non-specific effects.
Comparator
A comparator is whatever the treatment was measured against.
A picture of it, and where the picture fails
It is like the other runner in a race.
Where that stops being true. A race has one winner. A study can show both arms improved.
What people get wrong. Results are read without asking what the other group got. Beating nothing is not beating a treatment.
The control condition against which the experimental intervention is assessed.
Randomisation
Randomisation means chance decides who gets which treatment.
A picture of it, and where the picture fails
It is like a coin toss deciding the groups.
Where that stops being true. A coin toss is fair once. Fairness here comes from doing it for everyone.
What people get wrong. It is thought to make groups identical. It makes them similar on average, including on things nobody measured.
Allocation of participants to arms by a chance process, so that unmeasured factors are balanced in expectation.
What happened in people◇Read from sources, not yet reviewed
What happened in people
Each card is one study: the exact question it asked, who was in it, and whether it showed what it set out to show.
Hamilton Depression Rating Scale total score at six weeks, at fixed doses of 10, 20, 40 and 60 mg daily
Citalopram 40 mg and 60 mg daily effective on the Hamilton total score; no clear effect of the 10 mg and 20 mg daily doses; 60 mg not more effective than 40 mg
Repeated elsewhere
Partially Replicated
What this does not prove. Meeting one endpoint in one population does not carry to other goals or other people.
The limits of this study, and where it came from
Main limit. The 60 mg arm that contributed to the positive result is now prohibited on cardiac grounds, and the 20 mg dose that showed no clear effect is now the maximum permitted in patients over 60, in hepatic impairment and in CYP2C19 poor metabolisers. Section 14 does not state the randomised sample size, so none is asserted here.
How far it carries. This study is recorded from the curated record, not from the registry match.
Form and route. Oral tablet at 10, 20 and 40 mg and oral solution at 10 mg/5 mL, once daily with or without food
Interval reported. Not recorded in this summary
Written into the record, not signed off as a reviewed claim.
Citalopram United States prescribing information — Dosage and Administration 2.1 to 2.5, Warnings and Precautions 5.1 to 5.10, Clinical Pharmacology 12.2 Car… · a recorded source, not a stored snapshot
Sequenced Treatment Alternatives to Relieve Depression (STAR*D) registry record (NCT00021528) · a recorded source, not a stored snapshot
Pigott HE, Kim T, Xu C, Kirsch I, Amsterdam J. What are the treatment remission, response and extent of improvement rates after up to four trials of antidepr… · a recorded source, not a stored snapshot
Maximum mean difference from placebo in individually corrected QTc (QTcNi) at 20 mg and 60 mg in healthy subjects
✓ The study showed what it set out to show
Who was studied
Thorough QT study (NDA 020822, section 12.2 Cardiac Electrophysiology)
How many people
119
Study design
Randomised, placebo- and active-controlled (moxifloxacin 400 mg) cross-over, escalating multiple-dose
Compared against
A dummy treatment
Kind of result
A number that stands in for health
What was found
8.5 msec (upper bound of the 95% one-sided CI 10.8) at 20 mg and 18.5 msec (21.0) at 60 mg; 12.6 msec (14.3) predicted at the Cmax for 40 mg
Repeated elsewhere
Unreplicated
What this does not prove. Meeting one endpoint in one population does not carry to other goals or other people.
The limits of this study, and where it came from
Main limit. This is the study that produced the 2011 dose restriction, thirteen years after approval. It measures an electrocardiographic interval in healthy volunteers, not arrhythmia in patients; torsade de pointes, ventricular tachycardia and sudden death come from postmarketing reports rather than from a controlled trial.
How far it carries. This study is recorded from the curated record, not from the registry match.
Form and route. Oral tablet at 10, 20 and 40 mg and oral solution at 10 mg/5 mL, once daily with or without food
Interval reported. Not recorded in this summary
Written into the record, not signed off as a reviewed claim.
Citalopram United States prescribing information — Dosage and Administration 2.1 to 2.5, Warnings and Precautions 5.1 to 5.10, Clinical Pharmacology 12.2 Car… · a recorded source, not a stored snapshot
Sequenced Treatment Alternatives to Relieve Depression (STAR*D) registry record (NCT00021528) · a recorded source, not a stored snapshot
Pigott HE, Kim T, Xu C, Kirsch I, Amsterdam J. What are the treatment remission, response and extent of improvement rates after up to four trials of antidepr… · a recorded source, not a stored snapshot
Remission, defined as an exit score of 7 or below on the 17-item Hamilton Depression Rating Scale, after up to 14 weeks of flexible-dose citalopram
Open-label effectiveness study under measurement-based care, no placebo arm
Compared against
A dummy treatment
Kind of result
A number that stands in for health
What was found
Remission 28% (Hamilton) and 33% (QIDS-SR); response 47% (QIDS-SR); mean exit dose 41.8 mg/day
Repeated elsewhere
Partially Replicated
What this does not prove. Meeting one endpoint in one population does not carry to other goals or other people.
The limits of this study, and where it came from
Main limit. There is no placebo arm, so the 28% cannot be read as a drug effect. The mean exit dose exceeds the maximum the label has permitted since 2011. A 2023 reanalysis with fidelity to the protocol found the multi-level cumulative remission rate to be 35.0% rather than the 67% originally reported.
How far it carries. This study is recorded from the curated record, not from the registry match.
Form and route. Oral tablet at 10, 20 and 40 mg and oral solution at 10 mg/5 mL, once daily with or without food
Interval reported. Not recorded in this summary
Written into the record, not signed off as a reviewed claim.
