Drug interactions
Citalopram + Levomilnacipran
Severity: Major
Citalopram and Levomilnacipran: 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
Combining an SSRI with an SNRI increases serotonergic load and risk of serotonin syndrome. Features include agitation, tremor, sweating, hyperreflexia and fever.
What this interaction means in plain words
Citalopram and Levomilnacipran 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; Levomilnacipran belongs to Central Nervous System.
Why it happens
Additive inhibition of serotonin reuptake.
What to do
Avoid combining two serotonergic antidepressants outside specialist supervision. If a switch is required, taper and cross-titrate cautiously while monitoring 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 Citalopram
- Cisapride + Citalopram Contraindicated
- Citalopram + Dronedarone Contraindicated
- Citalopram + Escitalopram Contraindicated
- Citalopram + Isocarboxazid Contraindicated
- Citalopram + Methylene blue Contraindicated
- Citalopram + Phenelzine Contraindicated
Other interactions of Levomilnacipran
- Isocarboxazid + Levomilnacipran Contraindicated
- Levomilnacipran + Linezolid Contraindicated
- Levomilnacipran + Methylthioninium chloride Contraindicated
- Levomilnacipran + Phenelzine Contraindicated
- Levomilnacipran + Procarbazine Contraindicated
- Levomilnacipran + Rasagiline Contraindicated
Frequently asked questions
Can I take Citalopram with Levomilnacipran?
MediHelp rates the interaction as major. Citalopram and Levomilnacipran 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. Combining an SSRI with an SNRI increases serotonergic load and risk of serotonin syndrome. Features include agitation, tremor, sweating, hyperreflexia and fever.
How serious is the interaction between Citalopram and Levomilnacipran?
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 serotonergic antidepressants outside specialist supervision. If a switch is required, taper and cross-titrate cautiously while monitoring for serotonin toxicity.
What other medicines interact with Citalopram?
MediHelp also lists interactions of Citalopram with, for example, Cisapride, Dronedarone, Escitalopram. The full list is on the Citalopram page.
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