Citalopram interactions to avoid

Key takeaways | Drug interactions | Food interactions | Other interactions | Avoiding interactions | When to see a doctor

Citalopram hydrobromide is commonly referred to by its brand name, Celexa, and remains one of the foremost first-line antidepressants. Hailing from the selective serotonin-reuptake inhibitor (SSRI) class of drugs, citalopram is often used for the treatment of major depressive disorder or off-label use treating anxiety disorder. For all the good work that it does, citalopram also has its downsides. Drug interactions are a significant element of that risk, but they can be avoided. Drugs that increase serotonin prolong the heart’s QT interval, thin the blood, or lower sodium can be problematic when coupled with citalopram. Knowledge about what meds, foods, and health conditions interact negatively with this SSRI is a major factor in keeping you safe.

Citalopram drug interactions

There are a few important categories to watch out for if you are taking citalopram, namely drugs with serotonin activity, QT-prolonging agents, anticoagulants, and medications that lower sodium. Other drug interactions exist, of course, but these are the ones to focus on.

Serotonergic agents

Not enough serotonin activity in the CNS seems to be connected to depression and anxiety states. Still, too much serotonin can be dangerous, producing serotonin syndrome with the symptoms above and even fever, unconsciousness, and seizures in extreme cases. In the setting of depression, citalopram may help to strike the right balance. The serotonin activity may go too far in high doses or in combination with other serotonergic agents. 

Drugs that could dangerously amplify serotonin effects with citalopram include other SSRIs, of course, but also other antidepressants, such as the serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, antipsychotics, and especially monoamine oxidase inhibitors (MAOIs). Triptans, which are popular migraine relievers, the nausea medication ondansetron, opioid pain relievers, and the popular cough suppressant dextromethorphan, have this risk as well. These different serotonergic agents include the following:

• Prozac (fluoxetine)
• Lexapro (escitalopram)
• Paxil (paroxetine)
• Zoloft (sertraline)
• Effexor XR (venlafaxine extended-release)
• Cymbalta (duloxetine)
• Amitriptyline
• Silenor (doxepin)
• Pamelor (nortriptyline)
• Seroquel (quetiapine)
• Risperdal (risperidone)
• Abilify (aripiprazole)
• Zyprexa (olanzapine)
• Zyvox (linezolid)
• Methylene Blue
• Nardil (phenelzine)
• Azilect (rasagiline)
• Selegiline
• Parnate (tranylcypromine)
• Imitrex (sumatriptan)
• Maxalt (rizatriptan)
• Ondansetron
• Percocet (oxycodone-acetaminophen)
• Hydrocodone-acetaminophen
• MS Contin (morphine sulfate)
• Xtampza ER (oxycodone)
• Qdolo (tramadol)
• Dextromethorphan

Some of these interactions, such as those with monoamine oxidase inhibitors, must be avoided, while others, like antipsychotics, could be cautiously combined with citalopram in some situations. If you have symptoms of serotonin syndrome, get medical help immediately for this serious condition. If you notice your med list contains a drug that could interact with citalopram or you feel you are at risk, contact your healthcare provider to discuss whether your medication regimen or dose needs to be adjusted.

QT-prolonging drugs

Citalopram can lead to QT prolongation, which involves slowing down the electrical reset after heartbeats. This delay raises the risk of a life-threatening heart arrhythmia called torsades de pointes. Other medications can prolong the QT interval, and when used along with citalopram, this adverse effect can be additive. Examples of QT-prolonging agents include

• Zithromax (azithromycin)
• Clarithromycin
• Levofloxacin
• Moxifloxacin
• Seroquel (quetiapine)
• Risperdal (risperidone)
• Abilify (aripiprazole)
• Zyprexa (olanzapine)
• Remeron (mirtazapine)
• Silenor (doxepin)

These drugs are only a small sampling of a much longer list of medications that can prolong the QT interval. Those examples come from the macrolide antibiotic, quinolone antibiotic, antipsychotic, and antidepressant categories. As you might imagine, situations arise frequently when those classes could be called upon concurrently with citalopram. This is typically when QT prolongation arises. 

If multiple medications on your list can prolong the QT interval, call your medical provider to discuss the concern. They may order an electrocardiogram (EKG), a simple diagnostic test, to measure the QT interval.

