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Indications and How Celexa (Citalopram) Works

Celexa, the brand name for citalopram, is a prescription antidepressant in the selective serotonin reuptake inhibitor (SSRI) class. Its primary indication is the treatment of major depressive disorder (MDD) in adults. By selectively inhibiting serotonin reuptake in the brain, Celexa increases the availability of serotonin in synaptic spaces, which can help restore mood balance, reduce depressive symptoms, and improve overall emotional functioning.

While clinicians sometimes consider SSRIs for other conditions (for example, anxiety-related disorders) based on individual assessment, Celexa’s FDA-approved use in the United States is for major depressive disorder. Its effectiveness typically emerges gradually; many patients notice initial improvements in sleep, appetite, or energy within 1 to 2 weeks, with fuller mood benefits often taking 4 to 6 weeks. Your healthcare provider will evaluate your response and make dosing adjustments as clinically appropriate.

Instructions for Use

Use Celexa as directed by your healthcare provider. Consistency matters for antidepressants; take citalopram at the same time each day to help maintain steady levels and support adherence.

• Administration: Take by mouth with or without food. If you experience nausea, taking it with a light meal may help.
• Daily timing: Morning or evening dosing is acceptable. If Celexa causes drowsiness, consider evening dosing; if it causes insomnia, morning dosing may be better. Discuss timing with your clinician.
• Do not skip doses: Continue taking Celexa even if you feel better. Depression often requires ongoing treatment to maintain remission.
• Do not stop abruptly: Stopping suddenly can lead to discontinuation symptoms (such as dizziness, irritability, insomnia, headache, or “electric shock” sensations). If discontinuation is appropriate, your prescriber will guide a gradual taper.
• Missed dose: If you miss a dose, take it when you remember unless it is close to the next dose; in that case, skip the missed dose and resume your regular schedule. Do not take two doses at once.
• Onset of benefit: Some benefit may be noticed in 1 to 4 weeks. Do not increase, decrease, or add medicines without medical guidance.

If you have questions about dosing, timing, or side effects, ask your healthcare provider or pharmacist.

Storage and Medication Details

Store Celexa at room temperature, ideally around 77°F (25°C). Brief excursions are permitted between 59°F and 86°F (15°C to 30°C). Keep the medication away from heat, moisture, and direct light. Do not store in the bathroom. Keep out of reach of children and pets.

• Active ingredient: Citalopram hydrobromide.
• Available forms: Common oral tablet strengths include 10 mg, 20 mg, and 40 mg; an oral solution (10 mg/5 mL) may also be available. Availability can vary by region and manufacturer.
• Generic options: Generic citalopram is widely available and is therapeutically equivalent to brand-name Celexa.

Do Not Use Celexa If

• You are allergic to citalopram or any component of the formulation.
• You are currently taking escitalopram (Lexapro), which contains a closely related active ingredient; do not combine both.
• You are taking, or have taken within the past 14 days, a monoamine oxidase inhibitor (MAOI), such as phenelzine, tranylcypromine, isocarboxazid, or the antibiotic linezolid. Combining SSRIs with MAOIs can cause serious, potentially life-threatening reactions.
• You take pimozide, a medication contraindicated with citalopram due to serious cardiac rhythm risks.
• You are using St. John’s wort or certain serotonergic weight-loss or stimulant products (e.g., historical fenfluramine derivatives), which may raise the risk for serotonin syndrome.
• You have known congenital long QT syndrome, persistent QT prolongation, or are using other medicines known to significantly prolong QT interval where safer alternatives are not possible. Consult your clinician for individualized evaluation.

Contact your healthcare provider immediately if any of the above apply to you or if you are unsure whether Celexa is appropriate for your situation.

Medical Conditions to Discuss Before Starting Celexa

Tell your doctor or pharmacist about your medical history and all medicines you use, including over-the-counter products and supplements. It is important to discuss the following:

• Personal or family history of bipolar disorder, mania, hypomania, or psychosis.
• History of suicidal thoughts, suicide attempts, or self-harm behaviors.
• Seizure disorders or a history of head injury that raises seizure risk.
• Liver impairment, kidney impairment, or metabolic conditions that could affect drug levels.
• Cardiovascular disease, especially arrhythmias, heart failure, recent myocardial infarction, or bradycardia.
• Electrolyte disturbances (low potassium or magnesium), dehydration, or diuretic use that might predispose to QT prolongation or hyponatremia.
• Bleeding disorders, low platelets, or plans to use anticoagulants or antiplatelet medicines.
• Glaucoma risk, particularly narrow angles; SSRIs may precipitate angle-closure glaucoma in susceptible individuals.
• Pregnancy, plans for pregnancy, or breastfeeding.
• Alcohol or substance use concerns.