Citalopram United States prescribing information — Dosage and Administration 2.1 to 2.5, Warnings and Precautions 5.1 to 5.10, Clinical Pharmacology 12.2 Car… · a recorded source, not a stored snapshot
Sequenced Treatment Alternatives to Relieve Depression (STAR*D) registry record (NCT00021528) · a recorded source, not a stored snapshot
Pigott HE, Kim T, Xu C, Kirsch I, Amsterdam J. What are the treatment remission, response and extent of improvement rates after up to four trials of antidepr… · a recorded source, not a stored snapshot
What we know
RNAWiki holds 3 written-up human studies for this substance, each with the question it asked.
How we know it
Each card names the study, the number of people and what the study set out to measure.
What this does not prove
These summaries were written by a person and have not been signed off as reviewed claims.
Why it matters
A study that failed is as informative as one that worked, and both are here.
What we still do not know
No reviewed claim exists, so no exact population, effect size or interval is published yet.
What it changes in the body◇Read from sources, not yet reviewed
The path through the body
From what a person takes to what changes. A solid line is a step measured in people. A dashed line is a step nobody has measured that way.
Start
Citalopram
What a person takes: Oral tablet at 10, 20 and 40 mg and oral solution at 10 mg/5 mL, once daily with or without food.
The measurement behind this step
Absorption is unaffected by food. Metabolism is principally by CYP2C19 with a CYP3A4 contribution, and the resulting exposure differences drive the label’s population-specific dose ceilings rather than being footnotes to them. Discontinuation is directed to be gradual: there is no long-lived active metabolite to soften an abrupt stop.
Getting in
One tablet, two mirror-image halves
Citalopram is an equal mixture of two mirror-image forms. Only one of them meaningfully blocks the serotonin pump. The other half is why escitalopram exists as a separate product.
╌╌Described, with no measurement named. No measurement is named for this step, so it is drawn as an unconfirmed link.
The measurement behind this step
A racemate of S- and R-citalopram in which transporter inhibition resides essentially entirely in the S-enantiomer. Escitalopram, launched in 2002 while citalopram was still on patent, is that enantiomer isolated. Absorption is unaffected by food and the drug is given once daily.
Citalopram United States prescribing information — Dosage and Administration 2.1 to 2.5, Warnings and Precautions 5.1 to 5.10, Clinical Pharmacology 12.2 Car… · a recorded source, not a stored snapshot
Sequenced Treatment Alternatives to Relieve Depression (STAR*D) registry record (NCT00021528) · a recorded source, not a stored snapshot
Reaching the cell
Cleared by an enzyme not everyone has
The liver breaks it down using an enzyme that a minority of people have little of. Those people build up higher levels, which is why the label caps their dose.
──Measured in people. Written by a person from the study named beside the step. Not signed off as a reviewed claim.
The measurement behind this step
Metabolism is principally by CYP2C19 with a contribution from CYP3A4, to desmethylcitalopram and didesmethylcitalopram. CYP2C19 poor metabolisers, patients over 60, patients with hepatic impairment and patients taking cimetidine or another CYP2C19 inhibitor all reach higher exposures, and the label limits all four groups to 20 mg once daily on that basis.
Citalopram United States prescribing information — Dosage and Administration 2.1 to 2.5, Warnings and Precautions 5.1 to 5.10, Clinical Pharmacology 12.2 Car… · a recorded source, not a stored snapshot
Sequenced Treatment Alternatives to Relieve Depression (STAR*D) registry record (NCT00021528) · a recorded source, not a stored snapshot
What it acts on
The serotonin pump is blocked, and very little else is
It plugs the transporter that recycles serotonin. Unlike the older antidepressants it barely touches the receptors responsible for dry mouth, blurred vision and sedation.
╌╌Described, with no measurement named. No measurement is named for this step, so it is drawn as an unconfirmed link.
The measurement behind this step
Selective inhibition of SLC6A4 with minimal effect on noradrenaline and dopamine reuptake. The label records no or very low affinity for 5-HT1A, 5-HT2A, D1, D2, alpha-1, alpha-2, beta-adrenergic, H1, GABA, muscarinic cholinergic and benzodiazepine receptors — the pharmacological reason the class displaced the tricyclics on tolerability rather than on efficacy.
Citalopram United States prescribing information — Dosage and Administration 2.1 to 2.5, Warnings and Precautions 5.1 to 5.10, Clinical Pharmacology 12.2 Car… · a recorded source, not a stored snapshot
Sequenced Treatment Alternatives to Relieve Depression (STAR*D) registry record (NCT00021528) · a recorded source, not a stored snapshot
The change it makes
At higher levels, the heart’s reset current slows
The same molecule slows one of the electrical currents that resets the heart between beats. The effect grows with the dose, and that is what sets the ceiling.
──Measured in people. Written by a person from the study named beside the step. Not signed off as a reviewed claim.
The measurement behind this step
Dose-dependent prolongation of the individually corrected QT interval: 8.5 (upper bound 10.8) msec at 20 mg and 18.5 (21.0) msec at 60 mg in 119 healthy subjects, with 12.6 (14.3) msec predicted at the Cmax for 40 mg. Torsade de pointes, ventricular tachycardia and sudden death appear in postmarketing reports. The label directs discontinuation at a persistent QTc above 500 msec.
Citalopram United States prescribing information — Dosage and Administration 2.1 to 2.5, Warnings and Precautions 5.1 to 5.10, Clinical Pharmacology 12.2 Car… · a recorded source, not a stored snapshot
Sequenced Treatment Alternatives to Relieve Depression (STAR*D) registry record (NCT00021528) · a recorded source, not a stored snapshot
What that does for a person
A Hamilton score falls, in some trials
What was measured was a questionnaire score over four to six weeks. Two of the five placebo-controlled trials on the label found a significant difference; three did not.
╌╌Described, with no measurement named. No measurement is named for this step, so it is drawn as an unconfirmed link.
