Drug interactions
Amitriptyline + Citalopram
Severity: Major
Amitriptyline and Citalopram: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Both agents increase serotonergic activity and can prolong the QT interval, so the combination raises the risk of serotonin syndrome and arrhythmia. Citalopram may also modestly raise tricyclic concentrations through CYP2D6 inhibition.
What this interaction means in plain words
Amitriptyline and Citalopram can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Amitriptyline belongs to Central Nervous System; Citalopram belongs to Central Nervous System.
Why it happens
Additive serotonin reuptake inhibition and QT prolongation, with weak CYP2D6 inhibition by citalopram.
What to do
Avoid if an alternative exists; if combined, keep citalopram at or below labeled maximum doses, monitor ECG and electrolytes, and watch for serotonin toxicity signs. Consider checking tricyclic levels.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Amitriptyline
- Amitriptyline + Isocarboxazid Contraindicated
- Amitriptyline + Methylene blue Contraindicated
- Amitriptyline + Phenelzine Contraindicated
- Amitriptyline + Pimozide Contraindicated
- Amitriptyline + Procarbazine Contraindicated
- Amitriptyline + Safinamide Contraindicated
Other interactions of Citalopram
- Cisapride + Citalopram Contraindicated
- Citalopram + Dronedarone Contraindicated
- Citalopram + Escitalopram Contraindicated
- Citalopram + Isocarboxazid Contraindicated
- Citalopram + Methylene blue Contraindicated
- Citalopram + Phenelzine Contraindicated
Frequently asked questions
Can I take Amitriptyline with Citalopram?
MediHelp rates the interaction as major. Amitriptyline and Citalopram can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Both agents increase serotonergic activity and can prolong the QT interval, so the combination raises the risk of serotonin syndrome and arrhythmia. Citalopram may also modestly raise tricyclic concentrations through CYP2D6 inhibition.
How serious is the interaction between Amitriptyline and Citalopram?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid if an alternative exists; if combined, keep citalopram at or below labeled maximum doses, monitor ECG and electrolytes, and watch for serotonin toxicity signs. Consider checking tricyclic levels.
What other medicines interact with Amitriptyline?
MediHelp also lists interactions of Amitriptyline with, for example, Isocarboxazid, Methylene blue, Phenelzine. The full list is on the Amitriptyline page.
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