Drug interactions
Citalopram + Paroxetine
Severity: Major
Citalopram and Paroxetine: 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 two SSRIs duplicates serotonergic therapy and increases the risk of serotonin syndrome without clear added benefit. Citalopram also prolongs QTc in a dose-dependent manner, and paroxetine may modestly raise its levels.
What this interaction means in plain words
Citalopram and Paroxetine 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; Paroxetine belongs to Central Nervous System.
Why it happens
Additive serotonin reuptake inhibition with possible pharmacokinetic increase of citalopram.
What to do
Avoid combining SSRIs; use a single agent and cross-taper when switching. Monitor for serotonin toxicity and check ECG if combination cannot be avoided.
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 Paroxetine
- Isocarboxazid + Paroxetine Contraindicated
- Methylene blue + Paroxetine Contraindicated
- Paroxetine + Phenelzine Contraindicated
- Paroxetine + Pimozide Contraindicated
- Paroxetine + Procarbazine Contraindicated
- Paroxetine + Selegiline 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 Paroxetine?
MediHelp rates the interaction as major. Citalopram and Paroxetine 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 two SSRIs duplicates serotonergic therapy and increases the risk of serotonin syndrome without clear added benefit. Citalopram also prolongs QTc in a dose-dependent manner, and paroxetine may modestly raise its levels.
How serious is the interaction between Citalopram and Paroxetine?
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 SSRIs; use a single agent and cross-taper when switching. Monitor for serotonin toxicity and check ECG if combination cannot be avoided.
What other medicines interact with Paroxetine?
MediHelp also lists interactions of Paroxetine with, for example, Isocarboxazid, Methylene blue, Phenelzine. The full list is on the Paroxetine page.
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