The measurement behind this step
Efficacy was established in two of five placebo-controlled trials described in section 14. In the fixed-dose study, 40 mg and 60 mg were effective and 10 mg and 20 mg showed no clear effect. In real-world use, STAR*D level 1 gave 28% remission on the blinded Hamilton scale in 2,876 outpatients at a mean exit dose of 41.8 mg/day.
Citalopram United States prescribing information — Dosage and Administration 2.1 to 2.5, Warnings and Precautions 5.1 to 5.10, Clinical Pharmacology 12.2 Car… · a recorded source, not a stored snapshot
Sequenced Treatment Alternatives to Relieve Depression (STAR*D) registry record (NCT00021528) · a recorded source, not a stored snapshot
What that does for a person
What has never been measured
No trial of this drug measured deaths or any other hard outcome, and no fixed-dose efficacy trial exists at 20 mg in the over-60s who are capped there.
╌╌Described, with no measurement named. No measurement is named for this step, so it is drawn as an unconfirmed link.
The measurement behind this step
The registration programme measured rating scales over four to six weeks and relapse in two randomised-withdrawal studies. There is no mortality endpoint, no cardiovascular outcome trial despite a labelled cardiac effect, and no efficacy study at the restricted 20 mg ceiling in the populations to whom that ceiling applies.
Citalopram United States prescribing information — Dosage and Administration 2.1 to 2.5, Warnings and Precautions 5.1 to 5.10, Clinical Pharmacology 12.2 Car… · a recorded source, not a stored snapshot
Sequenced Treatment Alternatives to Relieve Depression (STAR*D) registry record (NCT00021528) · a recorded source, not a stored snapshot
No suggested links are held for this record, so nothing is hidden from this path.
What we know
The record describes 6 steps from taking it to an effect in a person.
How we know it
Each step names the study behind it in the technical detail beside it.
What this does not prove
A change inside the body is a reason to look. It is not a result in a person.
Why it matters
A reader can see exactly where the chain stops being measured in people.
What we still do not know
No reviewed claim binds any of these steps to a named population.
What is missing or unclear◇Read from sources, not yet reviewed
Were people like you studied?
RNAWiki cannot tell whether a study fits you. It can show who was in it, and where the result stops carrying.
Who was studied
People similar to this profile were included.
Adults with major depressive disorder. It is not approved for anyone under 18, and the label footnotes that fact directly under its paediatric safety table. It should be avoided in congenital long QT syndrome, bradycardia, uncorrected hypokalaemia or hypomagnesaemia, recent myocardial infarction and uncompensated heart failure.
Who is missing from the studies
Which groups were under-represented in the studies has not been recorded for this substance. Pregnancy, breastfeeding, children, older adults, and people with liver or kidney conditions are commonly excluded from trials; nothing here says whether they were.
What the label states about particular groups
On pediatric, the label states: “The safety and effectiveness of citalopram have not been established in pediatric patients.”
US prescribing information · 0dfb11d9-f48d-56ee-e063-6294a90ad256 · read 2026-08-30
On older people, the label states: “Of 4422 patients in clinical studies of citalopram tablets, 1357 were 60 and over, 1034 were 65 and over, and 457 were 75 and over.”
US prescribing information · 0dfb11d9-f48d-56ee-e063-6294a90ad256 · read 2026-08-30
On people who are pregnant, the label states: “Exposure Registry There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to antidepressants during pregnancy.”
US prescribing information · 0dfb11d9-f48d-56ee-e063-6294a90ad256 · read 2026-08-30
On people who are breastfeeding, the label states: “Risk Summary Data from the published literature report the presence of citalopram in human milk at relative infant doses ranging between 0.7 to 9.4% of the maternal weight-adjusted dosage and a milk/plasma ratio ranging between 0.78 to 4.3.”
US prescribing information · 0dfb11d9-f48d-56ee-e063-6294a90ad256 · read 2026-08-30
On people with reduced liver function, the label states: “Increased citalopram exposure occurs in patients with hepatic impairment.”
US prescribing information · 0dfb11d9-f48d-56ee-e063-6294a90ad256 · read 2026-08-30
Where the result stopped carrying
Three of the five placebo-controlled major depressive disorder trials described on the label were not statistically significant
The 60 mg dose used in the registration programme was withdrawn from the licensed range in 2011 on cardiac grounds
A dose ceiling for the over-60s was imposed at a strength the pivotal fixed-dose trial found ineffective, with no efficacy trial run at that dose in that population
Its United States marketer pleaded guilty in 2010 to charges including illegal promotion of the drug for children and adolescents, a population it has never been approved for
This is a scope explorer, not a diagnosis engine.
It shows who was studied so you can see whether people similar to you were included.
RNAWiki cannot tell whether a study fits you. It can show who was in it.
What it would be like to take◇Read from sources, not yet reviewed
Why it might seem to do nothing
A real effect and a noticed effect are different things. These are the recorded reasons the two come apart.
It was studied in different people
The people in the studies were not much like the reader.
On this record: Which groups were under-represented in the studies has not been recorded for this substance. Pregnancy, breastfeeding, children, older adults, and people with liver or kidney conditions are commonly excluded from trials; nothing here says whether they were.
The evidence may simply be wrong
Small early studies often do not hold up.
On this record: RNAWiki has not yet published a reviewed conclusion for this use.
Other reasons RNAWiki checked and found nothing for (11)
It was studied for a different goal
The studies measured something else entirely. Nothing in this record points to this reason.
A different form was studied
The studied form is not the form on the shelf. Nothing in this record points to this reason.
There was nothing to correct
Where a level is already normal, topping it up may change nothing. Nothing in this record points to this reason.
Something else had to happen too
In the studies it was paired with training, a diet or another treatment. Nothing in this record points to this reason.
The change is too small to feel
A real change can still sit below what a person notices. Nothing in this record points to this reason.
