Drug interactions
Citalopram + Milnacipran
Severity: Major
Citalopram and Milnacipran: 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
Both drugs enhance serotonergic neurotransmission, and combining them raises the risk of serotonin syndrome with agitation, tremor, hyperthermia, clonus and autonomic instability. The risk is highest at initiation and after dose increases.
What this interaction means in plain words
Citalopram and Milnacipran 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; Milnacipran belongs to Central Nervous System.
Why it happens
Additive serotonin reuptake inhibition (SSRI plus SNRI) leading to excess serotonergic stimulation.
What to do
Avoid the combination where possible and choose a single agent. If both are used, start low, titrate slowly and monitor for serotonin toxicity, stopping one drug if it appears.
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 Milnacipran
- Isocarboxazid + Milnacipran Contraindicated
- Methylene blue + Milnacipran Contraindicated
- Milnacipran + Phenelzine Contraindicated
- Milnacipran + Procarbazine Contraindicated
- Milnacipran + Rasagiline Contraindicated
- Milnacipran + Safinamide Contraindicated
Frequently asked questions
Can I take Citalopram with Milnacipran?
MediHelp rates the interaction as major. Citalopram and Milnacipran 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 drugs enhance serotonergic neurotransmission, and combining them raises the risk of serotonin syndrome with agitation, tremor, hyperthermia, clonus and autonomic instability. The risk is highest at initiation and after dose increases.
How serious is the interaction between Citalopram and Milnacipran?
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 the combination where possible and choose a single agent. If both are used, start low, titrate slowly and monitor for serotonin toxicity, stopping one drug if it appears.
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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