Citalopram (Celexa) is an SSRI used to treat major depressive disorder and other conditions by increasing serotonin levels in the brain. However, it can interact significantly with other substances, potentially leading to severe complications.
Monoamine Oxidase Inhibitors (MAOIs) and Other Serotonergic Agents
Combining citalopram with MAOIs, an older class of antidepressants, can be extremely dangerous. Taking them with citalopram can cause a fatal condition called serotonin syndrome. A 14-day washout period is necessary when switching between these medications.
The Danger of Serotonin Syndrome
Serotonin syndrome results from excessive serotonin activity. Seek immediate medical attention if symptoms occur. Other serotonergic agents to avoid include other SSRIs, SNRIs, TCAs, certain opioid pain medications, triptans, the herbal supplement St. John's Wort, some antibiotics, and illicit substances.
Medications Affecting Heart Rhythm
Citalopram can prolong the QT interval on an ECG, increasing the risk of Torsade de Pointes, a dangerous heart rhythm abnormality. Doses above 40 mg daily are generally not recommended.
The Risk of QT Prolongation
Combining citalopram with other drugs that prolong the QT interval increases this risk. Always inform your doctor about medications that might affect heart rhythm. Drugs specifically contraindicated with citalopram include pimozide, Class 1A and III antiarrhythmics, certain antipsychotics, specific antibiotics, and methadone.
Increased Risk of Bleeding
SSRIs like citalopram can affect platelet function, increasing the risk of bleeding.
Interacting Blood Thinners and Antiplatelets
Exercise caution when taking citalopram with anticoagulants, antiplatelets, and NSAIDs. Watch for unexplained bruising, nosebleeds, or blood in stool or urine, and ensure close monitoring by your healthcare provider.
Other Important Interactions to Note
- Alcohol: Can worsen citalopram's side effects like drowsiness and dizziness, and may exacerbate depression.
- Cimetidine (Tagamet): Inhibits an enzyme that metabolizes citalopram, potentially increasing citalopram levels and the risk of side effects like QT prolongation.
Comparison of Major Citalopram Interactions
| Interaction Type | Primary Risk | Specific Examples | Symptoms to Watch For |
|---|---|---|---|
| Serotonergic Agents | Serotonin Syndrome | MAOIs (phenelzine, linezolid), other SSRIs/SNRIs (sertraline, venlafaxine), triptans (sumatriptan), tramadol, St. John's Wort | Agitation, fever, sweating, fast heart rate, muscle twitching, confusion |
| QT-Prolonging Drugs | Abnormal Heart Rhythms (TdP) | Pimozide (contraindicated), antiarrhythmics (amiodarone), certain antibiotics (azithromycin), methadone | Dizziness, palpitations, shortness of breath, fainting |
| Blood Thinners / NSAIDs | Increased Bleeding Risk | Warfarin, apixaban, aspirin, ibuprofen, naproxen | Unexplained bruising, nosebleeds, blood in stool or urine |
| CYP2C19 Inhibitors | Increased Citalopram Levels | Cimetidine | Enhanced side effects, higher risk of QT prolongation |
| Alcohol | Exacerbated Sedation | Any alcoholic beverage | Increased dizziness, sleepiness, impaired judgment |
Conclusion
Citalopram is an effective depression treatment, but it carries significant drug interaction risks, particularly with MAOIs (serotonin syndrome) and QT-prolonging drugs (cardiac issues). Increased bleeding risk exists with blood thinners and NSAIDs. Always inform your healthcare provider and pharmacist about all medications and supplements. Consult reliable sources like the {Link: FDA website https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-revised-recommendations-celexa-citalopram-hydrobromide-related} for detailed information on drug interactions.