Day-to-day swing hides it
Sleep, food, stress and time of day move most numbers more than this would. Nothing in this record points to this reason.
Not enough time yet
The studies ran longer than the person has waited. Nothing in this record points to this reason.
It was not taken as studied
Missed days change the result, and studies count them. Nothing in this record points to this reason.
Something else changed at the same time
Two changes at once cannot be told apart afterwards. Nothing in this record points to this reason.
The product may not be what it says
Contents of a sold product are not always what the label states. Nothing in this record points to this reason.
No recorded reason
RNAWiki has nothing stored that would explain it. Nothing in this record points to this reason.
None of these is a reason to take more. Taking more is not a step this page ever suggests.
What it would be like to take◇Read from sources, not yet reviewed
What taking it involves
The recorded facts about getting hold of it and using it. Nothing here is a suggestion about what you should do.
How it is supplied
Prescription only
❝ Quoted from a source
Where this came from
Copied from a source RNAWiki stored, with the source named.
Read from the recorded approval status.
No source is stored against this line.
Form and route
Oral tablet at 10, 20 and 40 mg and oral solution at 10 mg/5 mL, once daily with or without food
✎ Source-linked record
Where this came from
A person wrote this into the record with the study named beside it. No reviewer has signed it off.
The form and route recorded on this substance.
No source is stored against this line.
Who oversees it
Professional supervision is normally required. A regulator classifies this substance in a way that restricts how it is supplied.
❝ Quoted from a source
Where this came from
Copied from a source RNAWiki stored, with the source named.
Suppression classes recorded: S6.
No source is stored against this line.
What is in the pack
Absorption is unaffected by food. Metabolism is principally by CYP2C19 with a CYP3A4 contribution, and the resulting exposure differences drive the label’s population-specific dose ceilings rather than being footnotes to them. Discontinuation is directed to be gradual: there is no long-lived active metabolite to soften an abrupt stop.
✎ Source-linked record
Where this came from
A person wrote this into the record with the study named beside it. No reviewer has signed it off.
Recorded notes on how this is sold and what that means for what is in the pack.
No source is stored against this line.
Where it is registered
Regulatory records are listed in the technical disclosure at the foot of this page.
# Counted from records
Where this came from
A count of rows RNAWiki holds. It describes our records, not your body.
Register entries are stored per jurisdiction and shown with their dates.
No source is stored against this line.
Why people stop
Not recorded.
∅ Nothing recorded
Where this came from
RNAWiki holds nothing here and says so rather than guessing.
No record of why people stopped taking it is stored for this substance.
No source is stored against this line.
What it would be like to take◇Read from sources, not yet reviewed
What can go wrong
Sorted by where each line came from. A regulator's label and a report somebody sent in are not the same kind of fact.
·Worth asking a clinician aboutWritten into the record from the studies named on this page
Boxed warning for suicidal thoughts and behaviour in adolescents and young adults; not approved under 18. Dose-dependent QTc prolongation with reported torsade de pointes, ventricular tachycardia and sudden death — avoid in congenital long QT syndrome, bradycardia, hypokalaemia, hypomagnesaemia, recent myocardial infarction, uncompensated heart failure and with other QT-prolonging drugs; discontinue if QTc persists above 500 msec. Also labelled for serotonin syndrome, increased bleeding risk with aspirin, NSAIDs, other antiplatelets and anticoagulants, activation of mania or hypomania, seizures, angle-closure glaucoma, hyponatraemia with SIADH, and sexual dysfunction. Contraindicated with monoamine oxidase inhibitors, with a 14-day gap required in either direction.
Nobody counted how many people took this and were fine, so this cannot be turned into a rate.
Where this came from
Citalopram United States prescribing information — Dosage and Administration 2.1 to 2.5, Warnings and Precautions 5.1 to 5.10, Clinical Pharmacology 12.2 Car… · a recorded source, not a stored snapshot
Sequenced Treatment Alternatives to Relieve Depression (STAR*D) registry record (NCT00021528) · a recorded source, not a stored snapshot
Over a long time. No completed tested study window is recorded, so long-term effects are not established by the registry record.
Groups the studies covered thinly. Which groups were under-represented in the studies has not been recorded for this substance. Pregnancy, breastfeeding, children, older adults, and people with liver or kidney conditions are commonly excluded from trials; nothing here says whether they were.
What is missing or unclear◇Read from sources, not yet reviewed
Does the exact form matter?
Evidence belongs to the exact thing that was tested. A different salt, a different mixture or a different preparation is a different question.
The form that was studied
Oral tablet at 10, 20 and 40 mg and oral solution at 10 mg/5 mL, once daily with or without food
✎ Source-linked record
Where this came from
A person wrote this into the record with the study named beside it. No reviewer has signed it off.
The form used in the studies cited on this page.
No source is stored against this line.
What is sold
Metabolism is principally by CYP2C19 with a CYP3A4 contribution, and the resulting exposure differences drive the label’s population-specific dose ceilings rather than being footnotes to them. Discontinuation is directed to be gradual: there is no long-lived active metabolite to soften an abrupt stop.
✎ Source-linked record
Where this came from
A person wrote this into the record with the study named beside it. No reviewer has signed it off.
Recorded notes on which forms are sold and how they compare.
No source is stored against this line.
What is recorded as being sold
148 products list this as an active ingredient in the United States drug directory. 148 of them contain it and nothing else.
FDA National Drug Code directory · 71610-413 · read 2026-08-29
They are sold as capsule, pellet, powder, solution, tablet and tablet, film coated, taken oral.
FDA National Drug Code directory · 71610-413 · read 2026-08-29
The regulator's established pharmacologic class for it is serotonin reuptake inhibitor [epc] and serotonin uptake inhibitors [moa].
FDA National Drug Code directory · 71610-413 · read 2026-08-29
92 published labels name it as an active ingredient. 92 of them describe this substance alone, which is where its own label text on this page comes from.
