citalopram (Rx)

Depression

Depression in patients whose diagnosis corresponds most closely to the DSM-III and DSM-III-R category of major depressive disorder

Initial dose: 20 mg PO qDay

If needed, may increase to 40 mg/day after at least 1 week

Doses above 40 mg/day are not recommended, because of risk for QT prolongation without additional benefit for treating depression

Dosing Modifications

Poor CYP2C19 metabolizers or coadministration with CYP2C19 inhibitors (eg, cimetidine, fluconazole, omeprazole): Do not exceed 20 mg/day

Hepatic impairment decreases clearance and therefore increases risk of QT prolongation; do not exceed 20 mg/day

MAO inhibitors

• Not for administration within 14 days of administering a MAO inhibitor

Linezolid or Methylene Blue Therapy

• Not for administration to patients that are receiving linezolid or IV methylene blue; consider other forms of therapy; if therapy required and benefits outweigh risks discontinue citalopram therapy, administer linezolid or methylene blue and monitor for serotonin syndrome for 2 weeks or 24 hr after last dose of linezolid or methylene blue

Renal impairment

• Mild to moderate renal impairment: No dosage adjustment required
• Severe renal impairment (CrCl <20 mL/min): Not studied; use with caution

Alcoholism (Off-label)

20-40 mg PO qDay

Binge-eating Disorder (Off-label)

20-60 PO qDay

Generalized Anxiety Disorder (Off-label)

Initial: 10 mg PO qDay; may titrate to 40 mg/day

Panic Disorder (Off-label)

20 mg PO qDay initially; after 1 week, may increase to 40 mg/day if warranted

Not to exceed 40 mg/day because of increased risk for QT prolongation

Hot Flashes (Off-label)

Initial: 10 mg PO qDay; may increase to 20 mg/day after 1 week

Obsessive-Compulsive Disorder (Off-label)

Initial: 20 mg PO qDay; may titrate to 40-60 mg/day; improvement may be seen 4-6 weeks after initiating therapy

Premenstrual Dysphoric Disorder (Off-label)

5 mg PO on the estimated day of ovulation; increase dose by 5 mg each day thereafter to maximum 30 mg; continue thereafter until menstruation begins; decrease dose to 20 mg on the first day of menstruation; the next day, decrease to 10 mg; stop the treatment from day 3 until ovulation begins

Depression (Off-label)

<12 years

• 10 mg PO qDay; may increase by 5 mg/day every 2 weeks to 40 mg PO qDay; doses >40 mg not recommended (may increase risk of QT prolongation)

≥12 years

• 20 mg PO qDay; may increase by 10 mg/day every 2 weeks to 40 mg PO qDay; doses >40 mg not recommended (may increase risk of QT prolongation)

Impulsive Aggresive Behavior (Off-label)

10 mg PO qDay; titrate by 10 mg/week, as tolerated to maximum 40 mg/day

Depression

>60 years: Do not exceed 20 mg PO qDay

Dosing Considerations

-The elderly are more prone to SSRI/SNRI-induced hyponatremia and risk for QT prolongation

Contraindicated (12)

• dronedarone

  dronedarone and citalopram both increase QTc interval. Contraindicated. Concurrent use of dronedarone with other agents that can prolong QT interval is contraindicated.

• fluconazole

  citalopram and fluconazole both increase QTc interval. Contraindicated.

• goserelin

  goserelin increases toxicity of citalopram by QTc interval. Contraindicated. Increases risk of torsades de pointes.

• isocarboxazid

  isocarboxazid and citalopram both increase serotonin levels. Contraindicated. At least 2 weeks should elapse between discontinuation of MAOI therapy and the start of citalopram therapy, and at least 2 weeks between discontinuation of citalopram therapy and commencement of MAOI therapy.

• leuprolide

  leuprolide increases toxicity of citalopram by QTc interval. Contraindicated. Increases risk of torsades de pointes.

• phenelzine

  phenelzine and citalopram both increase serotonin levels. Contraindicated. At least 2 weeks should elapse between discontinuation of MAOI therapy and the start of citalopram therapy, and at least 2 weeks between discontinuation of citalopram therapy and commencement of MAOI therapy.

• pimozide

  citalopram and pimozide both increase QTc interval. Contraindicated.

• procarbazine

  procarbazine and citalopram both increase serotonin levels. Contraindicated. At least 2 weeks should elapse between discontinuation of MAOI therapy and the start of citalopram therapy, and at least 2 weeks between discontinuation of citalopram therapy and commencement of MAOI therapy.

• selegiline

  selegiline and citalopram both increase serotonin levels. Contraindicated. At least 2 weeks should elapse between discontinuation of MAOI therapy and the start of citalopram therapy, and at least 2 weeks between discontinuation of citalopram therapy and commencement of MAOI therapy.

• selegiline transdermal

  selegiline transdermal and citalopram both increase serotonin levels. Contraindicated. At least 2 weeks should elapse between discontinuation of MAOI therapy and the start of citalopram therapy, and at least 2 weeks between discontinuation of citalopram therapy and commencement of MAOI therapy.

• tranylcypromine

  tranylcypromine and citalopram both increase serotonin levels. Contraindicated. At least 2 weeks should elapse between discontinuation of MAOI therapy and the start of citalopram therapy, and at least 2 weeks between discontinuation of citalopram therapy and commencement of MAOI therapy.

• ziprasidone

  ziprasidone and citalopram both increase QTc interval. Contraindicated.

Serious - Use Alternative (144)

• adagrasib

  adagrasib, citalopram. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Each drug prolongs the QTc interval, which may increased the risk of Torsade de pointes, other serious arryhthmias, and sudden death. If coadministration unavoidable, more frequent monitoring is recommended for such patients.

• alfentanil

  alfentanil, citalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• alfuzosin

  alfuzosin and citalopram both increase QTc interval. Avoid or Use Alternate Drug.

• almotriptan

  citalopram, almotriptan. Mechanism: unknown. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome. If concomitant treatment with citalopram and a triptan is clinically warranted, careful observation of the patient is advised, particularly during treatment initiation and dose increases.

• amisulpride

  citalopram and amisulpride both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.

• amitriptyline

  citalopram and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug. Citalopram may increase TCA levels. Increased risk of serotonin syndrome or neuroleptic malignant syndrome. Potential risk for QT prolongation. ECG monitoring is recommended.
  
  citalopram and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.

• amoxapine

  citalopram and amoxapine both increase serotonin levels. Avoid or Use Alternate Drug. Citalopram may increase TCA levels. Increased risk of serotonin syndrome or neuroleptic malignant syndrome. Potential risk for QT prolongation. ECG monitoring is recommended.

• anagrelide

  citalopram and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.

• apalutamide

  apalutamide will decrease the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP2C19 inducer, with drugs that are CYP2C19 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered.
  
  apalutamide will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.

• aripiprazole

  aripiprazole and citalopram both increase QTc interval. Avoid or Use Alternate Drug.

• artemether

  artemether and citalopram both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine

  citalopram and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine buccal

  buprenorphine buccal and citalopram both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine subdermal implant

  buprenorphine subdermal implant and citalopram both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine transdermal

  buprenorphine transdermal and citalopram both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine, long-acting injection

  buprenorphine, long-acting injection and citalopram both increase QTc interval. Avoid or Use Alternate Drug.

• buspirone

  citalopram and buspirone both increase serotonin levels. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• ceritinib

  ceritinib and citalopram both increase QTc interval. Avoid or Use Alternate Drug.
  
  ceritinib will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• cisapride

  citalopram and cisapride both increase QTc interval. Avoid or Use Alternate Drug.

• clarithromycin

  clarithromycin, citalopram. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. To monitor for the prolongation of QT/QTc and/or development of ventricular tachyarrhythmias the labeling recommends monitoring QT interval or ECG.

• clomipramine

  citalopram and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug. Citalopram may increase TCA levels. Increased risk of serotonin syndrome or neuroleptic malignant syndrome. Potential risk for QT prolongation. ECG monitoring is recommended.
  
  citalopram and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.

• clozapine

  citalopram and clozapine both increase QTc interval. Avoid or Use Alternate Drug.

• cocaine topical

  citalopram and cocaine topical both increase serotonin levels. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• crizotinib

  citalopram and crizotinib both increase QTc interval. Avoid or Use Alternate Drug.

• cyclobenzaprine

  citalopram and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

• dacomitinib

  dacomitinib will increase the level or effect of citalopram by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid use with CYP2D6 substrates where minimal increases in concentration of the CYP2D6 substrate may lead to serious or life-threatening toxicities.

• desflurane

  desflurane and citalopram both increase QTc interval. Avoid or Use Alternate Drug.

• desipramine

  citalopram and desipramine both increase serotonin levels. Avoid or Use Alternate Drug. Citalopram may increase TCA levels. Increased risk of serotonin syndrome or neuroleptic malignant syndrome. Potential risk for QT prolongation. ECG monitoring is recommended.
  
  desipramine and citalopram both increase QTc interval. Avoid or Use Alternate Drug.

• desvenlafaxine

  citalopram and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.

• dextromethorphan

  citalopram and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• dolasetron

  dolasetron, citalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• donepezil

  donepezil and citalopram both increase QTc interval. Avoid or Use Alternate Drug.

• doxepin

  citalopram and doxepin both increase serotonin levels. Avoid or Use Alternate Drug. Citalopram may increase TCA levels. Increased risk of serotonin syndrome or neuroleptic malignant syndrome. Potential risk for QT prolongation. ECG monitoring is recommended.
  
  doxepin and citalopram both increase QTc interval. Avoid or Use Alternate Drug.

• duloxetine

  citalopram and duloxetine both increase serotonin levels. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• efavirenz

  efavirenz will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  efavirenz and citalopram both increase QTc interval. Avoid or Use Alternate Drug.

• eletriptan

  citalopram, eletriptan. Mechanism: unknown. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome. If concomitant treatment with citalopram and a triptan is clinically warranted, careful observation of the patient is advised, particularly during treatment initiation and dose increases.

• eliglustat

  citalopram and eliglustat both increase QTc interval. Avoid or Use Alternate Drug.

