Citalopram with Meperidine Interaction Details

Brand Names Associated with Citalopram

Brand Names Associated with Meperidine

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Nov 11, 2023

Interaction Effect

An increased risk of serotonin syndrome

Interaction Summary

Serotonin syndrome, a potentially life-threatening condition, has been reported with selective serotonin reuptake inhibitors, including citalopram, particularly when used in combination with other serotonergic medications. A 44-year-old female taking citalopram 40 mg daily developed serotonin syndrome 10 hours after the initiation of parenteral meperidine; symptoms resolved with 12 hours of meperidine discontinuation . If concomitant use of citalopram and meperidine is required, observe the patient closely for signs and symptoms of serotonin syndrome, including mental status changes, autonomic instability, and neuromuscular and gastrointestinal symptoms. Discontinue treatment if symptoms of serotonin syndrome occur and institute appropriate symptomatic treatment .

Severity

Major

Onset

Rapid

Evidence

Probable

How To Manage Interaction

Use caution when using citalopram and meperidine concomitantly due to the potential for developing serotonin syndrome as was reported in one case. Monitor patients for signs and symptoms of serotonin syndrome, especially during therapy initiation and changes in dosage. Discontinue treatment if symptoms occur and institute appropriate symptomatic treatment .

Mechanism Of Interaction

Additive serotonergic effects

Literature Reports

A) A 44-year-old female taking citalopram 40 mg daily developed serotonin syndrome 10 hours after the initiation of parenteral meperidine. The patient had been taking citalopram 20 mg for 9 months when the dose was increased to 40 mg for worsening depression during a hospitalization for a rectal wound debridement. The depressive symptoms improved and 5 weeks later, the patient was given parenteral meperidine for patient-controlled analgesia (total dose over 8 hours, 230 mg). Within 10 hours of initiation of meperidine, the patient became acutely agitated, disoriented, paranoid, and had perceptual disturbances and nausea. Vital signs indicated she had spiked a fever (39.1 degrees C), was hypertensive (161/86 mmHg), tachypneic (22 breaths per minute), and tachycardic (112 beats per minute). A complete metabolic panel was normal and a medical work up, including computed tomography, ECG, and chest X-ray, was not significant. In addition to meperidine, other as-needed medications included HYDROmorphone, HYDROcodone/acetaminophen, and promethazine. The patient's routine daily medication profile consisted of zolpidem, lansoprazole, subcutaneous enoxaparin, fentaNYL patch, and a 10-day course of gatifloxacin which was initiated 5 days prior to the onset of symptoms. Meperidine was stopped and her symptoms resolved with 12 hours of discontinuation and did not recur over the next 3 months .

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.

Meperidine Overview

• Meperidine is used to relieve moderate to severe pain. Meperidine is in a class of medications opiate (narcotic) analgesics. It works by changing the way the brain and nervous system respond to pain.

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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:

• Gold Standard Drug Database
• Micromedex
• Lexicomp
• DrugBank

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.