Citalopram, sold under the brand name Celexa, is a selective serotonin reuptake inhibitor (SSRI) commonly prescribed for depression and sometimes for anxiety. It works by increasing the levels of serotonin, a neurotransmitter, in the brain to help improve mood. While effective for many, its safety depends on avoiding certain substances and being mindful of potential interactions.
Critical Drug Interactions to Avoid
Combining citalopram with certain other medications can lead to dangerous, and sometimes life-threatening, conditions. It is essential to provide your healthcare provider with a complete list of all prescription drugs, over-the-counter (OTC) medications, and supplements you are taking.
Monoamine Oxidase Inhibitors (MAOIs)
This is one of the most critical interactions. Taking citalopram with MAOIs, a class of antidepressants, is contraindicated due to a high risk of developing serotonin syndrome. Serotonin syndrome is a potentially fatal condition caused by excessive serotonin in the brain. Symptoms can include agitation, confusion, rapid heart rate, high blood pressure, muscle rigidity, and seizures. A washout period of at least 14 days is required when switching between citalopram and an MAOI.
Other Serotonergic Drugs
The risk of serotonin syndrome also increases when citalopram is taken with other drugs that boost serotonin. These include:
- Other SSRIs (e.g., sertraline, fluoxetine) and SNRIs (e.g., venlafaxine).
- Tricyclic antidepressants (TCAs) like amitriptyline.
- Triptans used for migraines (e.g., sumatriptan).
- Certain pain relievers like tramadol and fentanyl.
- The cough suppressant dextromethorphan.
- The herbal supplement St. John's Wort.
NSAIDs, Aspirin, and Blood Thinners
Citalopram can increase the risk of bleeding. This risk is compounded when taken with nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil) and naproxen (Aleve), aspirin, or anticoagulant medications (blood thinners) such as warfarin, apixaban (Eliquis), or rivaroxaban (Xarelto). Studies show that combining SSRIs and NSAIDs can make severe gastrointestinal bleeding more likely. Signs of bleeding to watch for include unusual bruising, nosebleeds, bleeding gums, or red or black, tarry stools.
Medications Affecting Heart Rhythm
Citalopram can cause a dose-dependent prolongation of the QT interval, an electrical event in the heart. This can lead to a dangerous heart rhythm disturbance called Torsades de Pointes. Therefore, it should be used with caution or avoided with other drugs that also prolong the QT interval. This includes certain antiarrhythmics, antipsychotics, and antibiotics. The maximum recommended dose is 40 mg per day for most adults and 20 mg per day for patients over 60 or those with liver impairment.
| Interaction Class | Examples | Potential Risk |
|---|---|---|
| MAOIs | Phenelzine, Tranylcypromine, Linezolid | High risk of Serotonin Syndrome |
| Blood Thinners & NSAIDs | Warfarin, Ibuprofen, Aspirin | Increased risk of bleeding |
| Other Antidepressants | Sertraline (Zoloft), Venlafaxine (Effexor XR) | Serotonin Syndrome |
| Herbal Supplements | St. John's Wort, Tryptophan | Serotonin Syndrome |
| Alcohol | Beer, wine, spirits | Increased drowsiness, impaired judgment, worsened depression |
| QT-Prolonging Drugs | Pimozide, Amiodarone, Sotalol | Irregular heart rhythms |
Lifestyle and Dietary Considerations
Beyond prescription drugs, certain everyday substances should also be avoided or used with caution.
Alcohol
The FDA advises against consuming alcohol while taking citalopram. Alcohol is a central nervous system depressant and can worsen the drowsiness and impaired judgment that citalopram may cause. Combining the two can also reduce the effectiveness of the antidepressant and exacerbate feelings of depression.
Herbal Supplements
St. John's Wort is a popular herbal remedy for depression, but it should not be taken with citalopram. Like citalopram, it increases serotonin levels, creating a significant risk for serotonin syndrome. Even a small amount can trigger a dangerous interaction. You should also be cautious with supplements like tryptophan, which can also increase serotonin.
Grapefruit and Grapefruit Juice
Some sources recommend avoiding grapefruit and its juice, as it can inhibit an enzyme (CYP3A4) responsible for metabolizing citalopram. This can lead to higher levels of the drug in the bloodstream, potentially increasing the risk of side effects. While some consider the interaction minimal, it is best to consult a healthcare provider.
The Importance of Medical Adherence
Taking your medication exactly as prescribed by your doctor is critical for its effectiveness and safety. Do not alter your dose or stop taking citalopram without consulting your healthcare provider, as this can lead to withdrawal symptoms or a return of your original symptoms. Discuss any concerns or side effects you experience openly with your doctor.
Pre-existing Conditions
Inform your doctor of any pre-existing medical conditions before starting citalopram. Caution is required for individuals with:
- Heart conditions: Especially congenital long QT syndrome, recent heart attack, or heart failure.
- Liver or kidney disease: These conditions can affect how the body processes and eliminates the drug.
- History of seizures or bipolar disorder: Citalopram should be used with care in these populations.
- Bleeding problems: The medication can increase bleeding risk.
Conclusion: Prioritizing Safety with Citalopram
To maximize the benefits of citalopram while minimizing risks, open communication with your healthcare provider is paramount. Always disclose all medications, supplements, and lifestyle habits, including alcohol consumption. By understanding what you should avoid when taking citalopram, you can take an active role in your treatment and safeguard your health. Do not stop taking citalopram abruptly or change your dose without consulting your doctor, as this can cause withdrawal effects.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Consult with a qualified healthcare professional before making any decisions about your medication. For more information from the manufacturer, you can review the FDA label.