US prescribing information · 7307df53-d570-4e26-971d-e97522ccce7f · read 2026-08-29
Those labels are classed as human otc drug and human prescription drug.
US prescribing information · 7307df53-d570-4e26-971d-e97522ccce7f · read 2026-08-29
Citalopram is oral at 3 DOSAGE FORMS AND STRENGTHS Citalopram Tablets, USP are available containing citalopram hydrobromide, USP equivalent to 10 mg, 20 mg or 40 mg citalopram., recorded as fda label in effect 2024-01-02 in the United States.
US prescribing information · 0dfb11d9-f48d-56ee-e063-6294a90ad256 · read 2026-08-30
Recorded price in US: 0.02464–4.90981 USD per one unit as the pricing file counts it — a tablet, capsule, patch or single item, across 41 priced products whose strengths and pack forms differ, as of 2026-08-26, paid by retail pharmacies buying the product, as surveyed by the Centers for Medicare & Medicaid Services. It is not a list price, an insurance price, or what anyone pays at a counter..
Recorded source · 2026-08-26 · read 2026-08-28
Recorded price in US: 0.16999 USD per one millilitre, across 2 priced products whose strengths and pack forms differ, as of 2026-08-26, paid by retail pharmacies buying the product, as surveyed by the Centers for Medicare & Medicaid Services. It is not a list price, an insurance price, or what anyone pays at a counter..
Recorded source · 2026-08-26 · read 2026-08-28
Evidence carries across two names for one substance. It does not carry across a salt, a mirror form or a mixture.
What it would be like to take◇Read from sources, not yet reviewed
What you could measure
This one is decided with a clinician, so this section holds questions to ask rather than a plan to run.
Self-experiment planning is not offered for a prescription or clinician-supervised medicine. The questions below are for a clinician or pharmacist.
Questions worth asking
Which of the trials of Citalopram studied people like me?
What was measured, and for how long?
Was the result a laboratory value or a health outcome?
What would we watch for, and when would we stop?
Tracking can show whether something changed for you. It cannot show what caused it.
RNAWiki records evidence. It does not say whether this substance is right for you.
What is missing or unclear◇Read from sources, not yet reviewed
Claims that go past the evidence
Things said about this substance that sound reasonable, and the exact step that is missing between the evidence and the claim.
✗Goes past the evidence
That 20 mg daily is an effective antidepressant dose in patients over 60, in hepatic impairment or in CYP2C19 poor metabolisers — the groups the label caps there, and a dose its pivotal trial found had no clear effect
Why it sounds right. It follows from something real on this page: a body step, an animal result or a related finding.
The missing step. Nobody measured this in people for this use, or the study that did measure it did not show it.
What would change this
A study in people, for this exact use, measuring this exact thing, that a reviewer signs off.
RNAWiki has not yet published a reviewed conclusion for this use.
✗Goes past the evidence
That selective serotonin transporter blockade corrects a serotonergic abnormality in depression, which the 2022 umbrella review of that evidence does not support
Why it sounds right. It follows from something real on this page: a body step, an animal result or a related finding.
The missing step. Nobody measured this in people for this use, or the study that did measure it did not show it.
What would change this
A study in people, for this exact use, measuring this exact thing, that a reviewer signs off.
RNAWiki has not yet published a reviewed conclusion for this use.
✗Goes past the evidence
That STAR*D showed two thirds of patients eventually remit, when the protocol-stipulated analysis of the same data gives 35%
Why it sounds right. It follows from something real on this page: a body step, an animal result or a related finding.
The missing step. Nobody measured this in people for this use, or the study that did measure it did not show it.
What would change this
A study in people, for this exact use, measuring this exact thing, that a reviewer signs off.
RNAWiki has not yet published a reviewed conclusion for this use.
✗Goes past the evidence
That the tolerability advantage over the tricyclics — which is real and documented in the receptor-binding data — implies an efficacy advantage, which the network meta-analysis does not show
Why it sounds right. It follows from something real on this page: a body step, an animal result or a related finding.
The missing step. Nobody measured this in people for this use, or the study that did measure it did not show it.
What would change this
A study in people, for this exact use, measuring this exact thing, that a reviewer signs off.
RNAWiki has not yet published a reviewed conclusion for this use.
What is missing or unclear◇Read from sources, not yet reviewed
What nobody knows yet
Open questions, each with why it is open and what would close it.
Missing populations
Which groups were under-represented in the studies has not been recorded.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
Missing long-term data
No completed tested study window is recorded.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
No reviewed conclusion
RNAWiki has not yet published a reviewed conclusion for this use.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
Missing interaction studies
No interaction was found in the registers checked. Not finding one is not the same as showing there is none.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
Formulation uncertainty
Several salts, forms or products of Citalopram are recorded. Results from one form may not transfer to another.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
Mechanism not reviewed
No reviewed mechanism story exists for this substance.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
What happened in people◇Read from sources, not yet reviewed
Check any of this yourself
Every line above traced back to the study it came from. This is the technical layer, and the vocabulary changes here.
Every line above can be traced to the study named beside it. Follow the link and read it.
The licensed maximum dose was cut after thirteen years on the market
In plain words
Citalopram was licensed up to 60 mg. In 2011 the ceiling came down to 40 mg because a proper heart-rhythm study showed the effect grew with the dose — and to 20 mg for anyone over 60, anyone with liver impairment and anyone who clears the drug slowly.
What was measured
Individually corrected QTc change from placebo at 20 mg and 60 mg in 119 healthy subjects, and the licensed dose ceiling before and after 2011
Effect estimate
No reviewed effect estimate exists for this record.
Limits
See the technical detail.
