Citalopram with Trazodone Interaction Details
Brand Names Associated with Citalopram
- Celexa®
- Citalopram
Brand Names Associated with Trazodone
- Desyrel®
- Oleptro®
- Trazodone
- Trialodine®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 11, 2023
Interaction Effect
An increased risk of QT interval prolongation and serotonin syndrome (hypertension, hyperthermia, myoclonus, mental status changes)
Interaction Summary
QT/QTc interval prolongation and postmarketing cases of torsade de pointes have been reported with both citalopram and traZODone. Concomitant use may result in additive QT interval prolongation and an increased risk of serious ventricular arrhythmias, including torsade de pointes . A potentially life-threatening serotonin syndrome and neuroleptic malignant syndrome-like reaction (eg, hyperreflexia, incoordination, tachycardia, labile blood pressure, hyperthermia, agitation, hallucinations, coma) have occurred with citalopram alone, and the risk was increased when combined with other serotonergic drugs such as traZODone . If coadministration is required, monitor for ECG changes and do not exceed citalopram 40 mg/day; discontinue citalopram in patients who have persistent QTc measurements greater than 500 milliseconds . Patients should also be monitored for signs/symptoms of serotonin syndrome or neuroleptic malignant syndrome-like reactions, especially during initiation of treatment and dose increases, and therapy should be discontinued in patients who develop these symptoms .
Severity
Major
Onset
Unspecified
Evidence
Theoretical
How To Manage Interaction
The concomitant use of citalopram and traZODone is not recommended due to a potential for additive effects on QT interval prolongation with an increased risk of serious cardiovascular effects. Both agents also have the potential to cause a life-threatening serotonin syndrome or neuroleptic malignant syndrome-like reactions. If coadministration is required, monitor for ECG changes and signs/symptoms of serotonin syndrome or neuroleptic malignant syndrome-like reactions, especially during initiation of treatment and dose increases. Do not exceed citalopram 40 mg/day, and discontinue citalopram in patients who have persistent QTc measurements greater than 500 milliseconds. Discontinue therapy immediately and initiate treatment in patients who have symptoms of serotonin syndrome or neuroleptic malignant-syndrome-like reactions. Symptoms of serotonin syndrome include neuromuscular abnormalities (including hyperreflexia, tremor, muscle rigidity, clonus, peripheral hypertonicity, and shivering), autonomic hyperactivity (including tachycardia, mydriasis, diaphoresis, the presence of bowel sounds, and diarrhea), and mental status changes (including agitation and delirium). If serotonin syndrome develops, discontinue the offending agents and provide supportive care and other therapy as necessary .
Mechanism Of Interaction
Additive effects on QT interval prolongation; additive serotonergic effects
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.
Trazodone Overview
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Trazodone is used to treat depression. Trazodone is in a class of medications called serotonin modulators. 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.