Drug interactions
Citalopram + Fluvoxamine
Severity: Major
Citalopram and Fluvoxamine: major interaction.
Last updated Sources: US FDA label
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
Two SSRIs together raise the risk of serotonin syndrome without clear added benefit. Fluvoxamine inhibits CYP2C19 and CYP3A4, which can increase citalopram levels and the dose-related risk of QT prolongation.
What this interaction means in plain words
Citalopram and Fluvoxamine 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; Fluvoxamine belongs to Central Nervous System.
Why it happens
Additive serotonergic effects plus fluvoxamine inhibition of CYP2C19 and CYP3A4 metabolism of citalopram.
What to do
Avoid combining two SSRIs; use one agent and cross-taper carefully when switching. If unavoidable, limit the citalopram dose and monitor ECG and for serotonin toxicity.
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 Fluvoxamine
- Agomelatine + Fluvoxamine Contraindicated
- Alosetron + Fluvoxamine Contraindicated
- Fezolinetant + Fluvoxamine Contraindicated
- Fluvoxamine + Isocarboxazid Contraindicated
- Fluvoxamine + Mavacamten Contraindicated
- Fluvoxamine + Methylene blue 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 Fluvoxamine?
MediHelp rates the interaction as major. Citalopram and Fluvoxamine 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. Two SSRIs together raise the risk of serotonin syndrome without clear added benefit. Fluvoxamine inhibits CYP2C19 and CYP3A4, which can increase citalopram levels and the dose-related risk of QT prolongation.
How serious is the interaction between Citalopram and Fluvoxamine?
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 combining two SSRIs; use one agent and cross-taper carefully when switching. If unavoidable, limit the citalopram dose and monitor ECG and for serotonin toxicity.
What other medicines interact with Fluvoxamine?
MediHelp also lists interactions of Fluvoxamine with, for example, Agomelatine, Alosetron, Fezolinetant. The full list is on the Fluvoxamine page.
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