Citalopram with Fluvoxamine Interaction Details
Brand Names Associated with Citalopram
- Celexa®
- Citalopram
Brand Names Associated with Fluvoxamine
- Fluvoxamine
- Luvox®
- Luvox® CR
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 11, 2023
Interaction Effect
Increased citalopram exposure with risk of QT interval prolongation and an increased risk of serotonin syndrome
Interaction Summary
FluvoxaMINE is an SSRI and a potent CYP2C19 inhibitor and citalopram is an SSRI and a CYP2C19 substrate associated with QT prolongation. In a pharmacokinetic study, patients who received citalopram 40 mg/day for 21 days coadministered with cimetidine (another potent CYP2C19 inhibitor) 400 mg/day for 8 days experienced in an increase in citalopram AUC and Cmax of 43% and 39%, respectively . Although the interaction between citalopram and fluvoxaMINE has not been studied specifically, concomitant use may result in increased citalopram exposure and an increased risk of QT prolongation. If coadministration with fluvoxaMINE is required, do not exceed citalopram doses of 20 mg/day, and additionally monitor for symptoms of serotonin syndrome, including neuromuscular abnormalities, autonomic instability, and mental status changes, especially during treatment initiation and dose increases. Serotonin syndrome can be life-threatening. If serotonin syndrome develops, discontinue citalopram and fluvoxaMINE and initiate supportive care .
Severity
Major
Onset
Unspecified
Evidence
Theoretical
How To Manage Interaction
The concomitant use of citalopram with fluvoxaMINE may result in increased citalopram exposure and risk of QT prolongation. If coadministration of citalopram with fluvoxaMINE is required, do not exceed citalopram doses of 20 mg/day. Additionally, concurrent use of citalopram with fluvoxaMINE is not recommended because it may result in a life-threatening condition called serotonin syndrome. If concomitant use is necessary, discuss the risks of serotonin syndrome with the patient and monitor closely for symptoms of serotonin syndrome (mental status changes, autonomic instability, neuromuscular symptoms, seizures, and gastrointestinal symptoms), especially during treatment initiation and dose increases. If serotonin syndrome develops, discontinue citalopram and fluvoxaMINE and initiate supportive care.
Mechanism Of Interaction
Inhibition of CYP2C19-mediated citalopram metabolism by fluvoxaMINE; additive serotonergic effects
Literature Reports
A) In a pharmacokinetic study, patients who received citalopram 40 mg/day for 21 days coadministered with cimetidine (another potent CYP2C19 inhibitor) 400 mg/day for 8 days experienced in an increase in citalopram AUC and Cmax of 43% and 39%, respectively .
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.
Fluvoxamine Overview
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Fluvoxamine is used to treat obsessive-compulsive disorder (bothersome thoughts that won't go away and the need to perform certain actions over and over) and social anxiety disorder (extreme fear of interacting with others or performing in front of others that interferes with normal life). Fluvoxamine is in a class of medications 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.
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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.