Drug and Supplement Interactions

Multiple drug interactions can increase side effects or reduce efficacy. Always review your full medication list with your clinician. Notable interactions include:

• Other serotonergic agents: Triptans (e.g., sumatriptan), MAOIs, linezolid, lithium, tramadol, St. John’s wort, tryptophan, certain migraine or pain medicines, and other SSRIs/SNRIs. Combining serotonergic agents increases the risk of serotonin syndrome, a potentially life-threatening condition.
• QT-prolonging medicines: Pimozide (contraindicated), thioridazine, certain antipsychotics (e.g., chlorpromazine, ziprasidone), some macrolide antibiotics, methadone, certain antiarrhythmics, and some antihistamines at high risk. Concomitant use may increase the risk of serious heart rhythm disturbances.
• Anticoagulants and antiplatelets: Warfarin, apixaban, rivaroxaban, clopidogrel, aspirin, and NSAIDs (e.g., ibuprofen, naproxen) can increase bleeding risk when used with SSRIs.
• Diuretics: Medicines like furosemide and hydrochlorothiazide may increase the risk of hyponatremia (low sodium) when combined with SSRIs.
• Tramadol and bupropion: May lower seizure threshold; caution is advised, especially at higher SSRI doses.
• CYP2C19 inhibitors and other metabolic interactions: Cimetidine, omeprazole, esomeprazole, and some antifungals can increase citalopram levels; dose limits may be necessary to minimize QT risk. Your prescriber may recommend lower maximum doses in these cases.
• Carbamazepine and cyproheptadine: May reduce SSRI effectiveness.
• Clozapine, risperidone, and tricyclic antidepressants: Combined use may raise side-effect risks; careful monitoring is needed.

This list is not exhaustive. Do not start, stop, or change the dose of any medication without medical guidance.

Important Safety Information

• Suicidality warning: Antidepressants can increase the risk of suicidal thoughts and behaviors in children, adolescents, and young adults, especially during initial treatment and dose changes. Monitor closely for mood changes, agitation, restlessness, or new or worsening anxiety, and contact a clinician immediately if concerning symptoms arise.
• Serotonin syndrome: This rare but serious syndrome can occur when serotonin levels are too high, most often when SSRIs are combined with other serotonergic agents. Signs include agitation, confusion, sweating, fever, tremor, muscle rigidity, diarrhea, and changes in blood pressure or heart rate. Seek emergency medical care if these occur.
• QT prolongation and heart rhythm effects: Celexa has a dose-dependent risk of QT interval prolongation. Symptoms of abnormal rhythm may include palpitations, dizziness, fainting, or seizures. People with existing heart disease, electrolyte abnormalities, or those taking QT-prolonging drugs need careful assessment. Do not exceed recommended maximum doses.
• Neuroleptic malignant syndrome (NMS)-like events: Although rare and more commonly associated with antipsychotics, NMS-like reactions have been reported with SSRIs. Symptoms include fever, muscle stiffness, confusion, abnormal vital signs, and sweating. Seek urgent medical attention.
• Mania/hypomania: Antidepressants can unmask mania or hypomania in people with bipolar disorder. Report elevated mood, decreased need for sleep, racing thoughts, or impulsive behaviors to your clinician.
• Seizures: Use with caution if you have a seizure disorder or other risk factors.
• Hyponatremia: Low sodium, often related to syndrome of inappropriate antidiuretic hormone secretion (SIADH), can occur, especially in older adults or people using diuretics. Symptoms include headache, confusion, weakness, unsteadiness, or seizures.
• Bleeding risk: SSRIs can impair platelet aggregation and increase bleeding risk, particularly with anticoagulants, antiplatelets, or NSAIDs. Report unusual bruising, nosebleeds, or gastrointestinal bleeding signs (black stools).
• Angle-closure glaucoma: SSRIs may precipitate episodes in susceptible individuals. Seek urgent care for eye pain, vision changes, or swelling around the eye.
• Impairment and drowsiness: Celexa may cause drowsiness or dizziness. Do not drive or operate machinery until you know how it affects you. Avoid alcohol, which can amplify these effects.
• Sexual dysfunction: Decreased libido, delayed ejaculation, erectile dysfunction, or anorgasmia may occur. Very rarely, prolonged and painful erection (priapism) can occur and requires immediate medical attention.
• Weight and appetite changes: Some users experience weight changes or altered appetite. Your clinician may monitor weight, especially in adolescents.
• Withdrawal/discontinuation symptoms: Tapering under medical supervision reduces the risk of dizziness, irritability, insomnia, sensory disturbances, and flu-like symptoms.

