Can I take citalopram while pregnant or breastfeeding?

Pregnancy Pregnancy Category C In animal reproduction studies, citalopram has been shown to have adverse effects on embryo/fetal and postnatal development, including teratogenic effects, when administered at doses greater than human therapeutic doses. In two rat embryo/fetal development studies, oral administration of citalopram (32mg, 56mg, or 112 mg/kg/day) to pregnant animals during the period of organogenesis resulted in decreased embryo/fetal growth and survival and an increased incidence of fetal abnormalities (including cardiovascular and skeletal defects) at the high dose, which is approximately 18 times the MRHD of 60 mg/day on a body surface area (mg/m 2 ) basis. This dose was also associated with maternal toxicity (clinical signs, decreased body weight gain). The developmental, no-effect dose of 56 mg/kg/day is approximately 9 times the MRHD on a mg/m 2 basis. In a rabbit study, no adverse effects on embryo/fetal development were observed at doses of up to 16 mg/kg/day, or approximately 5 times the MRHD on a mg/m 2 basis. Thus, teratogenic effects were observed at a maternally toxic dose in the rat and were not observed in the rabbit.

Prescribing label, section “Pregnancy” (opening excerpt): CITALOPRAM HYDROBROMIDE (oral), Aphena Pharma Solutions - Tennessee, LLC. Read the full section on DailyMed. Quoted verbatim; US labels are written for US prescribers and patients.

Infants receive citalopram in breastmilk, and it is detectable in low levels in the serum of some. The dosage that the infant receives and serum level achieved are probably related to the genetic metabolic capacity of the mother and infant. A few cases of minor behavioral side effects such as drowsiness or fussiness have been reported, but no adverse effects on development have been found in infants followed for up to 5 years. Infants exposed in utero can have withdrawal effects postpartum despite breastfeeding and continued maternal citalopram use.[1,2] If citalopram is required by the mother, it is not a reason to discontinue breastfeeding. Some experts do not recommend citalopram during nursing,[3] but a safety scoring system finds citalopram to be acceptable during breastfeeding.[4] If the mother was taking citalopram during pregnancy or if other antidepressants have been ineffective, most experts recommend against changing medications during breastfeeding. Otherwise, agents with lower excretion into breastmilk may be preferred, especially while nursing a newborn or preterm infant. Monitor the infant for excess drowsiness, restlessness, irritability, poor feeding and poor weight gain, especially in younger, exclusively breastfed infants and when using combinations of psychotropic drugs.

Mothers taking an SSRI during pregnancy and postpartum may have more difficulty breastfeeding, although this might be a reflection of their disease state.[5] These mothers may need additional breastfeeding support. Breastfed infants exposed to an SSRI during the third trimester of pregnancy are at risk for neonatal withdrawal syndrome consisting of hypoglycemia, tremors, tachycardia, or hypotonia, and might be at a greater risk of readmission due to jaundice.[6,7]

“Summary of Use during Lactation”, LactMed record “Citalopram” (LM322), quoted verbatim. Everything LactMed reports about Citalopram while breastfeeding.

Nursing Mothers As has been found to occur with many other drugs, citalopram is excreted in human breast milk. There have been two reports of infants experiencing excessive somnolence, decreased feeding and weight loss in association with breastfeeding from a citalopram-treated mother; in one case, the infant was reported to recover completely upon discontinuation of citalopram by its mother and in the second case, no follow-up information was available. The decision whether to continue or discontinue either nursing or citalopram therapy should take into account the risks of citalopram exposure for the infant and the benefits of citalopram treatment for the mother .

Prescribing label, section “Nursing Mothers”: CITALOPRAM HYDROBROMIDE (oral), Aphena Pharma Solutions - Tennessee, LLC. Label on DailyMed. Quoted verbatim; US labels are written for US prescribers and patients.