• encorafenib

  encorafenib and citalopram both increase QTc interval. Avoid or Use Alternate Drug. Encorafenib is associated with dose-dependent QTc interval prolongation. Avoid with drugs known to prolong QT interval.

• entrectinib

  citalopram and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.

• eribulin

  citalopram and eribulin both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin base

  citalopram and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin ethylsuccinate

  citalopram and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin lactobionate

  citalopram and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin stearate

  citalopram and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug.

• escitalopram

  citalopram and escitalopram both increase serotonin levels. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• fentanyl

  fentanyl, citalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• fentanyl intranasal

  fentanyl intranasal, citalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• fentanyl transdermal

  fentanyl transdermal, citalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• fentanyl transmucosal

  fentanyl transmucosal, citalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• fexinidazole

  fexinidazole and citalopram both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.
  
  fexinidazole will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.

• fingolimod

  fingolimod and citalopram both increase QTc interval. Avoid or Use Alternate Drug.

• fluoxetine

  citalopram and fluoxetine both increase serotonin levels. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• fluvoxamine

  fluvoxamine and citalopram both increase serotonin levels. Avoid or Use Alternate Drug. Combinatiomay increase risk of serotonin syndrome or neuroleptic malignant syndromn e like reactions.

• frovatriptan

  citalopram, frovatriptan. Mechanism: unknown. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome. If concomitant treatment with citalopram and a triptan is clinically warranted, careful observation of the patient is advised, particularly during treatment initiation and dose increases.

• gilteritinib

  gilteritinib will decrease the level or effect of citalopram by Other (see comment). Avoid or Use Alternate Drug. Coadministration of gilteritinib with drugs that inhibit 5HT2B or sigma nonspecific receptors. Avoid use of these drugs with gilteritinib unless coadministration is necessary.
  
  citalopram and gilteritinib both increase QTc interval. Avoid or Use Alternate Drug.

• givosiran

  givosiran will increase the level or effect of citalopram by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2D6 substrates with givosiran. If unavoidable, decrease the CYP2D6 substrate dosage in accordance with approved product labeling.

• glasdegib

  citalopram and glasdegib both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, monitor for increased risk of QTc interval prolongation.

• granisetron

  granisetron, citalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
  
  citalopram and granisetron both increase QTc interval. Avoid or Use Alternate Drug.

• haloperidol

  citalopram will increase the level or effect of haloperidol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Increased risk of serotonin syndrome or neuroleptic malignant syndrome. Potential risk for QT prolongation. ECG monitoring is recommended.
  
  citalopram and haloperidol both increase QTc interval. Avoid or Use Alternate Drug.

• histrelin

  histrelin increases toxicity of citalopram by QTc interval. Avoid or Use Alternate Drug. Increases risk of torsades de pointes.

• hydromorphone

  hydromorphone, citalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• hydroxychloroquine sulfate

  hydroxychloroquine sulfate and citalopram both increase QTc interval. Avoid or Use Alternate Drug.

• hydroxyzine

  hydroxyzine increases toxicity of citalopram by QTc interval. Avoid or Use Alternate Drug. Increases risk of torsades de pointes.

• idelalisib

  idelalisib will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates

• imipramine

  citalopram and imipramine both increase serotonin levels. Avoid or Use Alternate Drug. Citalopram may increase TCA levels. Increased risk of serotonin syndrome or neuroleptic malignant syndrome. Potential risk for QT prolongation. ECG monitoring is recommended.

• inotuzumab

  inotuzumab and citalopram both increase QTc interval. Avoid or Use Alternate Drug. If unable to avoid concomitant use, obtain ECGs and electrolytes before and after initiation of any drug known to prolong QTc, and periodically monitor as clinically indicated during treatment.

• isoflurane

  citalopram and isoflurane both increase QTc interval. Avoid or Use Alternate Drug.

• itraconazole

  citalopram and itraconazole both increase QTc interval. Avoid or Use Alternate Drug.

• ivosidenib

  ivosidenib and citalopram both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.
  
  ivosidenib will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternate therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.

• L-tryptophan

  citalopram and L-tryptophan both increase serotonin levels. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• lefamulin

  citalopram and lefamulin both increase QTc interval. Avoid or Use Alternate Drug.

• levomilnacipran

  citalopram and levomilnacipran both increase serotonin levels. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• linezolid

  linezolid and citalopram both increase serotonin levels. Avoid or Use Alternate Drug. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first.

• lithium

  citalopram and lithium both increase QTc interval. Avoid or Use Alternate Drug.

• lonafarnib

  lonafarnib will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration with sensitive CYP3A substrates. If coadministration unavoidable, monitor for adverse reactions and reduce CYP3A substrate dose in accordance with product labeling.
  
  lonafarnib will increase the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Lonafarnib may increase the AUC and peak concentration of CYP2C19 substrates. If coadministration unavoidable, monitor for adverse reactions and reduce the CYP2C19 substrate dose in accordance with its approved product labeling.

• loperamide

  citalopram and loperamide both increase QTc interval. Avoid or Use Alternate Drug.

• lopinavir

  citalopram and lopinavir both increase QTc interval. Avoid or Use Alternate Drug.

• lorcaserin

  citalopram and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• macimorelin

  macimorelin and citalopram both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.

• maprotiline

  citalopram and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• mefloquine

  mefloquine and citalopram both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• meperidine

  meperidine, citalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• methylene blue

  methylene blue and citalopram both increase serotonin levels. Avoid or Use Alternate Drug. Methylene blue may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first.

• metoclopramide

  metoclopramide and citalopram both increase serotonin levels. Avoid or Use Alternate Drug. Additive effects; increased risk for serotonin syndrome, neuroleptic malignant syndrome, dystonia, or other extrapyramidal reactions

• metoclopramide intranasal

  citalopram, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

• midostaurin

  citalopram and midostaurin both increase QTc interval. Avoid or Use Alternate Drug.

• milnacipran

  citalopram and milnacipran both increase serotonin levels. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• mirtazapine

  citalopram and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.

• mobocertinib

  mobocertinib and citalopram both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.

• morphine

  morphine, citalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• naratriptan

  citalopram, naratriptan. Mechanism: unknown. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome. If concomitant treatment with citalopram and a triptan is clinically warranted, careful observation of the patient is advised, particularly during treatment initiation and dose increases.

• nefazodone

  citalopram and nefazodone both increase serotonin levels. Avoid or Use Alternate Drug.

• netupitant/palonosetron

  netupitant/palonosetron, citalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• nortriptyline

  citalopram and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug. Citalopram may increase TCA levels. Increased risk of serotonin syndrome or neuroleptic malignant syndrome. Potential risk for QT prolongation. ECG monitoring is recommended.
  
  citalopram and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.

• olanzapine

  citalopram and olanzapine both increase QTc interval. Avoid or Use Alternate Drug. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval in rare instances

• olopatadine intranasal

  citalopram and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• ondansetron

  citalopram and ondansetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.
  
  ondansetron, citalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• oxaliplatin

  citalopram and oxaliplatin both increase QTc interval. Avoid or Use Alternate Drug.

• ozanimod

  ozanimod increases toxicity of citalopram by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.

• palonosetron

  palonosetron, citalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• panobinostat

  citalopram and panobinostat both increase QTc interval. Avoid or Use Alternate Drug. Panobinostat is known to significantly prolong QT interval. Panobinostat prescribing information states use with drugs known to prolong QTc is not recommended.

• paroxetine

  citalopram and paroxetine both increase serotonin levels. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• phentermine

  citalopram, phentermine. Either increases toxicity of the other by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of serotonin syndrome.

• pimavanserin

  citalopram and pimavanserin both increase QTc interval. Avoid or Use Alternate Drug. Coadministration may increase the risk of QT prolongation and cardiac arrhythmia.

• pitolisant

  citalopram and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.

• ponesimod

  citalopram and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• posaconazole

  citalopram and posaconazole both increase QTc interval. Contraindicated.

• primaquine

  citalopram and primaquine both increase QTc interval. Avoid or Use Alternate Drug.

• primidone

  primidone will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• protriptyline

  citalopram and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug. Citalopram may increase TCA levels. Increased risk of serotonin syndrome or neuroleptic malignant syndrome. Potential risk for QT prolongation. ECG monitoring is recommended.
  
  citalopram and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.

• rasagiline

  rasagiline and citalopram both increase serotonin levels. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• remifentanil

  remifentanil, citalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• ribociclib

  ribociclib and citalopram both increase QTc interval. Avoid or Use Alternate Drug.
  
  ribociclib will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• risperidone

  citalopram and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

• rizatriptan

  citalopram, rizatriptan. Mechanism: unknown. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome. If concomitant treatment with citalopram and a triptan is clinically warranted, careful observation of the patient is advised, particularly during treatment initiation and dose increases.

• saquinavir

  saquinavir will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• selinexor

  selinexor, citalopram. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

• sertraline

  citalopram and sertraline both increase serotonin levels. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.
  
  citalopram and sertraline both increase QTc interval. Avoid or Use Alternate Drug.

• sevoflurane

  citalopram and sevoflurane both increase QTc interval. Avoid or Use Alternate Drug.

• siponimod

  citalopram and siponimod both increase QTc interval. Avoid or Use Alternate Drug.

• solifenacin

  citalopram and solifenacin both increase QTc interval. Avoid or Use Alternate Drug.

• St John's Wort

  citalopram and St John's Wort both increase serotonin levels. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• sufentanil

  sufentanil, citalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• sumatriptan

  citalopram, sumatriptan. Mechanism: unknown. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome. If concomitant treatment with citalopram and a triptan is clinically warranted, careful observation of the patient is advised, particularly during treatment initiation and dose increases.

• sumatriptan intranasal

  citalopram, sumatriptan intranasal. Mechanism: unknown. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome. If concomitant treatment with citalopram and a triptan is clinically warranted, careful observation of the patient is advised, particularly during treatment initiation and dose increases.

• tedizolid

  tedizolid, citalopram. Either increases effects of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. both increase serotonin levels; increased risk of serotonin syndrome.

• tetrabenazine

  citalopram and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

• thioridazine

  thioridazine and citalopram both increase QTc interval. Avoid or Use Alternate Drug. Thioridazine should be avoided in combination with drugs that are known to prolong QTc interval.

• trazodone

  citalopram and trazodone both increase QTc interval. Avoid or Use Alternate Drug.

