Citalopram

7 DRUG INTERACTIONS Table 5 presents clinically important drug interactions with citalopram hydrobromide. Table 5: Clinically Important Drug Interactions with Citalopram hydrobromide Monoamine Oxidase Inhibitors (MAOIs) Clinical Impact: Concomitant use of SSRIs, including citalopram hydrobromide, and MAOIs increases the risk of serotonin syndrome. Intervention: Citalopram hydrobromide is contraindicated in patients taking MAOIs, including MAOIs such as linezolid or intravenous methylene blue [see Dosage and Administration (2.5) , Contraindications (4) , Warnings and Precautions (5.3) ] .

Concomitant use increases risk of serotonin syndrome. Citalopram is contraindicated in patients taking linezolid.

Concomitant use increases risk of serotonin syndrome. Citalopram is contraindicated in patients taking intravenous methylene blue.

Contraindicated use with citalopram per CONTRAINDICATIONS and WARNINGS sections.

Serious, sometimes fatal reactions reported when used concomitantly with MAO inhibitors.

Concomitant use increases plasma concentrations of pimozide and may increase risk of QT prolongation and ventricular arrhythmias. Citalopram is contraindicated.

Concurrent use of aspirin with citalopram may potentiate the risk of upper gastrointestinal bleeding due to interference with serotonin reuptake and platelet hemostasis.

Concomitant use increases risk of serotonin syndrome.

Concomitant use increases risk of serotonin syndrome.

Cimetidine increases citalopram AUC by 43% and Cmax by 39%. Maximum citalopram dose 20 mg/day recommended with concurrent cimetidine due to QT prolongation risk.

Concomitant use can cause additional QT prolongation.

QT-prolonging drug with known torsades de pointes risk. Combined with fingolimod's QT prolongation and bradycardia effects, patients require overnight continuous ECG monitoring in medical facility.

QT-prolonging drug associated with torsades de pointes risk. Patients require overnight continuous ECG monitoring in medical facility during fingolimod initiation.

Concomitant use increases risk of serotonin syndrome.

Increases risk of QT prolongation and ventricular arrhythmias compared to citalopram alone.

Concurrent use of NSAIDs with citalopram may potentiate the risk of upper gastrointestinal bleeding due to interference with serotonin reuptake and platelet hemostasis.

Concomitant use increases risk of serotonin syndrome.

Concomitant use increases risk of serotonin syndrome.

Rare postmarketing reports of serotonin syndrome with concurrent use of citalopram and triptans. Careful observation advised, particularly during treatment initiation and dose increases.

Concomitant use increases risk of serotonin syndrome.

Altered anticoagulant effects including increased bleeding reported with citalopram and warfarin coadministration. Careful monitoring required when citalopram is initiated or discontinued.

Concomitant use may potentiate risk of bleeding.

Use of alcohol by depressed patients taking citalopram is not recommended despite lack of potentiation in cognitive and motor effects in clinical trials.

Tricyclic antidepressants increase risk of serotonin syndrome when used with citalopram. Monitor for signs and symptoms of serotonin syndrome.

SSRI that inhibits CYP2D6, may increase plasma concentration of doxepin hydrochloride. Caution advised in coadministration; monitor plasma levels.

SNRIs increase risk of serotonin syndrome. Monitor for signs and symptoms, particularly during initiation and dosage increases.

CYP2C19 substrate; potential for interaction with esomeprazole.

CYP2C19 substrate; concomitant use with esomeprazole may alter exposure due to CYP2C19 inhibition.

CYP2C19 substrate; concomitant use with esomeprazole may alter citalopram exposure.

CYP2C19 substrate that may have altered exposure when used concomitantly with esomeprazole.

QT prolonging drug with torsades de pointes risk. Monitor overnight with continuous ECG in medical facility during initiation.

CYP2C19 inhibitor increases risk of QT prolongation. Maximum recommended citalopram dosage is 20 mg daily.

Other SSRIs increase risk of serotonin syndrome when used with citalopram. Monitor for signs and symptoms of serotonin syndrome.

Drug known to prolong QTc interval; caution advised when used with haloperidol decanoate due to risk of QT prolongation.

Drug known to prolong QTc interval; caution advised when used with haloperidol due to risk of QT prolongation.

May increase or decrease ioflupane binding to dopamine transporter and may interfere with imaging results.

Opioids increase risk of serotonin syndrome when used with citalopram. Monitor for signs and symptoms of serotonin syndrome.

CYP2C19 substrate; concomitant use with omeprazole may alter citalopram exposure.

CYP2C19 substrate; concomitant use with omeprazole may increase exposure due to inhibition of CYP2C19.

CYP2C19 substrate; concomitant use with omeprazole may alter citalopram concentrations.

CYP2C19 substrate with increased plasma concentrations when combined with omeprazole.

Concomitant use may potentiate risk of bleeding.

Other SSRIs increase risk of serotonin syndrome when used concomitantly with citalopram. Monitor for serotonin syndrome symptoms.

Other SSRIs increase risk of serotonin syndrome when used concomitantly with citalopram. Monitor for serotonin syndrome symptoms.

Triptans increase risk of serotonin syndrome when used with citalopram. Monitor for signs and symptoms of serotonin syndrome.

SNRIs increase risk of serotonin syndrome when used with citalopram. Monitor for signs and symptoms of serotonin syndrome.

Vonoprazan is a CYP2C19 inhibitor and may increase exposure of citalopram; monitor for adverse reactions.

Combined administration of citalopram and digoxin did not significantly affect pharmacokinetics of either drug.

Ketoconazole Combined administration of citalopram (40 mg) and ketoconazole (200 mg) decreased the C max and AUC of ketoconazole by 21% and 10%, respectively, and did not significantly affect the pharmacokinetics of citalopram.

Metoprolol Administration of 40 mg/day citalopram for 22 days resulted in a two-fold increase in the plasma levels of the beta-adrenergic blocker metoprolol. Increased metoprolol plasma levels have been associated with decreased cardioselectivity. Coadministration of citalopram and metoprolol had no clinically significant effects on blood pressure or heart rate.

Triazolam Combined administration of citalopram (titrated to 40 mg/day for 28 days) and the CYP3A4 substrate triazolam (single dose of 0.25 mg) did not significantly affect the pharmacokinetics of either citalopram or triazolam.