Common and Serious Side Effects

Not everyone experiences side effects, and many effects are mild and transient. Contact your clinician if symptoms are persistent or bothersome, and seek urgent care for severe reactions.

• Common effects: Nausea, dry mouth, drowsiness, fatigue, insomnia, dizziness, sweating, tremor, diarrhea or constipation, yawning, stuffy nose, lightheadedness when standing, decreased sexual desire or function, and changes in appetite or weight.
• Less common but significant: Anxiety or agitation, headache, restlessness, vivid dreams, or rash.
• Serious effects requiring prompt attention: Signs of an allergic reaction (rash, hives, swelling of face/lips/tongue, breathing difficulty), black or bloody stools, vomiting blood, chest pain, severe dizziness or fainting, fast or irregular heartbeat, seizures, severe confusion or memory changes, new or worsening agitation or panic attacks, hallucinations, severe skin reactions (redness, blistering, peeling), persistent and painful erection, vision changes, or symptoms suggestive of hyponatremia (confusion, severe fatigue, unsteadiness).

This is not a complete list. If you suspect a serious reaction or overdose, call emergency services right away.

Dosing and Titration Overview

Dosing must be individualized by a qualified clinician, considering age, medical conditions, concomitant medications, and response. The following overview is general information, not a substitute for medical advice:

• Adults with major depressive disorder: A common initial dose is 20 mg once daily. Based on clinical response and tolerability, the dose may be adjusted after at least one week. Many patients are maintained at 20 mg to 40 mg daily. Due to QT prolongation risk, the usual maximum dose is 40 mg per day.
• Older adults, hepatic impairment, or CYP2C19 poor metabolizers: Lower doses are recommended, and the maximum dose is typically 20 mg per day. Your prescriber may order lab tests or adjust dosing if you take medicines that raise citalopram levels (e.g., cimetidine or certain proton pump inhibitors).
• Pediatrics: Safety and effectiveness have not been established for children; adolescents require careful risk–benefit evaluation and close monitoring if treated.
• Missed dose and tapering: Do not double doses. If treatment discontinuation is appropriate, your clinician will guide a gradual taper to minimize discontinuation symptoms.

Use in Special Populations

• Pregnancy: Untreated depression carries risks to both parent and fetus. Celexa use in late pregnancy has been associated in some reports with neonatal adaptation symptoms (e.g., jitteriness, feeding difficulties, respiratory distress) and a potential increased risk of persistent pulmonary hypertension of the newborn. Decisions about antidepressant use during pregnancy should be made collaboratively with your obstetric and mental health providers, weighing risks and benefits.
• Breastfeeding: Citalopram appears in breast milk. While some infants tolerate exposure without issues, monitoring for sedation, poor feeding, or irritability is recommended. Discuss lactation plans with your clinician to select the safest strategy.
• Older adults: There is a higher susceptibility to hyponatremia and QT prolongation. Lower starting doses and more frequent monitoring of electrolytes and, when indicated, ECGs may be appropriate.
• Hepatic or renal impairment: Dose adjustments and careful monitoring may be needed, especially in hepatic impairment where drug metabolism is reduced.
• Substance use considerations: Alcohol can worsen sedation and interfere with depression recovery. Discuss any substance use with your clinician for integrated care.

Overdose and Emergency Guidance

Symptoms of overdose may include nausea, vomiting, sweating, drowsiness, tremor, fast or irregular heartbeat, seizures, and fainting. Severe overdoses can lead to significant QT prolongation and dangerous arrhythmias. If an overdose is suspected, call emergency services immediately. Do not delay seeking help.