• trimipramine

  citalopram and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug. Citalopram may increase TCA levels. Increased risk of serotonin syndrome or neuroleptic malignant syndrome. Potential risk for QT prolongation. ECG monitoring is recommended.
  
  citalopram and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.

• triptorelin

  triptorelin increases toxicity of citalopram by QTc interval. Avoid or Use Alternate Drug. Increases risk of torsades de pointes.

• tucatinib

  tucatinib will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.

• umeclidinium bromide/vilanterol inhaled

  citalopram increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• vandetanib

  citalopram, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.

• vemurafenib

  vemurafenib and citalopram both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.

• venlafaxine

  citalopram and venlafaxine both increase serotonin levels. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• vilanterol/fluticasone furoate inhaled

  citalopram increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• vilazodone

  citalopram, vilazodone. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• voriconazole

  citalopram and voriconazole both increase QTc interval. Avoid or Use Alternate Drug.

• vorinostat

  citalopram and vorinostat both increase QTc interval. Avoid or Use Alternate Drug.

• vortioxetine

  citalopram, vortioxetine. Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug.

• voxelotor

  voxelotor will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.

• ziprasidone

  citalopram and ziprasidone both increase QTc interval. Contraindicated.

• zolmitriptan

  citalopram, zolmitriptan. Mechanism: unknown. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome. If concomitant treatment with citalopram and a triptan is clinically warranted, careful observation of the patient is advised, particularly during treatment initiation and dose increases.

Monitor Closely (289)

• 5-HTP

  citalopram and 5-HTP both increase serotonin levels. Use Caution/Monitor. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• abciximab

  citalopram increases effects of abciximab by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• abiraterone

  abiraterone increases levels of citalopram by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Avoid coadministration of abiraterone with substrates of CYP2D6. If alternative therapy cannot be used, exercise caution and consider a dose reduction of the CYP2D6 substrate.

• activated charcoal

  activated charcoal decreases effects of citalopram by pharmacodynamic antagonism. Use Caution/Monitor. Charcoal can reduce absorption of citalopram, resulting in decreased efficacy.

• albuterol

  albuterol and citalopram both increase QTc interval. Use Caution/Monitor.

• alfuzosin

  citalopram and alfuzosin both increase QTc interval. Use Caution/Monitor.

• amifampridine

  citalopram increases toxicity of amifampridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Amifampridine can cause seizures. Coadministration with drugs that lower seizure threshold may increase this risk.

• amiodarone

  amiodarone and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• amobarbital

  amobarbital will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• amoxapine

  citalopram and amoxapine both increase QTc interval. Use Caution/Monitor.

• anagrelide

  citalopram increases effects of anagrelide by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• antithrombin III

  citalopram increases effects of antithrombin III by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• apixaban

  citalopram increases effects of apixaban by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

• apomorphine

  apomorphine and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• arformoterol

  arformoterol and citalopram both increase QTc interval. Use Caution/Monitor.

• argatroban

  citalopram increases effects of argatroban by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• arsenic trioxide

  arsenic trioxide and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• artemether/lumefantrine

  artemether/lumefantrine and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• asenapine

  asenapine and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• asenapine transdermal

  asenapine transdermal and citalopram both increase QTc interval. Use Caution/Monitor.

• aspirin

  citalopram, aspirin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• aspirin rectal

  citalopram, aspirin rectal. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• aspirin/citric acid/sodium bicarbonate

  citalopram, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• atazanavir

  atazanavir increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• atomoxetine

  citalopram increases levels of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Although citalopram is a weak inhibitor of 2D6, the potential for an interaction exists.
  
  atomoxetine and citalopram both increase QTc interval. Use Caution/Monitor.

• azithromycin

  azithromycin and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• bedaquiline

  citalopram and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely

• belzutifan

  belzutifan will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information.

• benzhydrocodone/acetaminophen

  benzhydrocodone/acetaminophen, citalopram. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

• betrixaban

  citalopram, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

• bivalirudin

  citalopram increases effects of bivalirudin by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• bosentan

  bosentan will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• bumetanide

  bumetanide, citalopram. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Possible additive hyponatremia.

• buprenorphine subdermal implant

  citalopram, buprenorphine subdermal implant. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.

• buprenorphine, long-acting injection

  citalopram, buprenorphine, long-acting injection. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.

• bupropion

  bupropion will increase the level or effect of citalopram by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• cannabidiol

  cannabidiol will increase the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider reducing the dose of sensitive CYP2C19 substrates, as clinically appropriate, when coadministered with cannabidiol.

• carbamazepine

  carbamazepine decreases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. The possibility that carbamazepine might increase the clearance of citalopram should be considered when both drugs are coadministered.

• carvedilol

  citalopram increases levels of carvedilol by decreasing metabolism. Use Caution/Monitor.

• celecoxib

  citalopram, celecoxib. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• cenobamate

  cenobamate will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.
  
  cenobamate will decrease the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.
  
  cenobamate, citalopram. Either increases effects of the other by sedation. Use Caution/Monitor.

• chloramphenicol

  chloramphenicol will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

• chloroquine

  chloroquine increases toxicity of citalopram by QTc interval. Use Caution/Monitor.

• chlorothiazide

  chlorothiazide, citalopram. pharmacodynamic synergism. Use Caution/Monitor. Possible additive hyponatremia.

• chlorpromazine

  chlorpromazine and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• choline magnesium trisalicylate

  citalopram, choline magnesium trisalicylate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of GI adverse effects may be increased. If possible, avoid concurrent use.

• cilostazol

  citalopram increases effects of cilostazol by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• cimetidine

  cimetidine increases levels of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Citalopram 20 mg/day is the maximum recommended dose for patients taking CYP2C19 inhibitors because of the risk of QT prolongation.

• ciprofloxacin

  ciprofloxacin and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• clofazimine

  citalopram and clofazimine both increase QTc interval. Use Caution/Monitor.

• clonidine

  clonidine, citalopram. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration enhances CNS depressant effects.

• clopidogrel

  citalopram increases effects of clopidogrel by pharmacodynamic synergism. Use Caution/Monitor. SSRIs affect platelet activation; coadministration of SSRIs with clopidogrel may increase the risk of bleeding.

• clozapine

  citalopram increases effects of clozapine by pharmacodynamic synergism. Use Caution/Monitor. Increased risk for serotonin syndrome.

• cobicistat

  cobicistat will increase the level or effect of citalopram by Other (see comment). Use Caution/Monitor. Carefully titrate dose of the antidepressant to the desired effect, including using the lowest feasible initial or maintenance dose, and monitor its response during coadministration with SSRIs and cobicistat.
  
  cobicistat will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• conivaptan

  conivaptan increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• crizotinib

  crizotinib increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Dose reduction may be needed for coadministered drugs that are predominantly metabolized by CYP3A. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• crofelemer

  crofelemer increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed.

• cyclobenzaprine

  cyclobenzaprine and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• cyproheptadine

  cyproheptadine decreases effects of citalopram by pharmacodynamic antagonism. Use Caution/Monitor. Cyproheptadine may diminish the serotonergic effect of SSRIs.

• dabigatran

  citalopram increases effects of dabigatran by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• dabrafenib

  dabrafenib will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

• dalteparin

  citalopram increases effects of dalteparin by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• daridorexant

  citalopram and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• darunavir

  darunavir will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration with SSRIs, TCAs, or trazodone may require dose titration of antidepressant to desired effect (eg, using the lowest feasible initial or maintenance dose). Monitor for antidepressant response.

• dasatinib

  citalopram and dasatinib both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• defibrotide

  defibrotide increases effects of citalopram by Other (see comment). Use Caution/Monitor. Comment: Defibrotide may enhance effects of platelet inhibitors.

• degarelix

  degarelix and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• deutetrabenazine

  citalopram and deutetrabenazine both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).

• dexmethylphenidate

  dexmethylphenidate increases effects of citalopram by decreasing metabolism. Use Caution/Monitor. Potential risk for serotonin syndrome or neuroleptic malignant syndrome-like reactions, caution should be observed during coadministration.

• dextroamphetamine

  citalopram and dextroamphetamine both increase serotonin levels. Use Caution/Monitor. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• dextroamphetamine transdermal

  citalopram, dextroamphetamine transdermal. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and concomitant serotonergic drug(s).

• diazepam intranasal

  diazepam intranasal, citalopram. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.

• dichlorphenamide

  dichlorphenamide and citalopram both decrease serum potassium. Use Caution/Monitor.

• diclofenac

  citalopram, diclofenac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• difelikefalin

  difelikefalin and citalopram both increase sedation. Use Caution/Monitor.

• diflunisal

  citalopram, diflunisal. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• dihydroergotamine

  citalopram and dihydroergotamine both increase serotonin levels. Use Caution/Monitor. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• dihydroergotamine intranasal

  citalopram and dihydroergotamine intranasal both increase serotonin levels. Use Caution/Monitor. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• dipyridamole

  citalopram increases effects of dipyridamole by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• disopyramide

  disopyramide and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• dofetilide

  dofetilide and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• dolasetron

  dolasetron and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• droperidol

  droperidol and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• duvelisib

  duvelisib will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. will increase the level or effect of

• elagolix

  elagolix will increase the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak CYP2C19 inhibitor. Caution with sensitive CYP2C19 substrates.
  
  elagolix will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.

• eliglustat

  eliglustat increases levels of citalopram by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the concomitant drug and titrate to clinical effect.

• elvitegravir/cobicistat/emtricitabine/tenofovir DF

  elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.
  
  elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of citalopram by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP2D6 inhibitor; caution with CYP2D6 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

• encorafenib

  encorafenib, citalopram. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.

• enoxaparin

  citalopram increases effects of enoxaparin by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• enzalutamide

  enzalutamide will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• eptifibatide

  citalopram increases effects of eptifibatide by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• ergotamine

  citalopram and ergotamine both increase serotonin levels. Use Caution/Monitor. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• erythromycin base

  erythromycin base increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• erythromycin ethylsuccinate

  erythromycin ethylsuccinate increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• erythromycin lactobionate

  erythromycin lactobionate increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• erythromycin stearate

  erythromycin stearate increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• eslicarbazepine acetate

  eslicarbazepine acetate will increase the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

• esomeprazole

  esomeprazole will increase the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Citalopram 20 mg/day is the maximum recommended dose for patients taking CYP2C19 inhibitors because of the risk of QT prolongation.