From the source
A randomised, placebo- and active-controlled (moxifloxacin 400 mg) cross-over escalating multiple-dose study in 119 healthy subjects measured individually corrected QTc. The maximum mean difference from placebo, with the upper bound of the 95% one-sided confidence interval in brackets, was 8.5 (10.8) msec at 20 mg and 18.5 (21.0) msec at 60 mg. From the established exposure-response relationship the predicted change at the Cmax for 40 mg is 12.6 (14.3) msec. Section 5.2 now states that citalopram should not be given above 40 mg once daily, and section 2.3 caps the dose at 20 mg once daily in patients over 60, in hepatic impairment and in CYP2C19 poor metabolisers, with section 2.4 extending the same cap to concomitant CYP2C19 inhibitors. Torsade de pointes, ventricular tachycardia and sudden death appear in the postmarketing section. The drug was approved in 1998; the restriction arrived in 2011.
Source
Citalopram United States prescribing information, sections 2.1 to 2.4, 5.2 and 12.2 Cardiac Electrophysiology (NDA 020822)
Role in the trial
Not matched to a registered study
Identity check
no open identity hold
Audit mark
caution
Review state
Written into the record, not signed off as a reviewed claim
The dose older patients are capped at is the dose the pivotal trial could not show worked
In plain words
The fixed-dose registration trial tested 10, 20, 40 and 60 mg. It found no clear effect at 10 mg or 20 mg. Twenty milligrams is now the maximum permitted dose for everyone over 60.
What was measured
Doses shown effective in the pivotal fixed-dose trial against the doses permitted by the current label, by patient group
Effect estimate
No reviewed effect estimate exists for this record.
Limits
This entry records a failure.
From the source
Section 14 of the label describes Study 1, a six-week fixed-dose trial at 10, 20, 40 and 60 mg daily with the Hamilton total score as the primary endpoint. It reports that citalopram 40 mg and 60 mg daily were effective, that the study "showed no clear effect of the 10 mg and 20 mg daily doses", and that 60 mg was not more effective than 40 mg. Sixty milligrams is now prohibited on cardiac grounds; forty is the ceiling for the general adult population and twenty is the ceiling for patients over 60, patients with hepatic impairment, CYP2C19 poor metabolisers and anyone taking a CYP2C19 inhibitor. For those four groups the label’s own efficacy evidence and its own dose restriction do not overlap. The usual defence is that older and slow-metabolising patients reach the same plasma concentration at half the dose, which is a pharmacokinetic argument rather than a demonstrated clinical one; no fixed-dose efficacy trial at 20 mg in an over-60 population is described anywhere on the document.
Source
Citalopram United States prescribing information, sections 2.3, 5.2 and 14 Clinical Studies (NDA 020822)
Role in the trial
Not matched to a registered study
Identity check
no open identity hold
Audit mark
caution
Review state
Written into the record, not signed off as a reviewed claim
Three of the five placebo-controlled trials on the label were negative
In plain words
The label describes five short placebo-controlled trials in depression. Two supported approval. In the other three, the difference between citalopram and placebo was not statistically significant.
What was measured
Number of placebo-controlled major depressive disorder trials on the label reaching statistical significance
Effect estimate
No reviewed effect estimate exists for this record.
Limits
This entry records a failure.
From the source
Section 14 states that efficacy was established in two placebo-controlled studies of four to six weeks in adult outpatients — the fixed-dose Study 1 and the flexible-dose Study 2, in which the dose was titrated to a maximum of 80 mg daily, twice the currently permitted maximum. It then states plainly: "In three additional placebo-controlled trials in patients with MDD, the difference in response to treatment between patients receiving citalopram and patients receiving placebo was not statistically significant." A two-in-five success rate on the licensing document itself is the concrete form of what the Turner analysis found across the class, where the FDA judged 51% of registered trials positive while the published literature implied 94%.
Written into the record, not signed off as a reviewed claim
STAR*D level 1: 28% remitted, at a mean dose now above the ceiling
In plain words
The largest real-world trial of this drug treated 2,876 outpatients with citalopram for up to fourteen weeks. Twenty-eight per cent reached remission on the blinded scale. The average dose people ended on was 41.8 mg a day — a strength the label no longer permits.
What was measured
Remission rate on the 17-item Hamilton scale after up to 14 weeks of open citalopram in 2,876 real-world outpatients
Effect estimate
No reviewed effect estimate exists for this record.
Limits
See the technical detail.
From the source
STAR*D (NCT00021528) enrolled outpatients with major depressive disorder across 23 psychiatric and 18 primary care settings and treated them with flexible-dose citalopram under measurement-based care for up to 14 weeks. Nearly 80% of the 2,876 analysed patients had chronic or recurrent depression and most had comorbid medical or psychiatric conditions. The mean exit dose was 41.8 mg/day. Remission was 28% on the 17-item Hamilton scale (the protocol’s primary outcome) and 33% on the self-report QIDS-SR; response was 47%. Remission and response did not differ between primary and psychiatric care settings, and a substantial proportion of those who responded or remitted did so at or after eight weeks. The mean exit dose sits above the 40 mg maximum imposed in 2011 and well above the 20 mg ceiling that now applies to patients over 60, so the best effectiveness data this drug has were generated under a dosing regime its current label prohibits.
Written into the record, not signed off as a reviewed claim
The famous 67% figure became 35% when the protocol was followed
In plain words
STAR*D is quoted for the claim that two thirds of people eventually get better with enough antidepressant trials. A 2023 reanalysis of the same patient-level data, following the study’s own protocol, put the cumulative remission rate at 35%.
What was measured
Cumulative remission after up to four antidepressant trials, protocol-stipulated blinded Hamilton scale against the originally published figure
Effect estimate
No reviewed effect estimate exists for this record.
Limits
See the technical detail.
