Citalopram with Lepirudin Interaction Details
Brand Names Associated with Citalopram
- Celexa®
- Citalopram
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 11, 2023
Interaction Effect
An increased risk of bleeding
Interaction Summary
The release of serotonin by platelets is important for maintaining hemostasis. Case-control and cohort studies have shown that the combined use of SSRIs and anticoagulants has been associated with an increased risk of bleeding. Bleeding events reported have included epistaxis, ecchymosis, hematoma, petechiae, and life-threatening hemorrhages. Altered anticoagulant effects (including increased bleeding) have been reported with the coadministration of SSRIs with warfarin . When citalopram and an anticoagulant are given concurrently, monitor patient for signs of increased bleeding and caution patients about the increased risk of bleeding .
Severity
Major
Onset
Unspecified
Evidence
Probable
How To Manage Interaction
Concomitant use of citalopram with drugs that interfere with hemostasis (eg, anticoagulants) may increase the risk of bleeding. When citalopram and an anticoagulant are given concurrently, monitor patient for signs of increased bleeding and caution patients about the increased risk of bleeding.
Mechanism Of Interaction
Release of serotonin by platelets; additive effects on hemostasis
Literature Reports
A) According to a retrospective cohort study (n=234), there was an increased risk of clinically relevant bleeding (hospital admission due to bleeding) in patients receiving warfarin for atrial fibrillation during concomitant SSRI therapy or within 2 weeks following SSRI therapy termination. Patients with a mean age of 72 +/- 7 years receiving warfarin plus SSRI (n=117) were matched with randomly selected patients who received warfarin only (n=117). SSRI included FLUoxetine, citalopram, PARoxetine, sertraline, fluvoxaMINE, or escitalopram. Nine patients experienced 11 bleeding episodes during 213.9 treatment years in the warfarin plus SSRI group, and 10 patients experienced 14 bleedings during 586.4 treatment years in the warfarin-only group. The corresponding total incidences of bleedings were 51.4 and 23.9 per 1000 treatment years, respectively. The hazard ratio for first bleedings during treatment with warfarin plus SSRI was 3.49 (95% CI; 1.37 to 8.91, p=0.009) compared with warfarin only. The SSRI implicated in patients experiencing bleeding at the time of concomitant administration were sertraline or citalopram. The addition of an SSRI was not associated with a change in warfarin dose or INR (p=0.48 and p=0.31 respectively). The results of the study may be limited by earlier bleeding events, unknown patient adherence, and exclusion of clopidogrel, dipyridamol, corticosteroids and anticoagulants other than warfarin in the model .
B) A population-based, case-controlled study of new coumarin users (acenocoumarol and phenprocoumon) with concomitant selective serotonin reuptake inhibitors (SSRIs) resulted in an increased risk of hospitalization due to nongastrointestinal bleeding. Using national pharmacy and hospitalization records, Netherlands researchers identified 1848 cases that were admitted for abnormal bleeding and compared them with 5818 control subjects also taking coumarins. Median duration of treatment in patients was 220 days (range, 1 to 4690 days). Patients on SSRIs showed greater risk for hospitalization for non-gastrointestinal bleeding (adjusted odds ratio (OR) 1.7, 95% confidence interval (CI), 1.1 to 2.5), however, the rate of gastrointestinal bleeding (adjusted OR 0.8, 95% CI, 0.4 to 1.5) was not significantly different .
C) The pharmacokinetics of warfarin, a CYP3A4 substrate, were not affected by the administration of citalopram 40 mg/day for 21 days, while the prothrombin time was increased by 5%. The clinical significance of this is unknown .
D) Case reports and epidemiological studies (case-control and cohort studies) have demonstrated an association between the use of drugs that interfere with serotonin reuptake and the occurrence of gastrointestinal bleeding. Based on data from published observational studies, exposure to SSRIs, particularly in the month before delivery, has been associated with a less than 2-fold increase in the risk of postpartum hemorrhage. Bleeding events related to SSRIs and SNRIs have ranged from ecchymosis, hematoma, epistaxis, and petechiae to life-threatening hemorrhages .
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.
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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.