• ethacrynic acid

  ethacrynic acid, citalopram. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Possible additive hyponatremia.

• ethanol

  ethanol, citalopram. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive CNS depression.

• etodolac

  citalopram, etodolac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• etravirine

  etravirine will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• ezogabine

  ezogabine, citalopram. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.

• fedratinib

  fedratinib will increase the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2C19 substrates as necessary.
  
  fedratinib will increase the level or effect of citalopram by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2D6 substrates as necessary.

• fenfluramine

  fenfluramine, citalopram. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

• fenoprofen

  citalopram, fenoprofen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• fexinidazole

  fexinidazole will increase the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

• fish oil triglycerides

  fish oil triglycerides will increase the level or effect of citalopram by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

• flecainide

  flecainide and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• fluconazole

  fluconazole will increase the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Citalopram 20 mg/day is the maximum recommended dose for patients taking CYP2C19 inhibitors because of the risk of QT prolongation. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• fluoxetine

  citalopram and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.

• fluphenazine

  citalopram and fluphenazine both increase QTc interval. Use Caution/Monitor.

• flurbiprofen

  citalopram, flurbiprofen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• fluvoxamine

  fluvoxamine will increase the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Citalopram 20 mg/day is maximum recommended dose for patients taking CYP2C19 inhibitors because of the risk of QT prolongation

• fondaparinux

  citalopram increases effects of fondaparinux by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• fosamprenavir

  fosamprenavir increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .

• foscarnet

  foscarnet and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• fosphenytoin

  fosphenytoin will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• furosemide

  furosemide, citalopram. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Possible additive hyponatremia.

• gabapentin

  gabapentin, citalopram. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• gabapentin enacarbil

  gabapentin enacarbil, citalopram. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• gadobenate

  citalopram and gadobenate both increase QTc interval. Use Caution/Monitor.

• ganaxolone

  citalopram and ganaxolone both increase sedation. Use Caution/Monitor.

• gemifloxacin

  gemifloxacin and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• gemtuzumab

  citalopram and gemtuzumab both increase QTc interval. Use Caution/Monitor.

• gepirone

  gepirone and citalopram both increase QTc interval. Modify Therapy/Monitor Closely.
  
  gepirone and citalopram both increase serotonin levels. Use Caution/Monitor. Monitor for symptoms of serotonin syndrome when gepirone is used gepirone with other drugs that may affect the serotonergic neurotransmitter systems. If serotonin syndrome occurs, consider discontinue gepirone and/or concomitant serotonergic drug.

• green tea

  green tea, citalopram. Other (see comment). Use Caution/Monitor. Comment: Combination may increase risk of bleeding.

• heparin

  citalopram increases effects of heparin by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• hydrochlorothiazide

  hydrochlorothiazide, citalopram. pharmacodynamic synergism. Use Caution/Monitor. Possible additive hyponatremia.

• hydrocodone

  hydrocodone, citalopram. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

• ibrutinib

  ibrutinib will increase the level or effect of citalopram by anticoagulation. Use Caution/Monitor. Ibrutinib may increase the risk of hemorrhage in patients receiving antiplatelet or anticoagulant therapies and monitor for signs of bleeding.

• ibuprofen

  citalopram, ibuprofen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• ibuprofen IV

  citalopram, ibuprofen IV. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• ibutilide

  ibutilide and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• icosapent

  icosapent, citalopram. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Icosapent may prolong bleeding time. Periodically monitor if coadministered with other drugs that affect bleeding.

• iloperidone

  iloperidone and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.
  
  iloperidone increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4.

• imatinib

  imatinib increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• indacaterol, inhaled

  indacaterol, inhaled, citalopram. QTc interval. Use Caution/Monitor. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.

• indapamide

  indapamide, citalopram. pharmacodynamic synergism. Use Caution/Monitor. Possible additive hyponatremia.
  
  indapamide and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• indinavir

  indinavir increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .

• indomethacin

  citalopram, indomethacin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• ioflupane I 123

  citalopram decreases effects of ioflupane I 123 by receptor binding competition. Use Caution/Monitor. Drugs that bind to dopamine transporter receptor with high affinity may interfere with the image following ioflupane I 123 administration.

• isoniazid

  isoniazid will increase the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Citalopram 20 mg/day is the maximum recommended dose for patients taking CYP2C19 inhibitors because of the risk of QT prolongation.

• isradipine

  isradipine and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• istradefylline

  istradefylline will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.

• itraconazole

  itraconazole increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• ketoprofen

  citalopram, ketoprofen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• ketorolac

  citalopram, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• ketorolac intranasal

  citalopram, ketorolac intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• lamotrigine

  lamotrigine increases toxicity of citalopram by unspecified interaction mechanism. Modify Therapy/Monitor Closely. CNS depressants may increase the toxic effects of selective serotonin reuptake inhibitors; psychomotor impairment may be enhanced.

• lapatinib

  lapatinib and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• lasmiditan

  lasmiditan, citalopram. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.
  
  citalopram increases effects of lasmiditan by serotonin levels. Use Caution/Monitor. Coadministration may increase risk of serotonin syndrome.

• lemborexant

  lemborexant, citalopram. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

• lenacapavir

  lenacapavir will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lencapavir (a moderate CYP3A4 inhibitor) may increase CYP3A4 substrates initiated within 9 months after last SC dose of lenacapavir, which may increase potential risk of adverse reactions of CYP3A4 substrates.

• lenvatinib

  citalopram and lenvatinib both increase QTc interval. Use Caution/Monitor. Lenvatinib prescribing information recommends monitoring ECG closely when coadministered with QT prolonging drugs.

• letermovir

  letermovir increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• levalbuterol

  citalopram and levalbuterol both increase QTc interval. Use Caution/Monitor.

• levofloxacin

  levofloxacin and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• lisdexamfetamine

  citalopram, lisdexamfetamine. Either increases effects of the other by unknown mechanism. Use Caution/Monitor. Risk of serotonin syndrome.
  
  citalopram, lisdexamfetamine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue along with concomitant serotonergic drug(s).

• lithium

  citalopram, lithium. Mechanism: unknown. Use Caution/Monitor. Lithium may enhance the serotonergic effects of citalopram, caution should be exercised when citalopram and lithium are coadministered.

• lofexidine

  citalopram and lofexidine both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended.

• lopinavir

  lopinavir increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• lorcaserin

  lorcaserin will increase the level or effect of citalopram by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• lorlatinib

  lorlatinib will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• lumacaftor/ivacaftor

  lumacaftor/ivacaftor, citalopram. affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. In vitro studies suggest that lumacaftor may induce and ivacaftor may inhibit CYP2C19 substrates. .
  
  lumacaftor/ivacaftor will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. A higher dose of citalopram may be required to obtain desired therapeutic effect. Citalopram is a CYP3A and CYP2C19 substrate. Lumacaftor/ivacaftor is a strong inducer of CYP3A and has the potential to induce CYP2C19.

• lumefantrine

  lumefantrine and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• lurasidone

  lurasidone, citalopram. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

• maprotiline

  citalopram and maprotiline both increase serotonin levels. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• mavacamten

  citalopram will increase the level or effect of mavacamten by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Inititiation of weak CYP2C19 inhibitors may require decreased mavacamten dose.

• meclofenamate

  citalopram, meclofenamate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• mefenamic acid

  citalopram, mefenamic acid. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• meloxicam

  citalopram, meloxicam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• meperidine

  citalopram and meperidine both increase serotonin levels. Use Caution/Monitor. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• metformin

  citalopram increases effects of metformin by pharmacodynamic synergism. Use Caution/Monitor.

• methadone

  methadone and citalopram both increase QTc interval. Use Caution/Monitor. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome like reactions. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• methamphetamine

  methamphetamine, citalopram. Either increases effects of the other by unknown mechanism. Use Caution/Monitor. Risk of serotonin syndrome.

• methyclothiazide

  methyclothiazide, citalopram. pharmacodynamic synergism. Use Caution/Monitor. Possible additive hyponatremia.

• methylphenidate transdermal

  methylphenidate transdermal will increase the level or effect of citalopram by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

• metolazone

  metolazone, citalopram. pharmacodynamic synergism. Use Caution/Monitor. Possible additive hyponatremia.

• metoprolol

  citalopram increases levels of metoprolol by decreasing metabolism. Use Caution/Monitor. Increased metoprolol plasma levels have been associated with decreased cardioselectivity.

• midazolam intranasal

  midazolam intranasal, citalopram. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

• mifepristone

  mifepristone, citalopram. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
  
  mifepristone will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If concurrent therapy considered essential, ECG monitoring recommended

• mirabegron

  mirabegron will increase the level or effect of citalopram by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• mirtazapine

  citalopram and mirtazapine both increase serotonin levels. Use Caution/Monitor. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• mitotane

  mitotane decreases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.

• modafinil

  modafinil will increase the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Citalopram 20 mg/day is the maximum recommended dose for patients taking CYP2C19 inhibitors because of the risk of QT prolongation.

• morphine

  citalopram and morphine both increase serotonin levels. Use Caution/Monitor. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• moxifloxacin

  moxifloxacin and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• nabumetone

  citalopram, nabumetone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• nafcillin

  nafcillin will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• naproxen

  citalopram, naproxen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• nefazodone

  nefazodone increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• nelfinavir

  nelfinavir increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .

• nevirapine

  nevirapine will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• nicardipine

  nicardipine increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• nilotinib

  nilotinib and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• octreotide

  octreotide and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• ofloxacin

  ofloxacin and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• oliceridine

  citalopram, oliceridine. Either increases toxicity of the other by serotonin levels. Modify Therapy/Monitor Closely.

• olodaterol inhaled

  citalopram and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. Drugs that prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias

• omeprazole

  omeprazole will increase the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Citalopram 20 mg/day is the maximum recommended dose for patients taking CYP2C19 inhibitors because of the risk of QT prolongation.

• osilodrostat

  osilodrostat and citalopram both increase QTc interval. Use Caution/Monitor.

