Can you take diazePAM with citalopram?: Understanding the Drug Interaction and Risks

October 13, 2025 •

4 min read

According to drug interaction databases, using diazepam and citalopram together is classified as a moderate drug interaction. The potential risks associated with combining these medications include increased side effects, such as heightened drowsiness, confusion, and difficulty concentrating. Therefore, you should always consult a healthcare provider to understand the full implications and ensure your safety when taking diazePAM with citalopram.

Quick Summary

Taking diazepam and citalopram together can result in an additive central nervous system depressant effect, leading to excessive drowsiness, confusion, and impaired motor skills. This combination requires careful medical supervision and monitoring, with increased risk for elderly or debilitated individuals.

Key Points

Moderate Drug Interaction: Combining diazepam and citalopram is considered a moderate, clinically significant interaction due to their cumulative CNS depressant effects.
Increased Sedation Risk: The primary risk is excessive drowsiness, dizziness, and sedation, which can impair mental alertness and physical coordination.
Enhanced Side Effects: Patients may experience amplified confusion, impaired judgment, and motor coordination difficulties.
Avoid CNS Depressants: Do not consume alcohol or other CNS-depressing substances, like certain antihistamines, while on this combination.
Requires Medical Supervision: Concomitant use should only occur under a doctor's careful monitoring, especially for the elderly, and often involves cautious dosage titration.
Different Mechanisms of Action: Diazepam is a short-acting benzodiazepine for immediate anxiety relief, while citalopram is a long-acting SSRI for long-term management of mental health conditions.
Risk of Respiratory Depression: The combined CNS depressant effect can increase the risk of respiratory depression, which is a serious and potentially life-threatening condition.

Understanding the Combination of Diazepam and Citalopram

Diazepam (Valium) is a benzodiazepine that acts as a central nervous system (CNS) depressant, primarily used for its anxiolytic (anxiety-reducing), sedative, muscle relaxant, and anticonvulsant properties. Citalopram (Celexa) is a selective serotonin reuptake inhibitor (SSRI), an antidepressant that works by increasing the levels of serotonin in the brain over a period of weeks to treat depression and, off-label, anxiety. While a doctor might prescribe these medications together, typically for a short overlap period, it is crucial to understand their interaction and risks.

The core of the interaction lies in their combined effect on the CNS. Both drugs cause sedation and drowsiness independently. When taken together, their CNS depressant effects can become additive or synergistic, meaning the combined effect is greater than the sum of their individual effects. This can significantly increase the risk and severity of side effects, especially in vulnerable patient populations, such as the elderly or those with underlying health issues.

The Nature and Risks of the Drug Interaction

The interaction between diazepam and citalopram is generally classified as moderate and clinically significant. The primary danger is the potentiated central nervous system depression. Patients are monitored for potentially excessive or prolonged CNS and respiratory depression. Respiratory depression, characterized by slow and shallow breathing, can be life-threatening in severe cases. This risk is compounded by other factors, including the use of alcohol or other CNS-depressing substances.

Key risks of combining these medications include:

Excessive Sedation and Drowsiness: Both drugs can cause sleepiness, which is heightened when they are used together. This can severely affect daily functioning, alertness, and reaction time.
Impaired Cognitive and Motor Function: The combination can cause confusion, difficulty concentrating, and impaired judgment and motor coordination. This increases the risk of accidents, especially when driving or operating heavy machinery.
Risk for the Elderly: Elderly individuals are particularly susceptible to these adverse effects. Their slower metabolism and higher sensitivity to psychotropic medications can lead to excessive accumulation of the drugs, increasing the risk of falls, confusion, and prolonged sedation.
Respiratory Depression: As CNS depressants, both can suppress breathing. The additive effect of combining them elevates the risk of respiratory depression, which is particularly dangerous.

Comparison of Diazepam and Citalopram

To better understand why a doctor might use these drugs together cautiously, it helps to compare their pharmacological differences.