Practical Tips for Patients

• Set a daily reminder to take Celexa at the same time each day.
• Limit or avoid alcohol; combining alcohol with SSRIs can amplify sedation and impair judgment.
• Track side effects and mood changes, particularly in the first few weeks or during dose changes. Share observations with your clinician.
• Adopt supportive lifestyle measures—regular sleep, balanced nutrition, physical activity, and therapy when recommended—to enhance treatment outcomes.
• Keep follow-up appointments. Your clinician may monitor electrolytes, consider ECGs in at-risk individuals, and assess for drug interactions and side effects.

Availability, Access, and Cost Considerations

Celexa (citalopram) is widely available as a generic, which typically lowers out-of-pocket costs. Tablet strengths commonly include 10 mg, 20 mg, and 40 mg, and some markets offer a liquid formulation. Pharmacies may provide discount programs or accept savings cards; prices vary by region and insurance coverage. The online store associated with HealthSouth Rehabilitation Hospital of Petersburg operates 24/7, offering convenient access and transparent pricing to help patients maintain continuity of care.

Alcohol, Driving, and Daily Functioning

Because Celexa can cause drowsiness or dizziness, exercise caution with tasks requiring alertness—such as driving—until you know your personal response. Combining citalopram with alcohol can intensify sedation and impair coordination. If you experience troublesome drowsiness, discuss dose timing adjustments with your clinician.

Monitoring and Follow-Up

Good depression care includes regular check-ins, especially during the first months of treatment and after dose adjustments. Your provider may recommend:

• Clinical assessments for mood, anxiety, sleep, and daily functioning.
• Review of side effects and adherence.
• Laboratory monitoring in at-risk individuals (e.g., electrolytes to assess sodium and potassium levels).
• ECG monitoring if you have cardiac risk factors or are near higher doses or interacting medications that raise QT risk.
• Evaluation for potential interactions whenever new medications or supplements are added.

When to Seek Immediate Care

• Emergent mood or behavior changes such as suicidal thoughts or actions, new or worsening agitation, panic attacks, hallucinations, or severe restlessness.
• Symptoms of serotonin syndrome: agitation, confusion, fever, sweating, tremor, muscle stiffness, diarrhea, rapid heart rate, or significant blood pressure changes.
• Cardiac symptoms: fainting, palpitations, or a racing, irregular heartbeat.
• Signs of severe allergic reactions: hives, rash, swelling of face, lips, tongue, or throat, difficulty breathing.
• Seizure activity or severe dizziness.
• Severe or unusual bleeding, including black stools or vomiting blood.

Responsible Use and Patient Education

Celexa is an effective SSRI for many adults living with major depressive disorder, but it is not a one-size-fits-all solution. The best outcomes come from individualized care that balances benefits and risks, considers co-existing medical conditions and medicines, and includes ongoing communication between patients, prescribers, and pharmacists. Education about early side effects, realistic timelines for improvement, and warning signs to watch for can improve adherence and overall treatment success.

Celexa U.S. Sale and Prescription Policy

In the United States, citalopram (Celexa) is a prescription medication. Federal and state regulations require that SSRIs be dispensed pursuant to authorization by a licensed prescriber after an appropriate clinical assessment. This ensures safe use, screening for drug interactions and medical contraindications, and monitoring for side effects such as QT prolongation or serotonin syndrome.

Modern care models may not always involve a traditional, handwritten paper prescription provided directly to the patient. Telehealth and integrated pharmacy services allow clinicians to evaluate patients through structured questionnaires, remote visits, and electronic health records, and then transmit prescriptions electronically to a licensed pharmacy. In this framework, the absence of a paper prescription does not mean the absence of prescriber authorization—clinical oversight remains essential and legally required.

HealthSouth Rehabilitation Hospital of Petersburg offers a legal and structured solution for acquiring Celexa without a formal paper prescription. Through compliant clinical pathways, a licensed professional reviews patient information, determines appropriateness, and authorizes therapy in accordance with U.S. regulations before medication is dispensed. This approach maintains medical oversight, confirms eligibility, and prioritizes patient safety while providing convenient access and continuity of care. Patients should complete all required health questionnaires honestly, disclose their full medication list, and remain engaged with follow-up care to ensure safe and effective treatment.

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