• osimertinib

  osimertinib and citalopram both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.

• oxaliplatin

  oxaliplatin will increase the level or effect of citalopram by Other (see comment). Use Caution/Monitor. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval.

• oxaprozin

  citalopram, oxaprozin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• oxycodone

  oxycodone increases effects of citalopram by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Opioids may enhance the serotonergic effects of SSRIs and increase risk for serotonergic syndrome.

• ozanimod

  ozanimod and citalopram both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.

• paliperidone

  paliperidone and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• pasireotide

  citalopram and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.

• pazopanib

  pazopanib and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• pentamidine

  pentamidine and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• pentazocine

  citalopram and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

• perphenazine

  citalopram and perphenazine both increase QTc interval. Use Caution/Monitor.

• phenobarbital

  phenobarbital will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• phenytoin

  phenytoin will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• piroxicam

  citalopram, piroxicam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• posaconazole

  posaconazole will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome like reactions. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• prasugrel

  citalopram increases effects of prasugrel by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• pregabalin

  pregabalin, citalopram. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• procainamide

  procainamide and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• prochlorperazine

  citalopram and prochlorperazine both increase serotonin levels. Use Caution/Monitor. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• promethazine

  citalopram and promethazine both increase serotonin levels. Use Caution/Monitor. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• propafenone

  propafenone and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• propranolol

  citalopram increases levels of propranolol by decreasing metabolism. Use Caution/Monitor.

• quetiapine

  quetiapine, citalopram. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT interval and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT. ECG monitoring is recommended.

• quinidine

  quinidine and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• quinine

  quinine and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• quizartinib

  quizartinib, citalopram. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

• ranolazine

  ranolazine and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• remimazolam

  remimazolam, citalopram. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

• rifabutin

  rifabutin will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rifampin

  rifampin will decrease the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
  
  rifampin will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rifapentine

  rifapentine will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rilpivirine

  rilpivirine increases toxicity of citalopram by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsades de Pointes.

• risperidone

  citalopram will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• ritonavir

  ritonavir increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased risk of serotonin syndrome. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• rivaroxaban

  citalopram increases effects of rivaroxaban by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• rolapitant

  rolapitant will increase the level or effect of citalopram by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Rolapitant may increase plasma concentrations of CYP2D6 substrates for at least 28 days following rolapitant administration.

• romidepsin

  romidepsin and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• rucaparib

  rucaparib will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• safinamide

  citalopram, safinamide. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Monitor patients for symptoms of serotonin syndrome if SSRIs are coadministered with safinamide.

• salicylates (non-asa)

  citalopram, salicylates (non-asa). Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• salmeterol

  citalopram and salmeterol both increase QTc interval. Use Caution/Monitor.

• salsalate

  citalopram, salsalate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• SAMe

  citalopram and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.

• saquinavir

  saquinavir and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• secobarbital

  secobarbital will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• selpercatinib

  selpercatinib increases toxicity of citalopram by QTc interval. Use Caution/Monitor.

• serdexmethylphenidate/dexmethylphenidate

  serdexmethylphenidate/dexmethylphenidate increases effects of citalopram by decreasing metabolism. Use Caution/Monitor. Potential risk for serotonin syndrome or neuroleptic malignant syndrome-like reactions, caution should be observed during coadministration.

• sodium sulfate/?magnesium sulfate/potassium chloride

  sodium sulfate/?magnesium sulfate/potassium chloride increases effects of citalopram by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using bowel preps together with drugs that lower the seizure threshold.

• sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol

  citalopram, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

• sodium sulfate/potassium sulfate/magnesium sulfate

  sodium sulfate/potassium sulfate/magnesium sulfate increases effects of citalopram by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using bowel preps together with drugs that lower the seizure threshold.

• sorafenib

  sorafenib and citalopram both increase QTc interval. Use Caution/Monitor.

• sotalol

  sotalol and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• sparsentan

  sparsentan will decrease the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Sparsentan (a CYP2C19 inducer) decreases exposure of CYP2C19 substrates and reduces efficacy related to these substrates.

• stiripentol

  stiripentol, citalopram. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.
  
  stiripentol will increase the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Citalopram dose is not to exceed 20 mg/day if used with a moderate CYP2C19 inhibitor. Monitor closely for evidence of citalopram toxicity (eg, serotonin syndrome, QT prolongation)

• sufentanil SL

  sufentanil SL, citalopram. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

• sulindac

  citalopram, sulindac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• sunitinib

  sunitinib and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• tacrolimus

  tacrolimus and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• tapentadol

  citalopram and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely.

• tazemetostat

  tazemetostat will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• tecovirimat

  tecovirimat will increase the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Tecovirimat is a weak inhibitor of CYP2C8 and CYP2C19. Monitor for adverse effects if coadministered with sensitive substrates of these enzymes.
  
  tecovirimat will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.

• telavancin

  telavancin and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• terbinafine

  terbinafine will increase the level or effect of citalopram by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.

• thiothixene

  thiothixene and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• ticagrelor

  citalopram increases effects of ticagrelor by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• ticlopidine

  ticlopidine increases levels of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Citalopram 20 mg/day is the maximum recommended dose for patients taking CYP2C19 inhibitors because of the risk of QT prolongation.

• timolol

  citalopram increases levels of timolol by decreasing metabolism. Use Caution/Monitor.

• tipranavir

  tipranavir increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• tirofiban

  citalopram increases effects of tirofiban by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• tizanidine

  citalopram will increase the level or effect of tizanidine by Other (see comment). Use Caution/Monitor. Monitor for increased psychomotor impairment and adverse effects.

• tolmetin

  citalopram, tolmetin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• toremifene

  toremifene and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• torsemide

  torsemide, citalopram. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Possible additive hyponatremia.

• tramadol

  citalopram and tramadol both increase serotonin levels. Use Caution/Monitor. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• trazodone

  citalopram and trazodone both increase serotonin levels. Use Caution/Monitor. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• triclabendazole

  triclabendazole and citalopram both increase QTc interval. Use Caution/Monitor.
  
  triclabendazole will increase the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. If plasma concentrations of the CYP2C19 substrates are elevated during triclabendazole, recheck plasma concentration of the CYP2C19 substrates after discontinuation of triclabendazole.

• valbenazine

  valbenazine and citalopram both increase QTc interval. Use Caution/Monitor.

• valerian

  valerian and citalopram both increase sedation. Use Caution/Monitor.

• vandetanib

  vandetanib and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• vardenafil

  vardenafil and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• voclosporin

  voclosporin, citalopram. Either increases effects of the other by QTc interval. Use Caution/Monitor.

• vonoprazan

  vonoprazan will increase the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

• vorapaxar

  citalopram, vorapaxar. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive antiplatelet effect may occur; SSRIs and SNRIs may cause platelet serotonin depletion .

• voriconazole

  voriconazole increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• vorinostat

  vorinostat and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• warfarin

  citalopram, warfarin. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Serotonin release by platelets plays an important role in hemostasis. SSRIs and SNRIs may increase anticoagulation effect of warfarin. .

• zanubrutinib

  citalopram, zanubrutinib. Either increases effects of the other by anticoagulation. Modify Therapy/Monitor Closely. Zanubrutinib-induced cytopenias increases risk of hemorrhage. Coadministration of zanubritinib with antiplatelets or anticoagulants may further increase this risk.

Minor (4)

• acetazolamide

  acetazolamide will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• anastrozole

  anastrozole will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• cyclophosphamide

  cyclophosphamide will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• larotrectinib

  larotrectinib will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• 5-HTP

  Monitor Closely (1)citalopram and 5-HTP both increase serotonin levels. Use Caution/Monitor. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• abciximab

  Monitor Closely (1)citalopram increases effects of abciximab by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• abiraterone

  Monitor Closely (1)abiraterone increases levels of citalopram by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Avoid coadministration of abiraterone with substrates of CYP2D6. If alternative therapy cannot be used, exercise caution and consider a dose reduction of the CYP2D6 substrate.

• acetazolamide

  Minor (1)acetazolamide will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• activated charcoal

  Monitor Closely (1)activated charcoal decreases effects of citalopram by pharmacodynamic antagonism. Use Caution/Monitor. Charcoal can reduce absorption of citalopram, resulting in decreased efficacy.

• adagrasib

  Serious - Use Alternative (1)adagrasib, citalopram. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Each drug prolongs the QTc interval, which may increased the risk of Torsade de pointes, other serious arryhthmias, and sudden death. If coadministration unavoidable, more frequent monitoring is recommended for such patients.

• albuterol

  Monitor Closely (1)albuterol and citalopram both increase QTc interval. Use Caution/Monitor.

• alfentanil

  Serious - Use Alternative (1)alfentanil, citalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• alfuzosin

  Monitor Closely (1)citalopram and alfuzosin both increase QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)alfuzosin and citalopram both increase QTc interval. Avoid or Use Alternate Drug.

• almotriptan

  Serious - Use Alternative (1)citalopram, almotriptan. Mechanism: unknown. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome. If concomitant treatment with citalopram and a triptan is clinically warranted, careful observation of the patient is advised, particularly during treatment initiation and dose increases.

• amifampridine

  Monitor Closely (1)citalopram increases toxicity of amifampridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Amifampridine can cause seizures. Coadministration with drugs that lower seizure threshold may increase this risk.

• amiodarone

  Monitor Closely (1)amiodarone and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• amisulpride

  Serious - Use Alternative (1)citalopram and amisulpride both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.

• amitriptyline

  Serious - Use Alternative (2)citalopram and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug. Citalopram may increase TCA levels. Increased risk of serotonin syndrome or neuroleptic malignant syndrome. Potential risk for QT prolongation. ECG monitoring is recommended.
  
  citalopram and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.

• amobarbital

  Monitor Closely (1)amobarbital will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• amoxapine

  Monitor Closely (1)citalopram and amoxapine both increase QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)citalopram and amoxapine both increase serotonin levels. Avoid or Use Alternate Drug. Citalopram may increase TCA levels. Increased risk of serotonin syndrome or neuroleptic malignant syndrome. Potential risk for QT prolongation. ECG monitoring is recommended.

• anagrelide

  Monitor Closely (1)citalopram increases effects of anagrelide by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.Serious - Use Alternative (1)citalopram and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.

