Drug interactions
Citalopram + Clarithromycin
Severity: Major
Citalopram and Clarithromycin: major interaction.
Last updated Sources: Health Canada product monograph
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
Citalopram causes dose-dependent QT prolongation and clarithromycin adds to this effect. Clarithromycin may also modestly raise citalopram levels, increasing the risk of torsades de pointes.
What this interaction means in plain words
Citalopram and Clarithromycin 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.
Citalopram belongs to Central Nervous System; Clarithromycin belongs to Anti Bacterial.
Why it happens
Additive QT prolongation plus CYP3A4 and CYP2C19 inhibition reducing citalopram metabolism.
What to do
Use a non-QT-prolonging antibiotic when possible. If co-administered, monitor ECG and electrolytes and keep citalopram at the lowest effective dose.
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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References
Other interactions of Clarithromycin
- Astemizole + Clarithromycin Contraindicated
- Avanafil + Clarithromycin Contraindicated
- Cisapride + Clarithromycin Contraindicated
- Clarithromycin + Colchicine Contraindicated
- Clarithromycin + Conivaptan Contraindicated
- Clarithromycin + Dihydroergotamine 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 Citalopram with Clarithromycin?
MediHelp rates the interaction as major. Citalopram and Clarithromycin 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. Citalopram causes dose-dependent QT prolongation and clarithromycin adds to this effect. Clarithromycin may also modestly raise citalopram levels, increasing the risk of torsades de pointes.
How serious is the interaction between Citalopram and Clarithromycin?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Use a non-QT-prolonging antibiotic when possible. If co-administered, monitor ECG and electrolytes and keep citalopram at the lowest effective dose.
What other medicines interact with Clarithromycin?
MediHelp also lists interactions of Clarithromycin with, for example, Astemizole, Avanafil, Cisapride. The full list is on the Clarithromycin page.
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