Citalopram with Aripiprazole Interaction Details
Brand Names Associated with Citalopram
- Celexa®
- Citalopram
Brand Names Associated with Aripiprazole
- Abilify Mycite®
- Abilify®
- Aripiprazole
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 11, 2023
Interaction Effect
Increased risk of serotonin syndrome (hypertension, hyperthermia, myoclonus, mental status changes); increased risk of QT-interval prolongation
Interaction Summary
Citalopram is a serotonergic antidepressant, aripiprazole is an antipsychotic with partial agonist activity at serotonin (1A) receptors, both are associated with QTc-interval prolongation, and concurrent use should be avoided . Although this combination has not been studied, a 64-year-old man receiving citalopram experienced serotonin toxicity after just one 5-mg dose of aripiprazole , and coadministration may increase risk for QT-interval prolongation. If concurrent use is required, monitor ECG, electrolytes, and for serotonergic effects, especially during initiation and around dose increases. Drug discontinuation and supportive symptomatic treatment is recommended if serotonin syndrome develops .
Severity
Major
Onset
Unspecified
Evidence
Probable
How To Manage Interaction
Citalopram is a serotonergic known to cause dose-dependent QT-interval prolongation, and coadministration with another QT-prolonging drug, such as aripiprazole, should be avoided. Additionally, serotonin syndrome has been reported with concurrent use . If coadministration is required, monitor ECG, electrolytes, and for serotonergic effects, especially during initiation and around dose increases. Drug discontinuation and supportive symptomatic treatment is recommended if serotonin syndrome develops. Symptoms of serotonin syndrome include neuromuscular abnormalities (eg, hyperreflexia, tremor, and ataxia), autonomic instability (eg, tachycardia, diaphoresis, and hyperthermia), gastrointestinal symptoms (eg, nausea, vomiting, diarrhea), or mental status changes (eg, agitation and confusion) .
Mechanism Of Interaction
Additive serotonergic effects; additive effects on QT interval
Literature Reports
A) A case report described serotonin toxicity in 64-year-old man following the concomitant use of citalopram and aripiprazole. The patient, who had coronary heart disease and hypertension, presented to the emergency room (ER) with agitation, diaphoresis, tremors, and nausea more than 1 hour after taking his first dose of aripiprazole 5 mg in combination with citalopram 60 mg. Adherence with antihypertensives and a statin was reported, and citalopram dose had not changed in many years. While in the ER, the patient was somnolent but oriented and physical exam revealed blood pressure fluctuations, dilated pupils, diffuse fasciculations, upper-extremity postural tremors, cogwheel rigidity, diffuse hyperreflexia with clonus elicited at both knees and ankles, and appendicular ataxia that prevented the patient from standing independently. Laboratory and brain imaging studies were unremarkable, including CPK, TSH, and urine toxicology. All symptoms and clinical findings resolved within 24 hours of stopping psychiatric medications and treatment with cyproheptadine and supportive care .
Citalopram Overview
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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.
Aripiprazole Overview
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Aripiprazole is used to treat the symptoms of schizophrenia (a mental illness that causes disturbed or unusual thinking, loss of interest in life, and strong or inappropriate emotions) in adults and teenagers 13 years of age and older. It is also used alone or with other medications to treat episodes of mania or mixed episodes (symptoms of mania and depression that happen together) in adults, teenagers, and children 10 years of age and older with bipolar disorder (manic-depressive disorder; a disease that causes episodes of depression, episodes of mania, and other abnormal moods). Aripiprazole is also used with an antidepressant to treat depression when symptoms cannot be controlled by the antidepressant alone. Aripiprazole is also used to treat children 6 to 17 years of age who have autistic disorder (a developmental problem that causes difficulty communicating and interacting with others). Aripiprazole may help control irritable behavior such as aggression, temper tantrums, and frequent mood changes in these children. Aripiprazole is also used to treat children 6 to 18 years of age who have Tourette's disorder (a condition characterized by the need to perform repeated motions or to repeat sounds or words). Aripiprazole is in a class of medications called atypical antipsychotics. It works by changing the activity of certain natural substances in the brain.
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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.