• anastrozole

  Minor (1)anastrozole will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• antithrombin III

  Monitor Closely (1)citalopram increases effects of antithrombin III by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• apalutamide

  Serious - Use Alternative (2)apalutamide will decrease the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP2C19 inducer, with drugs that are CYP2C19 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered.
  
  apalutamide will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.

• apixaban

  Monitor Closely (1)citalopram increases effects of apixaban by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

• apomorphine

  Monitor Closely (1)apomorphine and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• arformoterol

  Monitor Closely (1)arformoterol and citalopram both increase QTc interval. Use Caution/Monitor.

• argatroban

  Monitor Closely (1)citalopram increases effects of argatroban by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• aripiprazole

  Serious - Use Alternative (1)aripiprazole and citalopram both increase QTc interval. Avoid or Use Alternate Drug.

• arsenic trioxide

  Monitor Closely (1)arsenic trioxide and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• artemether

  Serious - Use Alternative (1)artemether and citalopram both increase QTc interval. Avoid or Use Alternate Drug.

• artemether/lumefantrine

  Monitor Closely (1)artemether/lumefantrine and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• asenapine

  Monitor Closely (1)asenapine and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• asenapine transdermal

  Monitor Closely (1)asenapine transdermal and citalopram both increase QTc interval. Use Caution/Monitor.

• aspirin

  Monitor Closely (1)citalopram, aspirin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• aspirin rectal

  Monitor Closely (1)citalopram, aspirin rectal. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• aspirin/citric acid/sodium bicarbonate

  Monitor Closely (1)citalopram, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• atazanavir

  Monitor Closely (1)atazanavir increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• atomoxetine

  Monitor Closely (2)citalopram increases levels of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Although citalopram is a weak inhibitor of 2D6, the potential for an interaction exists.
  
  atomoxetine and citalopram both increase QTc interval. Use Caution/Monitor.

• azithromycin

  Monitor Closely (1)azithromycin and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• bedaquiline

  Monitor Closely (1)citalopram and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely

• belzutifan

  Monitor Closely (1)belzutifan will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information.

• benzhydrocodone/acetaminophen

  Monitor Closely (1)benzhydrocodone/acetaminophen, citalopram. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

• betrixaban

  Monitor Closely (1)citalopram, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

• bivalirudin

  Monitor Closely (1)citalopram increases effects of bivalirudin by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• bosentan

  Monitor Closely (1)bosentan will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• bumetanide

  Monitor Closely (1)bumetanide, citalopram. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Possible additive hyponatremia.

• buprenorphine

  Serious - Use Alternative (1)citalopram and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine buccal

  Serious - Use Alternative (1)buprenorphine buccal and citalopram both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine subdermal implant

  Monitor Closely (1)citalopram, buprenorphine subdermal implant. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.Serious - Use Alternative (1)buprenorphine subdermal implant and citalopram both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine transdermal

  Serious - Use Alternative (1)buprenorphine transdermal and citalopram both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine, long-acting injection

  Monitor Closely (1)citalopram, buprenorphine, long-acting injection. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.Serious - Use Alternative (1)buprenorphine, long-acting injection and citalopram both increase QTc interval. Avoid or Use Alternate Drug.

• bupropion

  Monitor Closely (1)bupropion will increase the level or effect of citalopram by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• buspirone

  Serious - Use Alternative (1)citalopram and buspirone both increase serotonin levels. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• cannabidiol

  Monitor Closely (1)cannabidiol will increase the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider reducing the dose of sensitive CYP2C19 substrates, as clinically appropriate, when coadministered with cannabidiol.

• carbamazepine

  Monitor Closely (1)carbamazepine decreases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. The possibility that carbamazepine might increase the clearance of citalopram should be considered when both drugs are coadministered.

• carvedilol

  Monitor Closely (1)citalopram increases levels of carvedilol by decreasing metabolism. Use Caution/Monitor.

• celecoxib

  Monitor Closely (1)citalopram, celecoxib. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• cenobamate

  Monitor Closely (3)cenobamate, citalopram. Either increases effects of the other by sedation. Use Caution/Monitor.
  
  cenobamate will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.
  
  cenobamate will decrease the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.

• ceritinib

  Serious - Use Alternative (2)ceritinib and citalopram both increase QTc interval. Avoid or Use Alternate Drug.
  
  ceritinib will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• chloramphenicol

  Monitor Closely (1)chloramphenicol will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

• chloroquine

  Monitor Closely (1)chloroquine increases toxicity of citalopram by QTc interval. Use Caution/Monitor.

• chlorothiazide

  Monitor Closely (1)chlorothiazide, citalopram. pharmacodynamic synergism. Use Caution/Monitor. Possible additive hyponatremia.

• chlorpromazine

  Monitor Closely (1)chlorpromazine and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• choline magnesium trisalicylate

  Monitor Closely (1)citalopram, choline magnesium trisalicylate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of GI adverse effects may be increased. If possible, avoid concurrent use.

• cilostazol

  Monitor Closely (1)citalopram increases effects of cilostazol by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• cimetidine

  Monitor Closely (1)cimetidine increases levels of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Citalopram 20 mg/day is the maximum recommended dose for patients taking CYP2C19 inhibitors because of the risk of QT prolongation.

• ciprofloxacin

  Monitor Closely (1)ciprofloxacin and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• cisapride

  Serious - Use Alternative (1)citalopram and cisapride both increase QTc interval. Avoid or Use Alternate Drug.

• clarithromycin

  Serious - Use Alternative (1)clarithromycin, citalopram. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. To monitor for the prolongation of QT/QTc and/or development of ventricular tachyarrhythmias the labeling recommends monitoring QT interval or ECG.

• clofazimine

  Monitor Closely (1)citalopram and clofazimine both increase QTc interval. Use Caution/Monitor.

• clomipramine

  Serious - Use Alternative (2)citalopram and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug. Citalopram may increase TCA levels. Increased risk of serotonin syndrome or neuroleptic malignant syndrome. Potential risk for QT prolongation. ECG monitoring is recommended.
  
  citalopram and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.

• clonidine

  Monitor Closely (1)clonidine, citalopram. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration enhances CNS depressant effects.

• clopidogrel

  Monitor Closely (1)citalopram increases effects of clopidogrel by pharmacodynamic synergism. Use Caution/Monitor. SSRIs affect platelet activation; coadministration of SSRIs with clopidogrel may increase the risk of bleeding.

• clozapine

  Monitor Closely (1)citalopram increases effects of clozapine by pharmacodynamic synergism. Use Caution/Monitor. Increased risk for serotonin syndrome.Serious - Use Alternative (1)citalopram and clozapine both increase QTc interval. Avoid or Use Alternate Drug.

• cobicistat

  Monitor Closely (2)cobicistat will increase the level or effect of citalopram by Other (see comment). Use Caution/Monitor. Carefully titrate dose of the antidepressant to the desired effect, including using the lowest feasible initial or maintenance dose, and monitor its response during coadministration with SSRIs and cobicistat.
  
  cobicistat will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• cocaine topical

  Serious - Use Alternative (1)citalopram and cocaine topical both increase serotonin levels. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• conivaptan

  Monitor Closely (1)conivaptan increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• crizotinib

  Monitor Closely (1)crizotinib increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Dose reduction may be needed for coadministered drugs that are predominantly metabolized by CYP3A. ECG monitoring is recommended, along with drugs that may prolong the QT interval.Serious - Use Alternative (1)citalopram and crizotinib both increase QTc interval. Avoid or Use Alternate Drug.

• crofelemer

  Monitor Closely (1)crofelemer increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed.

• cyclobenzaprine

  Monitor Closely (1)cyclobenzaprine and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.Serious - Use Alternative (1)citalopram and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

• cyclophosphamide

  Minor (1)cyclophosphamide will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• cyproheptadine

  Monitor Closely (1)cyproheptadine decreases effects of citalopram by pharmacodynamic antagonism. Use Caution/Monitor. Cyproheptadine may diminish the serotonergic effect of SSRIs.

• dabigatran

  Monitor Closely (1)citalopram increases effects of dabigatran by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• dabrafenib

  Monitor Closely (1)dabrafenib will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

• dacomitinib

  Serious - Use Alternative (1)dacomitinib will increase the level or effect of citalopram by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid use with CYP2D6 substrates where minimal increases in concentration of the CYP2D6 substrate may lead to serious or life-threatening toxicities.

• dalteparin

  Monitor Closely (1)citalopram increases effects of dalteparin by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• daridorexant

  Monitor Closely (1)citalopram and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• darunavir

  Monitor Closely (1)darunavir will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration with SSRIs, TCAs, or trazodone may require dose titration of antidepressant to desired effect (eg, using the lowest feasible initial or maintenance dose). Monitor for antidepressant response.

• dasatinib

  Monitor Closely (1)citalopram and dasatinib both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• defibrotide

  Monitor Closely (1)defibrotide increases effects of citalopram by Other (see comment). Use Caution/Monitor. Comment: Defibrotide may enhance effects of platelet inhibitors.

• degarelix

  Monitor Closely (1)degarelix and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• desflurane

  Serious - Use Alternative (1)desflurane and citalopram both increase QTc interval. Avoid or Use Alternate Drug.

• desipramine

  Serious - Use Alternative (2)citalopram and desipramine both increase serotonin levels. Avoid or Use Alternate Drug. Citalopram may increase TCA levels. Increased risk of serotonin syndrome or neuroleptic malignant syndrome. Potential risk for QT prolongation. ECG monitoring is recommended.
  
  desipramine and citalopram both increase QTc interval. Avoid or Use Alternate Drug.

• desvenlafaxine

  Serious - Use Alternative (1)citalopram and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.

• deutetrabenazine

  Monitor Closely (1)citalopram and deutetrabenazine both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).

• dexmethylphenidate

  Monitor Closely (1)dexmethylphenidate increases effects of citalopram by decreasing metabolism. Use Caution/Monitor. Potential risk for serotonin syndrome or neuroleptic malignant syndrome-like reactions, caution should be observed during coadministration.

