Risperidone with Citalopram Interaction Details

Brand Names Associated with Risperidone

Brand Names Associated with Citalopram

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

Interaction Effect

An increased risk of QT interval prolongation and torsade de pointes

Interaction Summary

Citalopram has been associated with dose-dependent QT interval prolongation. In a case report, torsade de pointes occurred in a 77-year-old woman who received both citalopram and risperiDONE for delusional depressive episodes . The concomitant use of citalopram and risperiDONE is not recommended due to a potential for additive effects on QT interval prolongation and an increased risk of cardiac adverse events, including ventricular arrhythmias and/or torsade de pointes. If coadministration is required, monitor for ECG changes. Do not exceed citalopram doses of 40 mg/day, and discontinue citalopram in patients who have persistent QTc measurements greater than 500 milliseconds .

Severity

Major

Onset

Unspecified

Evidence

Probable

How To Manage Interaction

The concomitant use of citalopram and risperiDONE is not recommended due to a potential for additive effects on QT interval prolongation and an increased risk of serious cardiovascular effects. If coadministration is required, monitor for ECG changes. Do not exceed citalopram doses of 40 mg/day, and discontinue citalopram in patients who have persistent QTc measurements greater than 500 milliseconds.

Mechanism Of Interaction

Additive effects on QT interval prolongation

Literature Reports

A) Torsade de pointes (TdP) occurred in a 77-year-old woman who received both citalopram and risperiDONE for delusional depressive episodes. During a routine Holter ECG, TdP was discovered and the patient was admitted for medical management. Approximately 3 months prior, citalopram 20 mg/day and risperiDONE 2 mg/day were initiated, at which time an ECG showed a normal heart rate (66 beats per minute) and corrected QT (QTc) interval (410 milliseconds). The patient's past medical history included latent hypothyroidism, type 2 diabetes, hypertension, and a cerebral insult 3 months prior to admission resulting in paresis of the hypoglossus nerve, dysphagia, dysarthria, and motor dysfunction. On admission, physical exam, vital signs, and laboratory values, including serum potassium, were all normal. An ECG showed QT and QTc intervals of 510 milliseconds and 490 milliseconds, respectively, and evidence of sinus bradycardia (48 beats per minute) and AV block I (PR 260 milliseconds). Citalopram and risperiDONE were discontinued and the QTc interval normalized (398 milliseconds), the heart rate returned to normal (80 beats per minute), and no further TdP episodes were detected on ECG telemetry. Later during hospitalization, the patient developed a cystitis for which sulfamethoxazole/trimethoprim was started. Although no arrhythmias were detected, after 3 doses, the QTc interval was again prolonged (500 milliseconds) and sulfamethoxazole/trimethoprim was replaced with a cephalosporin. The QTc interval normalized, and the patient was discharged home and advised to avoid all QT-prolonging medications .

Risperidone Overview

• Risperidone is used to treat the symptoms of schizophrenia (a mental illness that causes disturbed or unusual thinking, loss of interest in life, and strong or inappropriate emotions) in adults and teenagers 13 years of age and older. It is also used to treat episodes of mania (frenzied, abnormally excited, or irritated mood) or mixed episodes (symptoms of mania and depression that happen together) in adults and in teenagers and children 10 years of age and older with bipolar disorder (manic depressive disorder; a disease that causes episodes of depression, episodes of mania, and other abnormal moods). Risperidone is also used to treat behavior problems such as aggression, self-injury, and sudden mood changes in teenagers and children 5 to 16 years of age who have autism (a condition that causes repetitive behavior, difficulty interacting with others, and problems with communication). Risperidone is in a class of medications called atypical antipsychotics. It works by changing the activity of certain natural substances in the brain.

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.

Return To Our Drug Interaction Homepage

Feedback, Question Or Comment About This Information?

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.