Precautions:

• In rare cases, divalproex sodium has caused liver failure, sometimes resulting in death. Children younger than 2 years of age, especially those taking multiple seizure medicines, those with metabolic diseases, those with mental retardation, and those with organic brain disease are at the highest risk of liver failure. Notify your doctor immediately if you develop loss of seizure control, weakness, fatigue, swelling of the face, vomiting, or loss of appetite. These symptoms may be early signs of liver damage.
• In rare cases, divalproex sodium has also caused severe, even fatal, cases of pancreatitis (inflammation of the pancreas). Some of the cases have progressed rapidly from initial symptoms to death. Cases have been reported soon after starting treatment with divalproex sodium, as well as after several years of use. Notify your doctor immediately if you develop nausea, vomiting, abdominal pain, or loss of appetite. These symptoms may be early signs of pancreatitis.
• Do not stop taking your medication even if you feel better. It is important to continue taking divalproex sodium to prevent your seizures from recurring. Even if you are not being treated for a seizure disorder, abruptly discontinuing this medication can cause you to have seizures.
• Do not crush, chew, or break the capsules or delayed- or extended-release tablets (Depakote, Depakote ER). Swallow them whole.
• Carry or wear a medical identification tag to let others know that you are taking this medicine in the case of an emergency.
• Divalproex sodium may interact with other drugs that cause drowsiness, including alcohol, antidepressants, antihistamines, pain relievers, anxiety medicines, and muscle relaxants. Dangerous sedation, dizziness, or drowsiness may occur if divalproex sodium is taken with alcohol or any of these medications. Talk to your doctor before taking divalproex sodium in combination with alcohol or any other medicines.
• Your doctor will do blood testing at regular intervals to check the levels of Depakote in your blood.

Pregnancy and Breastfeeding:

• FDA pregnancy category D. This means that it is known to harm an unborn baby. Malformations of the face and head, heart, and nervous system have been reported. Do not take divalproex sodium without first talking to your doctor if you are pregnant.
• Divalproex sodium passes into breast milk and may affect a nursing infant. Do not take divalproex sodium without first talking to your doctor if you are breast-feeding a baby.

Other medical conditions:
Be sure to tell your doctor if you have any other medical problems, especially:

• Blood disease
• Brain disease
• Kidney disease—There is an increased risk of serious side effects
• Liver disease— divalproex may make the condition worse

Other medications:
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking citalopram, it is especially important that your health care professional know if you are taking any of the following:

• Bromocriptine (e.g., Parlodel)
• Buspirone (e.g., BuSpar)
• Certain tricyclic antidepressants (amitriptyline [e.g., Elavil], clomipramine [e.g., Anafranil], or imipramine [e.g., Tofranil])
• Dextromethorphan (cough medicine)
• Levodopa (e.g., Sinemet)
• Lithium (e.g., Eskalith)
• Meperidine (e.g., Demerol)
• Moclobemide (e.g., Manerix)
• Nefazodone (e.g., Serzone)
• Pentazocine (e.g., Talwin)
• Selective serotonin reuptake inhibitors, other (fluoxetine [e.g., Prozac], fluvoxamine [e.g., Luvox], paroxetine [e.g., Paxil], sertraline [e.g., Zoloft])
• Street drugs (LSD, MDMA [e.g., ecstasy], marijuana) or
• Tramadol (e.g., Ultram)
• Trazodone (e.g., Desyrel)
• Triptans (e.g., Imitrex, Maxalt, Zomig, Amerge, Axert, Frova)
• Tryptophan
• Venlafaxine (e.g., Effexor)—Using these medicines with citalopram may increase the chance of developing a rare, but very serious, unwanted effect known as the serotonin syndrome. This syndrome may cause confusion, diarrhea, fever, poor coordination, restlessness, shivering, sweating, talking or acting with excitement you cannot control, trembling or shaking, or twitching. If you develop these symptoms, contact your doctor as soon as possible
• Monoamine oxidase (MAO) inhibitors (furazolidone [e.g., Furoxone], isocarboxazid [e.g., Marplan], phenelzine [e.g., Nardil], procarbazine [e.g., Matulane], selegiline [e.g., Eldepryl], tranylcypromine [e.g., Parnate])—
• Do not take citalopram while you are taking or within 2 weeks of taking an MAO inhibitor. If you do, you may develop confusion, agitation, restlessness, stomach or intestinal symptoms, sudden high body temperature, extremely high blood pressure, severe convulsions, or the serotonin syndrome. At least 14 days should pass between stopping treatment with one medicine (citalopram or the MAO inhibitor) and starting treatment with the other.

Potential side effects:
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention. One rare, but very serious, effect that may occur is the serotonin syndrome. This syndrome (group of symptoms) is more likely to occur shortly after an increase in citalopram dose.

Check with your doctor as soon as possible if any of the following side effects occur:

• More common: Decrease in sexual desire or ability
• Less common: Agitation; blurred vision; confusion; fever; increase in frequency of urination or amount of urine produced; lack of emotion; loss of memory; menstrual changes; skin rash or itching; trouble in breathing
• Rare: Anxiety; behavior change similar to drunkenness; bleeding gums; breast tenderness or enlargement or unusual secretion of milk (in females); difficulty in concentrating; dizziness or fainting; increased hunger; irregular heartbeat; low blood sodium (confusion, convulsions [seizures], drowsiness, dryness of mouth, increased thirst, lack of energy); mood or mental changes; nervousness; nose bleed; painful urination; purple or red spots on skin; sore throat, fever, and chills; red or irritated eyes; redness, tenderness, itching, burning, or peeling of skin; serotonin syndrome (agitation, confusion, diarrhea, fever, overactive reflexes, poor coordination, restlessness, shivering, sweating, talking or acting with excitement you cannot control, trembling or shaking, twitching); shakiness; slow or irregular heartbeat (less than 50 beats per minute); trouble in holding or releasing urine; unusual or sudden body or facial movements or postures

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:

• More common: Drowsiness; dryness of mouth; nausea; trouble in sleeping
• Less common: Abdominal pain; anxiety; change in sense of taste; diarrhea; gas; headache (severe and throbbing); heartburn; increased sweating ; increased yawning; loss of appetite; pain in muscles or joints; stuffy or runny nose; tingling, burning, or prickly feelings on skin; tooth grinding; trembling or shaking; unusual increase or decrease in weight; unusual tiredness or weakness; vomiting; watering of mouth

After you stop using this medicine, your body may need time to adjust. The length of time this takes depends on the amount of medicine you were using and how long you used it. During this period of time check with your doctor if you notice any of the following side effects:

• Anxiety; dizziness; nervousness; trembling or shaking

Brand Names:

• U.S. & Canada: Celexa

Additional Information:

• Beyond the Pain of Migraine
  Studies published this month by the American Academy of Neurology show a decreased quality of life for migraineurs and a link between migraine and depression. Once again, it's shown that a migraine is NOT just a headache. 
• FDA info sheet
• FDA approved prescribing information (requires free Adobe Acrobat Reader)