6 Citalopram Interactions to Watch Out for

Citalopram (Celexa) is a commonly prescribed medication that treats conditions like anxiety and depression. It’s part of a medication class called selective serotonin reuptake inhibitors (SSRIs). These medications are thought to work by raising serotonin levels in your brain. Citalopram is available as an oral pill or liquid. It’s usually taken once a day.

Citalopram has the potential to interact with other medications and substances, like alcohol. Sometimes these interactions can cause worse or dangerous side effects. But some citalopram interactions are mild and can be easily managed.

Below, we discuss six important citalopram interactions you should know about.

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1. Monoamine oxidase inhibitors (MAOIs)

Monoamine oxidase inhibitors (MAOIs) treat conditions like Parkinson’s disease and depression. They aren’t used as often because they require a strict diet and have lots of side effects and interactions. Examples of MAOIs include selegiline (Zelapar, Emsam) and rasagiline (Azilect).

Citalopram and MAOIs both raise serotonin levels in your brain. Combining them can increase the risk of serotonin syndrome. This is a potentially serious medical condition caused by too much serotonin in the brain. Symptoms can range from mild to severe. Mild symptoms include sweating, a fast heartbeat, and tremors. Severe symptoms include agitation, high fever, and high blood pressure.

Serotonin syndrome can be life threatening. So even if you’re only having mild symptoms, you should still contact your healthcare provider for next steps. Fortunately, serotonin syndrome is rare. It’s more likely to happen when you’re taking multiple medications that raise serotonin levels.

You shouldn’t take citalopram and an MAOI together. If you’re switching medications, you should stop one medication for at least 14 days before starting the other. This helps make sure one medication is fully cleared from your body, and can help avoid this interaction.

2. Other medications that raise serotonin levels

In addition to citalopram and MAOIs, certain other medications also raise serotonin levels. Taking citalopram with any of these medications can also raise the risk for serotonin syndrome. However, the risk is typically lower than it is with MAOIs.

Examples of other medications that raise serotonin levels:

• Other SSRIs like sertraline (Zoloft)

• Serotonin and norepinephrine reuptake inhibitors (SNRIs) like venlafaxine (Effexor XR)

• Triptan migraine medications like sumatriptan (Imitrex)

• Some opioids like tramadol (Ultram)

• Tricyclic antidepressants (TCAs) like amitriptyline

If you’re taking one of these medications, check with your healthcare provider before starting citalopram. They may ask you to watch for symptoms of serotonin syndrome. Or they could suggest an alternative medication to avoid this interaction.

3. St. John’s wort

St. John’s wort is an herbal supplement that has been studied for treating depression. It’s notorious for interacting with many medications. St. John’s wort can raise serotonin levels. Combining citalopram with St. John’s wort increases your risk for serotonin syndrome.

If you take St. John’s wort, be sure your healthcare provider is aware. This supplement is available without a prescription. So your healthcare team may not know that you’re taking it. You should avoid combining citalopram and St. John’s wort unless told otherwise by your healthcare provider.

4. Blood thinners

Common types of blood thinners include antiplatelet and anticoagulant medications. They’re used to prevent unwanted blood clots. Since these medications thin the blood, they increase the risk of bleeding. Antidepressants like citalopram also raise the risk of bleeding, but not as much as blood thinners. But combining blood thinners and citalopram raises the risk of bleeding more than either medication alone.

Here are a few examples of blood thinners that can interact with citalopram:

• Apixaban (Eliquis)

• Rivaroxaban (Xarelto) 

• Warfarin (Coumadin, Jantoven)

• Clopidogrel (Plavix)

• Ticagrelor (Brilinta)

Your healthcare provider may determine that you need to take both citalopram and blood thinners. In this case, be sure to watch for any unusual bleeding. This can include bleeding from your gums, nosebleeds, and unexplained bruising. Report any increase in bleeding to your healthcare provider.

5. Medications that affect heart rhythm

Some medications can affect heart rhythm by changing the QT interval. The QT interval is when the heart relaxes in between beats. A long QT interval can cause heart rhythm problems.

Citalopram is known to prolong (lengthen) the QT interval. When combined with other medications that have this effect, it can be dangerous. Symptoms of a long QT interval include dizziness, sudden fainting, and even a heart attack or death in severe cases.

Medications that can prolong the QT interval include:

• Pimozide (this medication should be avoided completely with citalopram)

• Antiarrhythmic medications such as amiodarone (Pacerone) or sotalol (Betapace)

• Opioids such as methadone (Methadose)

• Antifungal medications such as fluconazole (Diflucan)

• Certain antidepressants such as trazodone

• Antipsychotics such as haloperidol (Haldol) and quetiapine (Seroquel)

• Some antibiotics such as ciprofloxacin (Cipro) or azithromycin (Zithromax)

It’s best to avoid combining medications that prolong the QT interval. Your healthcare provider may recommend a different medication that doesn’t have this risk. If they decide you do need both, they may recommend regular electrocardiograms (ECGs) to monitor your heart rhythm.

6. Alcohol

Alcohol has many different effects on the body. Many effects are harmful, and that’s why there’s no amount of alcohol that’s safe to drink. But drinking alcohol while taking citalopram can cause even more problems.

Combining alcohol with antidepressants like citalopram makes side effects worse. This can include severe dizziness or drowsiness. Changes in your sleep and worsening depression are also possible.

Overall, there’s not a lot of research on how small amounts of alcohol might affect citalopram. It’s best to avoid alcohol while taking this medication. Your healthcare provider can provide more information about your specific risks with combining citalopram and alcohol.

When should I contact my healthcare provider about a citalopram interaction?

Your healthcare provider and pharmacist are always good resources for interactions. It’s never a bad idea to ask if you have questions. Often, your healthcare provider is already aware of potential citalopram interactions. But it never hurts to double-check.

If you’re having severe side effects, like sweating, tremors, or agitation, seek medical care right away. These may be symptoms of serotonin syndrome. If you have serious bleeding or heart palpitations, you should also check with your healthcare provider.

Make sure to provide an updated medication list when you visit your healthcare provider. This will help them screen for interactions. That way they can help you avoid and manage potential interactions up front.

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Written by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

Edited by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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