Important Drug Interactions for the Antidepressant Citalopram (CELEXA)

Patients taking the commonly prescribed antidepressant citalopram (CELEXA) should be aware that it has clinically important and potentially dangerous interactions with many other prescription and over-the-counter medications.

Citalopram, a selective serotonin reuptake inhibitor (SSRI), was initially approved by the Food and Drug Administration in 1998 for treatment of major depression in adults.[1] Public Citizen’s Health Research Group has designated SSRIs as Limited Use drugs. For patients who need drug treatment for major depression, SSRIs like citalopram are first-choice medications.[2]

Increased risk of fatal heart-rhythm abnormalities[3],[4]

Citalopram can cause prolongation of the QT interval — a change in the electrical activity of the heart that can lead to a fatal heart-rhythm disturbance called torsades de pointes, which can cause cardiac arrest and sudden death.

Numerous oral drugs, when used concomitantly (at the same time) with citalopram, further increase the risk of QT prolongation (see Table 1, below, for examples). Such drugs include certain medications for treating abnormal heart rhythms, Alzheimer’s disease, bacterial infections, fungal infections, HIV infection, opioid-use disorder, pain and psychosis, among other conditions.

For several of these drugs, the risk of QT prolongation and potentially fatal abnormal heart rhythms is so high that they should not be taken concomitantly with citalopram.

Table 1: Examples of Oral Drugs That May Increase the Risk of Fatal Heart-Rhythm Abnormalities When Used Concomitantly With Citalopram

†Brand-name combination products that contain other active ingredients were excluded.
*Designated as Limited Use by Worst Pills, Best Pills News
**Designated as Do Not Use by Worst Pills, Best Pills News

Drugs interactions that increase bleeding risk[5],[6]

Citalopram, like other SSRIs, may increase the risk of bleeding in the gastrointestinal tract and elsewhere. Concomitant use of citalopram with any of the following drugs increases this bleeding risk further (brand names for combination products excluded):

• aspirin (BAYER ASPIRIN, DURLAZA, ECOTRIN, VAZALORE)
• other nonsteroidal anti-inflammatory drugs, including ibuprofen (ADVIL, MIDOL LIQUID GELS, MOTRIN IB, TAB-PROFEN) and naproxen (ALEVE, ANAPROX DS, EC-NAPROSYN, NAPRELAN, NAPROSYN
• anticoagulants (blood thinners) such as warfarin (COUMADIN, JANTOVEN)
• antiplatelet drugs such as clopidogrel (PLAVIX)

Interactions that increase the risk of serotonin syndrome

Citalopram and other SSRIs rarely can cause serotonin syndrome, a potentially fatal condition characterized by agitation, confusion, hallucinations, rapid heartbeat, high blood pressure, high fever, shivering, sweating, nausea, vomiting, diarrhea and muscle rigidity. In severe cases, the syndrome can lead to seizures and coma.

The risk of serotonin syndrome increases when citalopram is taken concomitantly with other drugs that cause elevated serotonin levels in the body (see Table 2, below, for a list of examples). Such drugs include monoamine oxidase (MAO) inhibitors, which are used to treat depression or Parkinson’s disease depending on the medication; lithium (LITHOBID), which is used to treat bipolar disorder; certain opioids; and tricyclic antidepressants, among others. For the MAO inhibitors and the antibiotic linezolid (ZYVOX), the risk of serotonin syndrome is so great that they should never be taken concomitantly with citalopram.

Concomitant use of citalopram with the dietary supplement St. John’s wort also raises the risk of serotonin syndrome.

Table 2: Examples of Oral Drugs That Increase the Risk of Serotonin Syndrome When Used Concomitantly With Citalopram

†Brand-name combination products were excluded.
*Designated as Limited Use by Worst Pills, Best Pills News
**Designated as Do Not Use by Worst Pills, Best Pills News

What You Can Do

If you need treatment with citalopram, review all your other medications with your doctor to assess for potentially significant drug interactions. If you are taking a medication that interacts with citalopram, you may need to stop or adjust the dosage of the interacting drug, or your doctor may advise you to take a different drug for your depression or other mental health disorder. Be aware that other drugs not listed in this article also may have dangerous interactions with citalopram.
 

References

[1] Allergan USA, Inc. Label: citalopram (CELEXA). February 2022. https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/020822s041lbl.pdf. Accessed July 20, 2022.

[2] How effective are antidepressants for depression? Worst Pills, Best Pills News. February 2014. https://www.worstpills.org/newsletters/view/890. Accessed July 20, 2022.

[3] Allergan USA, Inc. Label: citalopram (CELEXA). February 2022. https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/020822s041lbl.pdf. Accessed July 20, 2022.

[4] IBM Micromedex. Drug interactions. http://www.micromedexsolutions.com/home/dispatch. Search term: “citalopram.” Accessed July 20, 2022.

[5] Allergan USA, Inc. Label: citalopram (CELEXA). February 2022. https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/020822s041lbl.pdf. Accessed July 20, 2022.

[6] IBM Micromedex. Drug interactions. http://www.micromedexsolutions.com/home/dispatch. Search term: “citalopram.” Accessed July 20, 2022.