From the source
Pigott and colleagues reanalysed the STAR*D patient-level data set with fidelity to the original research protocol, which specified the blinded 17-item Hamilton scale as the primary outcome and explicitly excluded non-blinded clinic-administered assessments from use as research outcomes. They found that the investigators had reported cumulative remission using a non-blinded clinic-administered measure instead, and had included 99 patients who scored as remitted on the Hamilton scale at study outset and 125 who scored as remitted when starting their next-level treatment. Applying the protocol-stipulated outcome and inclusion criteria gave a cumulative remission rate of 35.0% after up to four treatment trials, against the 67% originally reported — approximately half. The reanalysis has been contested in the same literature and the dispute is part of the record; what is not in dispute is which outcome measure the protocol specified.
Written into the record, not signed off as a reviewed claim
A guilty plea over promoting it for children it was never approved for
In plain words
Citalopram has never been licensed for anyone under 18. In 2010 its United States marketer pleaded guilty to criminal charges that included illegally promoting it for depression in children and adolescents, and paid more than $313 million.
What was measured
Criminal and civil resolution amount, and the paediatric indication status on the label
Effect estimate
No reviewed effect estimate exists for this record.
Limits
This entry records a failure.
From the source
The United States Department of Justice announced in September 2010 that Forest Pharmaceuticals, a subsidiary of Forest Laboratories, agreed to plead guilty to charges relating to obstruction of justice, distribution of the unapproved new drug Levothroid, and illegal promotion of Celexa for use in treating children and adolescents with depression, and to pay more than $313 million to resolve criminal and civil liability, including a $150 million criminal fine and $14 million in forfeited assets. The government alleged that sales representatives were directed to promote paediatric use in calls to physicians and that speakers were hired to address paediatric specialists. The label carries no paediatric indication and footnotes its own suicidality table with "Citalopram is not approved for use in pediatric patients", directly beneath the row recording 14 additional patients with suicidal thoughts or behaviours per 1,000 treated under age 18.
Source
United States Department of Justice, Office of Public Affairs press release, 15 September 2010; citalopram United States prescribing information, section 5.1 Table 1 (NDA 020822)
Role in the trial
Not matched to a registered study
Identity check
no open identity hold
Audit mark
caution
Review state
Written into the record, not signed off as a reviewed claim
Selective for the transporter, silent on why that helps
In plain words
The label documents in unusual detail what citalopram does not bind — a dozen receptor families, at no or very low affinity. It says nothing about why blocking the one receptor it does bind should lift mood.
What was measured
That selective serotonin transporter blockade corrects an underlying serotonergic abnormality in depression — an inference the label does not make and the umbrella review of the evidence does not support
Effect estimate
No reviewed effect estimate exists for this record.
Limits
See the technical detail.
From the source
Section 12.2 states that in vitro and in vivo animal studies suggest citalopram is a selective serotonin reuptake inhibitor with minimal effects on noradrenaline and dopamine reuptake, and that it has no or very low affinity for 5-HT1A, 5-HT2A, dopamine D1 and D2, alpha-1, alpha-2 and beta-adrenergic, histamine H1, GABA, muscarinic cholinergic and benzodiazepine receptors. That selectivity is a genuine tolerability advantage over the tricyclics and it is not an explanation. The 2022 umbrella review of the serotonin theory synthesised 17 reviews and large data-set analyses — serotonin and 5-HIAA concentrations, 5-HT1A receptor binding, transporter binding by imaging and post-mortem, tryptophan depletion, transporter gene associations and gene-environment interactions — and reported no consistent evidence that depression is associated with lowered serotonin concentration or activity, alongside evidence that lowered plasma serotonin was associated with antidepressant use.
This order is fixed in code and does not count clicks or time on the page.
What is not here
7 questions this page could not answer
These sections were prepared and left out because there was nothing to put in them. They are listed rather than hidden, so the gaps in this record are visible.
What was measured, goal by goal — found nothing in the sources checked.
How close this is to real life — found nothing in the sources checked.
Felt, measured, or meaningful — found nothing in the sources checked.
How long anything takes — found nothing in the sources checked.
What it may clash with — found nothing in the sources checked.
Other ways to the same goal — found nothing in the sources checked.
What changed on this page — found nothing in the sources checked.
The record as stored
The full record, for auditing
Everything above is built from what is below. This layer keeps the technical vocabulary, record identifiers and every stored row, so a reader who wants to check the page can.
The older medicine-wide conclusion held in this record
Written for a clinical reader, and about the medicine as a whole rather than about one indication, population and set of trials. RNAWiki does not treat it as a programme conclusion and no reviewer has signed it off in that form. It is here word for word because it is what the record holds.
A serotonin reuptake inhibitor whose maximum dose was cut from 60 mg to 40 mg after a thorough QT study found individually corrected QTc rising 8.5 msec at 20 mg and 18.5 msec at 60 mg — leaving 20 mg, a dose its own pivotal fixed-dose trial found to have "no clear effect", as the permitted ceiling for everyone over 60, everyone with liver impairment and every CYP2C19 poor metaboliser.
Recorded evidence blocks (10)
Q2
On the Citalopram label: indicated for what?
"Citalopram tablets are indicated for the treatment of major depressive disorder (MDD) in adults [see Clinical Studies (14) ] . Citalopram tablets are a selective serotonin reuptake inhibitor (SSRI) indicated for the treatment of major depressive disorder (MDD) in adults ( 1 ) .": indications and usage on Citalopram's label. DailyMed label · aa9c1440-354f-43a6-9e70-fd7bafcb03c5 · 2026-07-27
Q3
154 registered trials of Citalopram — at which phases?
