Drug interactions
Citalopram + Nortriptyline
Severity: Major
Citalopram and Nortriptyline: 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
Citalopram dose-dependently prolongs the QT interval, and nortriptyline adds to this effect. Both are serotonergic, and citalopram may modestly raise tricyclic levels.
What this interaction means in plain words
Citalopram and Nortriptyline 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; Nortriptyline belongs to Central Nervous System.
Why it happens
Additive QT prolongation and serotonin reuptake inhibition, with weak CYP2D6 inhibition by citalopram.
What to do
Keep citalopram within labeled dose limits and obtain an ECG, especially with other risk factors. Monitor nortriptyline levels and watch 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 Nortriptyline
- Disopyramide + Nortriptyline Contraindicated
- Dofetilide + Nortriptyline Contraindicated
- Dronedarone + Nortriptyline Contraindicated
- Ibutilide + Nortriptyline Contraindicated
- Isocarboxazid + Nortriptyline Contraindicated
- Methylene blue + Nortriptyline 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 Nortriptyline?
MediHelp rates the interaction as major. Citalopram and Nortriptyline 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 dose-dependently prolongs the QT interval, and nortriptyline adds to this effect. Both are serotonergic, and citalopram may modestly raise tricyclic levels.
How serious is the interaction between Citalopram and Nortriptyline?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Keep citalopram within labeled dose limits and obtain an ECG, especially with other risk factors. Monitor nortriptyline levels and watch for serotonin toxicity.
What other medicines interact with Nortriptyline?
MediHelp also lists interactions of Nortriptyline with, for example, Disopyramide, Dofetilide, Dronedarone. The full list is on the Nortriptyline page.
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