Citalopram with Amiodarone Interaction Details

Brand Names Associated with Citalopram

  • Celexa®
  • Citalopram

Brand Names Associated with Amiodarone

  • Amiodarone
  • Cordarone®
  • Pacerone®

Medical Content Editor
Last updated Feb 27, 2024

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Interaction Effect

An increased risk of QT interval prolongation

Interaction Summary

Citalopram causes dose-dependent prolongation of the QTc interval[1] and amiodarone has been associated with QT prolongation [2]. Although this interaction has not been evaluated, the concomitant use of amiodarone with citalopram is not recommended as coadministration may increase the risk of QT interval prolongation and torsade de pointes [1]. A case of life-threatening torsade de pointes, precipitated by the concomitant use of citalopram and amiodarone, was reported in an 83-year-old female [3]. If coadministration is required, do not exceed citalopram doses of 40 mg/day and monitor for ECG changes. Discontinue citalopram in patients who have persistent QTc measurements greater than 500 milliseconds [1].

Severity

Major

Onset

Unspecified

Evidence

Probable

How To Manage Interaction

The concomitant use of amiodarone with citalopram is not recommended as concurrent use of these agents may increase the risk of cardiac adverse events, including torsade de pointes. If coadministration is required, do not exceed citalopram doses of 40 mg/day and monitor for ECG changes. Discontinue citalopram in patients who have persistent QTc measurements greater than 500 milliseconds[1].

Mechanism Of Interaction

Additive QT interval prolongation

Literature Reports

A) A case of life-threatening torsade de pointes (TdP), precipitated by the concomitant use of citalopram and amiodarone, was reported in an 83-year-old female. The patient's medical history included hypertension, atrial fibrillation, and depression, and her medication profile consisted of losartan 50 mg, amiodarone 200 mg, fluindione, lercanidipine 10 mg, and citalopram 20 mg. Three weeks after starting citalopram, the patient presented with complaints of dizziness and palpitations. Physical exam and laboratory values were significant only for a mitral systolic regurgitation (1/6) and hypokalemia (3 mmol/L). A prolonged corrected QT interval of 526 milliseconds and profound T waves in the precordial leads were evident on the initial ECG and continuous monitoring revealed self-terminating TdP following ventricular ectopic beats. Further workup with echocardiography showed the patient had moderate concentric left ventricular (LV) hypertrophy with a normal LV ejection fraction of 70%. Amiodarone and citalopram were discontinued and the patient received treatment with administration of magnesium and potassium. After 3 days, TdP did not recur, the potassium level and QT interval normalized (corrected QT interval of 385 milliseconds), and the patient was discharged home with no further complications [3].

References

    1 ) Product Information: CELEXA(R) oral tablets, citalopram oral tablets. Allergan USA Inc (per FDA), Madison, NJ, 2023.

    2 ) Product Information: Cordarone(R) oral tablets, amiodarone HCl oral tablets. Wyeth Pharmaceuticals Inc, Philadelphia, PA, 2010.

    3 ) Fayssoil A, Issi J, Guerbaa M, et al: Torsade de pointes induced by citalopram and amiodarone. Ann Cardiol Angeiol (Paris) 2011; 60(3):165-168.PubMed Abstract: http://www.ncbi.nlm.nih.gov/...

Citalopram Overview

  • Citalopram is used to treat depression. Citalopram is in a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs). It works by increasing the amount of serotonin, a natural substance in the brain that helps maintain mental balance.

See More information Regarding Citalopram

Amiodarone Overview

  • Amiodarone is used to treat and prevent certain types of serious, life-threatening ventricular arrhythmias (a certain type of abnormal heart rhythm when other medications did not help or could not be tolerated. Amiodarone is in a class of medications called antiarrhythmics. It works by relaxing overactive heart muscles.

See More information Regarding Amiodarone

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Definitions

Severity Categories

Contraindicated

These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.


Major

This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.


Moderate

This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.


Minor

While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.

Onset

Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.

Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.

Evidence

Level of documentation of the interaction.

Established: The interaction is documented and substantiated in peer-reviewed medical literature.

Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.

How To Manage The Interaction

Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.

It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.

Mechanism Of Interaction

The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.

Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.

Where Does Our Information Come From?

Information for our drug interactions is compiled from several drug compendia, including:

The prescribing information for each drug, as published on DailyMED, is also used. 

Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.

The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.