Registered studies posting no result
117 of 154
154 registered studies of Citalopram: 43 phase4, 30 na, 28 phase2, 24 phase1, 18 phase3, 14 na or unstated, 4 early phase1. CLINICALTRIALS_SNAPSHOT · 2026-09-01
885 with a PubMed record
Show the evidence
phase4
43
na
30
phase2
28
phase1
24
phase3
18
na or unstated
14
7 more recorded rows
early phase1
4
completed
106
unknown
26
terminated
10
withdrawn
7
recruiting
3
not yet recruiting
2
recorded 2026-09-01 · last checked 2026-09-04
Q4
13 of Citalopram's trials stopped: accrual/recruitment, funding/business, other?
35 hours; Biotransformation of citalopram is mainly hepatic, with a mean terminal half-life of about 35 hours.
bioavailabilitypharmacokinetics
80 %; The absolute bioavailability of citalopram was about 80% relative to an intravenous dose, and absorption is not affected by food.
metabolismpharmacokinetics
Elimination Metabolism Citalopram is metabolized to demethylcitalopram (DCT), didemethylcitalopram (DDCT), citalopram-N-oxide, and a deaminated propionic acid derivative.
recorded 2026-07-27 · last checked 2026-09-04
Q7
Which 68 trials of Citalopram posted no result?
Posted no result
68 of 68 completed trials
Registrations
NCT00217828, NCT00864890, NCT00865085, NCT00865943, NCT01149967 and NCT01149980, and 62 more
Completion dates
oldest 2003-02; newest 2023-11-17
Show the evidence
Trial
NCT00217828
2003-02
NCT00864890
2003-07
NCT00865085
2003-07
NCT00865943
2003-08
NCT01149967
2003-11
NCT01149980
2003-11
14 further recorded trials
NCT00015548
2004-10
NCT00297505
2004-11
NCT00073658
2005-06
NCT00157547
2006-08
NCT00021528
2006-09
NCT00047671
2006-11
NCT00018902
2007-03
NCT00067301
2007-04
NCT00086645
2007-04
NCT00351910
2007-04
NCT00080158
2007-06
NCT00433121
2007-08
NCT00047450
2007-09
NCT00893256
2007-09
Q8
At the median, Citalopram's trials enrolled 71.5 people — anything larger?
Median enrolment
71.5
Largest enrolment
3255526
Registered trials counted
150
Q9
What do 7112 spontaneous reports say about Citalopram — and not say?
These are reports people sent to a regulator. They do not show the medicine caused the reaction. Nobody counted how many people took the medicine and reported nothing. The same event can be reported more than once, and many reports are incomplete. News coverage, lawsuits and new warnings change how often people report. A count is not a rate and not a risk.
Citalopram appears in spontaneous reports to regulators. Across the 10 most-reported reaction terms, 7112 reaction mentions were counted: drug interaction 1115; suicide attempt 765; electrocardiogram qt prolonged 743; serotonin syndrome 739. FAERS via Open Targets · CHEMBL1200781 · 2026-06-24
Show the evidence
drug interaction
1115
suicide attempt
765
electrocardiogram qt prolonged
743
serotonin syndrome
739
hyponatraemia
730
anxiety
710
4 more recorded rows
confusional state
642
toxicity to various agents
586
depression
561
tremor
521
recorded 2026-06-24 · last checked 2026-09-04
Q10
Which 10 reactions does Citalopram's label not list?
In vitro studies using human liver microsomes indicated that CYP3A4 and CYP2C19 are the primary isozymes involved in the N-demethylation of citalopram.
pharmacokinetics
CYP2D6 Poor Metabolizers Citalopram steady state levels were not significantly different in poor metabolizers and extensive metabolizers of CYP2D6.
pharmacokinetics
Drug Interaction Studies In vitro enzyme inhibition data did not reveal an inhibitory effect of citalopram on CYP3A4, -2C9, or -2E1, but did suggest that it is a weak inhibitor of CYP1A2, -2D6, and -2C19.
pharmacokinetics
CYP3A4 and CYP2C19 Inhibitors Since CYP3A4 and CYP2C19 are the primary enzymes involved in the metabolism of citalopram, it is expected that potent inhibitors of CYP3A4 (e.g., ketoconazole, itraconazole, and macrolide antibiotics) and inhibitors of CYP2C19 (e.g., omeprazole, cimetidine) might decrease the clearance of citalopram.
pharmacokinetics
However, coadministration of citalopram and the potent CYP3A4 inhibitor ketoconazole did not significantly affect the pharmacokinetics of citalopram.
pharmacokinetics
CYP2D6 Inhibitors Coadministration of a drug that inhibits CYP2D6 with citalopram is unlikely to have clinically significant effects on citalopram metabolism, based on the study results in CYP2D6 poor metabolizers.
2 more recorded rows
Interaction statementpharmacokinetics
Theophylline Combined administration of citalopram tablets (40 mg/day for 21 days) and the CYP1A2 substrate theophylline (single dose of 300 mg) did not affect the pharmacokinetics of theophylline.
Interaction statementpharmacokinetics
Warfarin Administration of 40 mg/day citalopram tablets for 21 days did not affect the pharmacokinetics of warfarin, a CYP3A4 substrate.
ChEMBL 37 — CC BY-SA 3.0 Unported · ClinicalTrials.gov — US Government work · Open Targets 26.06 — CC0 · mixed register set; per-register licences in docs/specs/corpus-20k-sources.md · openFDA / DailyMed — US Government work
✗ required summary fields resolved: 4 required field(s) not terminal: Why people use it, Best-supported result, Biggest unanswered question, Human evidence
✓ public claims reviewed: 0 reviewed claim(s); drafts are never rendered
✓ source coverage passed: 6 source rows
✓ no critical contamination: no quarantine open
✓ canonical metadata passed: slug and display name present
✓ no raw internal fields: enforced by the copy-contract test over the rendered page
This is a record of evidence. It is not medical advice, and it does not say this substance suits you. Nothing here says any substance on RNAWiki is appropriate for a child.