• dextroamphetamine

  Monitor Closely (1)citalopram and dextroamphetamine both increase serotonin levels. Use Caution/Monitor. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• dextroamphetamine transdermal

  Monitor Closely (1)citalopram, dextroamphetamine transdermal. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and concomitant serotonergic drug(s).

• dextromethorphan

  Serious - Use Alternative (1)citalopram and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• diazepam intranasal

  Monitor Closely (1)diazepam intranasal, citalopram. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.

• dichlorphenamide

  Monitor Closely (1)dichlorphenamide and citalopram both decrease serum potassium. Use Caution/Monitor.

• diclofenac

  Monitor Closely (1)citalopram, diclofenac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• difelikefalin

  Monitor Closely (1)difelikefalin and citalopram both increase sedation. Use Caution/Monitor.

• diflunisal

  Monitor Closely (1)citalopram, diflunisal. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• dihydroergotamine

  Monitor Closely (1)citalopram and dihydroergotamine both increase serotonin levels. Use Caution/Monitor. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• dihydroergotamine intranasal

  Monitor Closely (1)citalopram and dihydroergotamine intranasal both increase serotonin levels. Use Caution/Monitor. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• dipyridamole

  Monitor Closely (1)citalopram increases effects of dipyridamole by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• disopyramide

  Monitor Closely (1)disopyramide and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• dofetilide

  Monitor Closely (1)dofetilide and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• dolasetron

  Monitor Closely (1)dolasetron and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.Serious - Use Alternative (1)dolasetron, citalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• donepezil

  Serious - Use Alternative (1)donepezil and citalopram both increase QTc interval. Avoid or Use Alternate Drug.

• doxepin

  Serious - Use Alternative (2)citalopram and doxepin both increase serotonin levels. Avoid or Use Alternate Drug. Citalopram may increase TCA levels. Increased risk of serotonin syndrome or neuroleptic malignant syndrome. Potential risk for QT prolongation. ECG monitoring is recommended.
  
  doxepin and citalopram both increase QTc interval. Avoid or Use Alternate Drug.

• dronedarone

  Contraindicated (1)dronedarone and citalopram both increase QTc interval. Contraindicated. Concurrent use of dronedarone with other agents that can prolong QT interval is contraindicated.

• droperidol

  Monitor Closely (1)droperidol and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• duloxetine

  Serious - Use Alternative (1)citalopram and duloxetine both increase serotonin levels. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• duvelisib

  Monitor Closely (1)duvelisib will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. will increase the level or effect of

• efavirenz

  Serious - Use Alternative (2)efavirenz will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  efavirenz and citalopram both increase QTc interval. Avoid or Use Alternate Drug.

• elagolix

  Monitor Closely (2)elagolix will increase the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak CYP2C19 inhibitor. Caution with sensitive CYP2C19 substrates.
  
  elagolix will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.

• eletriptan

  Serious - Use Alternative (1)citalopram, eletriptan. Mechanism: unknown. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome. If concomitant treatment with citalopram and a triptan is clinically warranted, careful observation of the patient is advised, particularly during treatment initiation and dose increases.

• eliglustat

  Monitor Closely (1)eliglustat increases levels of citalopram by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the concomitant drug and titrate to clinical effect.Serious - Use Alternative (1)citalopram and eliglustat both increase QTc interval. Avoid or Use Alternate Drug.

• elvitegravir/cobicistat/emtricitabine/tenofovir DF

  Monitor Closely (2)elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.
  
  elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of citalopram by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP2D6 inhibitor; caution with CYP2D6 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

• encorafenib

  Monitor Closely (1)encorafenib, citalopram. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.Serious - Use Alternative (1)encorafenib and citalopram both increase QTc interval. Avoid or Use Alternate Drug. Encorafenib is associated with dose-dependent QTc interval prolongation. Avoid with drugs known to prolong QT interval.

• enoxaparin

  Monitor Closely (1)citalopram increases effects of enoxaparin by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• entrectinib

  Serious - Use Alternative (1)citalopram and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.

• enzalutamide

  Monitor Closely (1)enzalutamide will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• eptifibatide

  Monitor Closely (1)citalopram increases effects of eptifibatide by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• ergotamine

  Monitor Closely (1)citalopram and ergotamine both increase serotonin levels. Use Caution/Monitor. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• eribulin

  Serious - Use Alternative (1)citalopram and eribulin both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin base

  Monitor Closely (1)erythromycin base increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.Serious - Use Alternative (1)citalopram and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin ethylsuccinate

  Monitor Closely (1)erythromycin ethylsuccinate increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.Serious - Use Alternative (1)citalopram and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin lactobionate

  Monitor Closely (1)erythromycin lactobionate increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.Serious - Use Alternative (1)citalopram and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin stearate

  Monitor Closely (1)erythromycin stearate increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.Serious - Use Alternative (1)citalopram and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug.

• escitalopram

  Serious - Use Alternative (1)citalopram and escitalopram both increase serotonin levels. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• eslicarbazepine acetate

  Monitor Closely (1)eslicarbazepine acetate will increase the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

• esomeprazole

  Monitor Closely (1)esomeprazole will increase the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Citalopram 20 mg/day is the maximum recommended dose for patients taking CYP2C19 inhibitors because of the risk of QT prolongation.

• ethacrynic acid

  Monitor Closely (1)ethacrynic acid, citalopram. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Possible additive hyponatremia.

• ethanol

  Monitor Closely (1)ethanol, citalopram. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive CNS depression.

• etodolac

  Monitor Closely (1)citalopram, etodolac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• etravirine

  Monitor Closely (1)etravirine will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• ezogabine

  Monitor Closely (1)ezogabine, citalopram. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.

• fedratinib

  Monitor Closely (2)fedratinib will increase the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2C19 substrates as necessary.
  
  fedratinib will increase the level or effect of citalopram by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2D6 substrates as necessary.

• fenfluramine

  Monitor Closely (1)fenfluramine, citalopram. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

• fenoprofen

  Monitor Closely (1)citalopram, fenoprofen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• fentanyl

  Serious - Use Alternative (1)fentanyl, citalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• fentanyl intranasal

  Serious - Use Alternative (1)fentanyl intranasal, citalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• fentanyl transdermal

  Serious - Use Alternative (1)fentanyl transdermal, citalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• fentanyl transmucosal

  Serious - Use Alternative (1)fentanyl transmucosal, citalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• fexinidazole

  Monitor Closely (1)fexinidazole will increase the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.Serious - Use Alternative (2)fexinidazole and citalopram both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.
  
  fexinidazole will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.

• fingolimod

  Serious - Use Alternative (1)fingolimod and citalopram both increase QTc interval. Avoid or Use Alternate Drug.

• fish oil triglycerides

  Monitor Closely (1)fish oil triglycerides will increase the level or effect of citalopram by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

• flecainide

  Monitor Closely (1)flecainide and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• fluconazole

  Contraindicated (1)citalopram and fluconazole both increase QTc interval. Contraindicated.Monitor Closely (1)fluconazole will increase the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Citalopram 20 mg/day is the maximum recommended dose for patients taking CYP2C19 inhibitors because of the risk of QT prolongation. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• fluoxetine

  Monitor Closely (1)citalopram and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)citalopram and fluoxetine both increase serotonin levels. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• fluphenazine

  Monitor Closely (1)citalopram and fluphenazine both increase QTc interval. Use Caution/Monitor.

• flurbiprofen

  Monitor Closely (1)citalopram, flurbiprofen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• fluvoxamine

  Monitor Closely (1)fluvoxamine will increase the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Citalopram 20 mg/day is maximum recommended dose for patients taking CYP2C19 inhibitors because of the risk of QT prolongationSerious - Use Alternative (1)fluvoxamine and citalopram both increase serotonin levels. Avoid or Use Alternate Drug. Combinatiomay increase risk of serotonin syndrome or neuroleptic malignant syndromn e like reactions.

• fondaparinux

  Monitor Closely (1)citalopram increases effects of fondaparinux by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• fosamprenavir

  Monitor Closely (1)fosamprenavir increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .

• foscarnet

  Monitor Closely (1)foscarnet and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• fosphenytoin

  Monitor Closely (1)fosphenytoin will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• frovatriptan

  Serious - Use Alternative (1)citalopram, frovatriptan. Mechanism: unknown. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome. If concomitant treatment with citalopram and a triptan is clinically warranted, careful observation of the patient is advised, particularly during treatment initiation and dose increases.

• furosemide

  Monitor Closely (1)furosemide, citalopram. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Possible additive hyponatremia.

• gabapentin

  Monitor Closely (1)gabapentin, citalopram. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• gabapentin enacarbil

  Monitor Closely (1)gabapentin enacarbil, citalopram. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• gadobenate

  Monitor Closely (1)citalopram and gadobenate both increase QTc interval. Use Caution/Monitor.

• ganaxolone

  Monitor Closely (1)citalopram and ganaxolone both increase sedation. Use Caution/Monitor.

• gemifloxacin

  Monitor Closely (1)gemifloxacin and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• gemtuzumab

  Monitor Closely (1)citalopram and gemtuzumab both increase QTc interval. Use Caution/Monitor.

• gepirone

  Monitor Closely (2)gepirone and citalopram both increase serotonin levels. Use Caution/Monitor. Monitor for symptoms of serotonin syndrome when gepirone is used gepirone with other drugs that may affect the serotonergic neurotransmitter systems. If serotonin syndrome occurs, consider discontinue gepirone and/or concomitant serotonergic drug.
  
  gepirone and citalopram both increase QTc interval. Modify Therapy/Monitor Closely.

• gilteritinib

  Serious - Use Alternative (2)gilteritinib will decrease the level or effect of citalopram by Other (see comment). Avoid or Use Alternate Drug. Coadministration of gilteritinib with drugs that inhibit 5HT2B or sigma nonspecific receptors. Avoid use of these drugs with gilteritinib unless coadministration is necessary.
  
  citalopram and gilteritinib both increase QTc interval. Avoid or Use Alternate Drug.

• givosiran

  Serious - Use Alternative (1)givosiran will increase the level or effect of citalopram by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2D6 substrates with givosiran. If unavoidable, decrease the CYP2D6 substrate dosage in accordance with approved product labeling.

• glasdegib

  Serious - Use Alternative (1)citalopram and glasdegib both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, monitor for increased risk of QTc interval prolongation.