Blood thinners

Anticoagulants and antiplatelet agents are subcategories under the umbrella term of blood thinners. Selective serotonin reuptake inhibitors (SSRIs) like citalopram can somewhat impair the function of platelet cells, which help our blood clot. As a result, bleeding is an uncommon but potentially severe side effect of citalopram. Putting the SSRI together with a blood thinner like the following can be dangerous.

• Eliquis (apixaban)
• Xarelto (rivaroxaban)
• Pradaxa (dabigatran)
• Jantoven (warfarin)
• Lovenox (enoxaparin)
• Aspirin
• Ibuprofen
• Naprosyn (naproxen)
• Meloxicam

If you notice that you are on a medicine that can interact with citalopram to cause bleeding, double-check with your healthcare team about the combination. It may be fine for some people to take them together, so get the medical advice of your provider before making any changes. Careful dosing of nonsteroidal anti-inflammatory drugs (NSAIDs) may be acceptable. Stopping an anticoagulant prematurely could be dangerous. If, before getting that advice, you experience bleeding or excess bruising, get medical attention immediately.

Thiazide diuretics

Hydrochlorothiazide, chlorthalidone, and metolazone are three of the most common thiazide diuretics. The former two are prescribed most often to lower blood pressure, and the latter is used to help eliminate fluid from the blood in congestive heart failure. All can have an adverse effect of reducing sodium concentrations in the bloodstream. Citalopram and other SSRIs can do so as well, and as you have been learning, doubling up on drugs with the same side effects is dangerous.

If you discover that you are on multiple medications that can lower sodium levels, talk to your doctor about it. The medications may be continued along with a plan to monitor sodium concentrations with blood work, or a change in your treatment regimen may be advised.

Citalopram food interactions

After going over so many drug interactions, it is nice to know that citalopram does not interact with food. You can take citalopram with or without food. If you experience nausea from the medicine, you might try taking it with food to see if that helps.

Other citalopram interactions

There are other important citalopram interactions to be aware of besides prescription medications. The SSRIs could be problematic with alcohol, a common supplement, and a few health conditions.

Citalopram and alcohol

Alcohol is a CNS depressant and is best avoided in depression states. Drinking alcohol while on citalopram could lead to more difficulty with drowsiness. Caution and getting the opinion of your prescribing professional is advisable.

Citalopram and St. John’s Wort

A herbal supplement purported to help with depression, St. John’s Wort may have a serotonergic action. Therefore, in combination with citalopram, it could escalate the risk of serotonin syndrome. This hazard highlights the importance of ensuring your healthcare provider has a list of all supplements you take. If prescription costs are sending you in search of alternatives, the SingleCare discount card might help.

Citalopram and kidney disease

When kidney disease is advanced, the body may not be able to eliminate citalopram, leaving more medication in the system. This could create an increased risk of QT prolongation in the setting of impaired renal function. If you have kidney disease, tell your doctor whether a lower dose of citalopram or a different drug is needed.

The liver extensively metabolizes citalopram and liver disease Citalopram. Impaired hepatic function in the setting of liver disease is another situation in which drug levels and adverse effects could increase. Cautious dosing or an alternative may be necessary.

Citalopram and seizure disorder

Caution is also advisable with citalopram in the setting of a seizure disorder or a high-risk state like alcoholism. A higher risk of seizures may exist while taking an SSRI.

Citalopram and pregnancy

The risks and benefits of medication must always be weighed, and that is certainly the case during pregnancy. If treatment for depression is needed during pregnancy, citalopram is an option to be used.

Citalopram and breastfeeding

Although citalopram can be detected in the breast milk of mothers who are taking it, any side effects may be offset by the benefits of breastfeeding and the benefits of adequately treating maternal depression. Determining how the risks and benefits compare must be done by each individual in consultation with their medical team.

How to minimize citalopram interactions

Your best protection against experiencing an interaction between citalopram and one of your other medications or health conditions is to be proactive. Once you experience an adverse reaction, get care right away, but there is much that can be done to prevent this. Keep organized by maintaining an updated list of your prescription drugs, over-the-counter (OTC) medications, and supplements. Have a record of your medical problems, too. Sharing this information regularly with your prescribing providers and your pharmacists is essential. They may not be aware of everything.

When to talk to a healthcare provider about citalopram interactions

Before taking citalopram and routinely during treatment with the antidepressant, you should ask the healthcare professional caring for you to review your list of medicines and health conditions to look for interactions. Likewise, if you are considering taking a new OTC product or are prescribed a new medicine by a specialist, check in with your primary care provider to ensure no interaction exists. These communication efforts can make all the difference.