Citalopram with Buspirone Interaction Details
Brand Names Associated with Citalopram
- Celexa®
- Citalopram
Brand Names Associated with Buspirone
- BuSpar®
- Buspirone
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Mar 06, 2024
Interaction Effect
An increased risk of serotonin syndrome (hypertension, hyperthermia, myoclonus, mental status changes)
Interaction Summary
Concomitant use of citalopram and other serotonergic drugs like busPIRone increases the risk of serotonin syndrome. Monitor patients for signs and symptoms of serotonin syndrome, especially during therapy initiation and changes in dosage. If serotonin syndrome occurs, consider discontinuation of citalopram and/or busPIRone[1][2]. An isolated case has been reported of serotonin syndrome and hyponatremia after ingesting higher than prescribed doses of citalopram and busPIRone [3]. Serotonin syndrome can result in death if it is not recognized and correctly treated [4].
Severity
Major
Onset
Delayed
Evidence
Theoretical
How To Manage Interaction
Concomitant use of citalopram and other serotonergic drugs like busPIRone increases the risk of serotonin syndrome. Monitor patients for signs and symptoms of serotonin syndrome, especially during therapy initiation and changes in dosage. If serotonin syndrome occurs, consider discontinuation of citalopram and/or busPIRone[1][2].
Mechanism Of Interaction
Additive serotonergic effects
Literature Reports
A) A 69-year-old female with recurrent depressive episodes was treated with citalopram 40 mg daily for approximately 18 months. BusPIRone 10 mg daily was initiated, and the patient developed signs of serotonin syndrome in six weeks. She became disoriented, confused, hyperactive, agitated, and experienced auditory and visual hallucinations. She also could not stand or walk, and experienced involuntary tremors of her arms and legs. Upon admission to the hospital, her serum sodium level was 121 mmol/L. Following the discontinuation of citalopram and busPIRone, the neuromuscular and psychiatric symptoms gradually disappeared, and her serum sodium level increased to 137 mmol/L without specific treatment. It was discovered that the patient had been taking higher than prescribed doses of both citalopram and busPIRone in the few days before her symptoms appeared. Four days after the discontinuation of citalopram, her serum concentration was 155 nmol/L. Although the citalopram level was not measured upon admission, it was extrapolated to be more than 1200 nmol/L. By comparison, 33 patients receiving citalopram 40 mg daily had a mean steady state citalopram level of 256 nmol/L [3].
References
1 ) Product Information: Citalopram oral capsules, citalopram oral capsules. Almatica Pharma LLC (per FDA), Morristown, NJ, 2022.
2 ) Product Information: CELEXA(R) oral tablets, citalopram oral tablets. Allergan USA Inc (per FDA), Madison, NJ, 2023.
3 ) Spigset O & Adielsson G: Combined serotonin syndrome and hyponatraemia caused by a citalopram-buspirone interaction. Int J Clin Psychopharmacol 1997; 12:61-63.
4 ) Sternbach H: The serotonin syndrome. Am J Psychiatr 1991; 148:705-713.
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.
Buspirone Overview
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Buspirone is used to treat anxiety disorders or in the short-term treatment of symptoms of anxiety. Buspirone is in a class of medications called anxiolytics. It works by changing the amounts 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.