Feature	Diazepam (Valium)	Citalopram (Celexa)
Drug Class	Benzodiazepine	Selective Serotonin Reuptake Inhibitor (SSRI)
Primary Indication	Anxiety, alcohol withdrawal, muscle spasms, seizures	Depression, anxiety (off-label)
Mechanism of Action	Enhances GABA, a calming neurotransmitter, to slow down brain activity.	Blocks the reuptake of serotonin, increasing its availability over time.
Onset of Action	Fast-acting (minutes to hours)	Delayed (weeks for full therapeutic effect)
Duration of Therapy	Typically short-term due to risk of dependence and withdrawal.	Typically long-term to manage symptoms of depression or anxiety.
Dependence & Withdrawal	Significant risk of physical dependence and withdrawal symptoms upon discontinuation.	Discontinuation syndrome (withdrawal) possible if stopped abruptly.
Potential for Misuse	High potential for misuse and addiction; controlled substance.	Low potential for misuse; not a controlled substance.

The Importance of Medical Guidance and Management

Despite the risks, a physician may decide to prescribe both diazepam and citalopram under specific circumstances. A common scenario is using diazepam for a short duration at the beginning of citalopram treatment. This is because citalopram can take several weeks to become fully effective, and the benzodiazepine can provide immediate relief from severe anxiety symptoms during this initial period. The diazepam is then typically tapered and discontinued as the citalopram's effects become established.

Management of this combination involves:

Careful Dosage Titration: A healthcare provider will likely start with low doses and adjust them cautiously while monitoring the patient's response.
Patient Monitoring: Ongoing supervision is essential to watch for signs of excessive sedation, confusion, or breathing problems.
Patient Education: Patients must be fully informed of the risks and side effects, and advised to avoid activities like driving until they know how the combination affects them.
Managing Related Interactions: Patients should be warned to avoid alcohol and other CNS depressants, as these will further amplify the side effects.

Other Interacting Substances

Patients taking diazepam and citalopram must also be aware of other substances that can increase the risk of adverse effects. These include:

Alcohol: Consumption of alcohol with this combination can be extremely dangerous due to intensified CNS depression, potentially leading to coma or death.
Grapefruit Juice: Grapefruit can inhibit the enzymes that metabolize diazepam, causing its levels to increase in the body and heightening the risk of side effects.
Opioids: The combination of benzodiazepines with opioids is particularly dangerous and carries a boxed warning from the FDA due to the severe risk of respiratory depression and death.

Conclusion

Combining diazepam and citalopram is possible under strict medical supervision, but it carries a moderate risk of interaction, primarily due to heightened CNS depression. The combination is typically managed by a healthcare provider for a temporary period to bridge the gap until the SSRI takes effect. It is crucial for patients to be aware of the risks, understand the warning signs of excessive sedation, and adhere strictly to their doctor's dosage and usage instructions. Never adjust dosages or stop medications without consulting a healthcare professional. For more in-depth information on drug interactions, refer to authoritative sources like the Drugs.com interaction checker.

Frequently Asked Questions

Common side effects include increased dizziness, drowsiness, confusion, and difficulty concentrating. Impairment of judgment, thinking, and motor coordination may also occur.

No, you should avoid driving or operating hazardous machinery until you understand how the combination affects you. The increased sedation and impaired coordination pose a significant safety risk.

If you experience any symptoms of excessive sedation or breathing problems, such as unusual drowsiness, dizziness, or confusion, contact your doctor immediately. In case of severe symptoms like extreme sleepiness or slowed breathing, seek emergency medical help.

Elderly patients are at a higher risk for excessive sedation, confusion, and motor impairment. Healthcare providers must exercise extreme caution, and the combination may be avoided entirely in this population.

A doctor might prescribe both for a short-term period to manage acute anxiety with diazepam while waiting for the long-term antidepressant effects of citalopram to take hold. This strategy is always closely monitored.

No, the primary risk is enhanced CNS depression, not serotonin syndrome. Serotonin syndrome is a risk when combining citalopram with other medications that increase serotonin levels, such as MAOIs, not benzodiazepines.

Drinking alcohol while taking diazepam and citalopram is highly dangerous. It can intensify the CNS depressant effects, leading to severe drowsiness, breathing problems, and potentially a coma or death.

A doctor can manage this by starting with low doses, carefully titrating the dosage, and closely monitoring the patient for adverse effects. The diazepam is typically tapered off as the citalopram becomes effective.