• goserelin

  Contraindicated (1)goserelin increases toxicity of citalopram by QTc interval. Contraindicated. Increases risk of torsades de pointes.

• granisetron

  Serious - Use Alternative (2)granisetron, citalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
  
  citalopram and granisetron both increase QTc interval. Avoid or Use Alternate Drug.

• green tea

  Monitor Closely (1)green tea, citalopram. Other (see comment). Use Caution/Monitor. Comment: Combination may increase risk of bleeding.

• haloperidol

  Serious - Use Alternative (2)citalopram will increase the level or effect of haloperidol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Increased risk of serotonin syndrome or neuroleptic malignant syndrome. Potential risk for QT prolongation. ECG monitoring is recommended.
  
  citalopram and haloperidol both increase QTc interval. Avoid or Use Alternate Drug.

• heparin

  Monitor Closely (1)citalopram increases effects of heparin by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• histrelin

  Serious - Use Alternative (1)histrelin increases toxicity of citalopram by QTc interval. Avoid or Use Alternate Drug. Increases risk of torsades de pointes.

• hydrochlorothiazide

  Monitor Closely (1)hydrochlorothiazide, citalopram. pharmacodynamic synergism. Use Caution/Monitor. Possible additive hyponatremia.

• hydrocodone

  Monitor Closely (1)hydrocodone, citalopram. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

• hydromorphone

  Serious - Use Alternative (1)hydromorphone, citalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• hydroxychloroquine sulfate

  Serious - Use Alternative (1)hydroxychloroquine sulfate and citalopram both increase QTc interval. Avoid or Use Alternate Drug.

• hydroxyzine

  Serious - Use Alternative (1)hydroxyzine increases toxicity of citalopram by QTc interval. Avoid or Use Alternate Drug. Increases risk of torsades de pointes.

• ibrutinib

  Monitor Closely (1)ibrutinib will increase the level or effect of citalopram by anticoagulation. Use Caution/Monitor. Ibrutinib may increase the risk of hemorrhage in patients receiving antiplatelet or anticoagulant therapies and monitor for signs of bleeding.

• ibuprofen

  Monitor Closely (1)citalopram, ibuprofen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• ibuprofen IV

  Monitor Closely (1)citalopram, ibuprofen IV. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• ibutilide

  Monitor Closely (1)ibutilide and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• icosapent

  Monitor Closely (1)icosapent, citalopram. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Icosapent may prolong bleeding time. Periodically monitor if coadministered with other drugs that affect bleeding.

• idelalisib

  Serious - Use Alternative (1)idelalisib will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates

• iloperidone

  Monitor Closely (2)iloperidone and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.
  
  iloperidone increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4.

• imatinib

  Monitor Closely (1)imatinib increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• imipramine

  Serious - Use Alternative (1)citalopram and imipramine both increase serotonin levels. Avoid or Use Alternate Drug. Citalopram may increase TCA levels. Increased risk of serotonin syndrome or neuroleptic malignant syndrome. Potential risk for QT prolongation. ECG monitoring is recommended.

• indacaterol, inhaled

  Monitor Closely (1)indacaterol, inhaled, citalopram. QTc interval. Use Caution/Monitor. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.

• indapamide

  Monitor Closely (2)indapamide and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.
  
  indapamide, citalopram. pharmacodynamic synergism. Use Caution/Monitor. Possible additive hyponatremia.

• indinavir

  Monitor Closely (1)indinavir increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .

• indomethacin

  Monitor Closely (1)citalopram, indomethacin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• inotuzumab

  Serious - Use Alternative (1)inotuzumab and citalopram both increase QTc interval. Avoid or Use Alternate Drug. If unable to avoid concomitant use, obtain ECGs and electrolytes before and after initiation of any drug known to prolong QTc, and periodically monitor as clinically indicated during treatment.

• ioflupane I 123

  Monitor Closely (1)citalopram decreases effects of ioflupane I 123 by receptor binding competition. Use Caution/Monitor. Drugs that bind to dopamine transporter receptor with high affinity may interfere with the image following ioflupane I 123 administration.

• isocarboxazid

  Contraindicated (1)isocarboxazid and citalopram both increase serotonin levels. Contraindicated. At least 2 weeks should elapse between discontinuation of MAOI therapy and the start of citalopram therapy, and at least 2 weeks between discontinuation of citalopram therapy and commencement of MAOI therapy.

• isoflurane

  Serious - Use Alternative (1)citalopram and isoflurane both increase QTc interval. Avoid or Use Alternate Drug.

• isoniazid

  Monitor Closely (1)isoniazid will increase the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Citalopram 20 mg/day is the maximum recommended dose for patients taking CYP2C19 inhibitors because of the risk of QT prolongation.

• isradipine

  Monitor Closely (1)isradipine and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• istradefylline

  Monitor Closely (1)istradefylline will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.

• itraconazole

  Monitor Closely (1)itraconazole increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)citalopram and itraconazole both increase QTc interval. Avoid or Use Alternate Drug.

• ivosidenib

  Serious - Use Alternative (2)ivosidenib and citalopram both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.
  
  ivosidenib will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternate therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.

• ketoprofen

  Monitor Closely (1)citalopram, ketoprofen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• ketorolac

  Monitor Closely (1)citalopram, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• ketorolac intranasal

  Monitor Closely (1)citalopram, ketorolac intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• L-tryptophan

  Serious - Use Alternative (1)citalopram and L-tryptophan both increase serotonin levels. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• lamotrigine

  Monitor Closely (1)lamotrigine increases toxicity of citalopram by unspecified interaction mechanism. Modify Therapy/Monitor Closely. CNS depressants may increase the toxic effects of selective serotonin reuptake inhibitors; psychomotor impairment may be enhanced.

• lapatinib

  Monitor Closely (1)lapatinib and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• larotrectinib

  Minor (1)larotrectinib will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• lasmiditan

  Monitor Closely (2)lasmiditan, citalopram. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.
  
  citalopram increases effects of lasmiditan by serotonin levels. Use Caution/Monitor. Coadministration may increase risk of serotonin syndrome.

• lefamulin

  Serious - Use Alternative (1)citalopram and lefamulin both increase QTc interval. Avoid or Use Alternate Drug.

• lemborexant

  Monitor Closely (1)lemborexant, citalopram. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

• lenacapavir

  Monitor Closely (1)lenacapavir will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lencapavir (a moderate CYP3A4 inhibitor) may increase CYP3A4 substrates initiated within 9 months after last SC dose of lenacapavir, which may increase potential risk of adverse reactions of CYP3A4 substrates.

• lenvatinib

  Monitor Closely (1)citalopram and lenvatinib both increase QTc interval. Use Caution/Monitor. Lenvatinib prescribing information recommends monitoring ECG closely when coadministered with QT prolonging drugs.

• letermovir

  Monitor Closely (1)letermovir increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• leuprolide

  Contraindicated (1)leuprolide increases toxicity of citalopram by QTc interval. Contraindicated. Increases risk of torsades de pointes.

• levalbuterol

  Monitor Closely (1)citalopram and levalbuterol both increase QTc interval. Use Caution/Monitor.

• levofloxacin

  Monitor Closely (1)levofloxacin and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• levomilnacipran

  Serious - Use Alternative (1)citalopram and levomilnacipran both increase serotonin levels. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• linezolid

  Serious - Use Alternative (1)linezolid and citalopram both increase serotonin levels. Avoid or Use Alternate Drug. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first.

• lisdexamfetamine

  Monitor Closely (2)citalopram, lisdexamfetamine. Either increases effects of the other by unknown mechanism. Use Caution/Monitor. Risk of serotonin syndrome.
  
  citalopram, lisdexamfetamine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue along with concomitant serotonergic drug(s).

• lithium

  Monitor Closely (1)citalopram, lithium. Mechanism: unknown. Use Caution/Monitor. Lithium may enhance the serotonergic effects of citalopram, caution should be exercised when citalopram and lithium are coadministered.Serious - Use Alternative (1)citalopram and lithium both increase QTc interval. Avoid or Use Alternate Drug.

• lofexidine

  Monitor Closely (1)citalopram and lofexidine both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended.

• lonafarnib

  Serious - Use Alternative (2)lonafarnib will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration with sensitive CYP3A substrates. If coadministration unavoidable, monitor for adverse reactions and reduce CYP3A substrate dose in accordance with product labeling.
  
  lonafarnib will increase the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Lonafarnib may increase the AUC and peak concentration of CYP2C19 substrates. If coadministration unavoidable, monitor for adverse reactions and reduce the CYP2C19 substrate dose in accordance with its approved product labeling.

• loperamide

  Serious - Use Alternative (1)citalopram and loperamide both increase QTc interval. Avoid or Use Alternate Drug.

• lopinavir

  Monitor Closely (1)lopinavir increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. ECG monitoring is recommended, along with drugs that may prolong the QT interval.Serious - Use Alternative (1)citalopram and lopinavir both increase QTc interval. Avoid or Use Alternate Drug.

• lorcaserin

  Monitor Closely (1)lorcaserin will increase the level or effect of citalopram by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)citalopram and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• lorlatinib

  Monitor Closely (1)lorlatinib will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• lumacaftor/ivacaftor

  Monitor Closely (2)lumacaftor/ivacaftor will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. A higher dose of citalopram may be required to obtain desired therapeutic effect. Citalopram is a CYP3A and CYP2C19 substrate. Lumacaftor/ivacaftor is a strong inducer of CYP3A and has the potential to induce CYP2C19.
  
  lumacaftor/ivacaftor, citalopram. affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. In vitro studies suggest that lumacaftor may induce and ivacaftor may inhibit CYP2C19 substrates. .

• lumefantrine

  Monitor Closely (1)lumefantrine and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• lurasidone

  Monitor Closely (1)lurasidone, citalopram. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

• macimorelin

  Serious - Use Alternative (1)macimorelin and citalopram both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.

• maprotiline

  Monitor Closely (1)citalopram and maprotiline both increase serotonin levels. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.Serious - Use Alternative (1)citalopram and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

• mavacamten

  Monitor Closely (1)citalopram will increase the level or effect of mavacamten by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Inititiation of weak CYP2C19 inhibitors may require decreased mavacamten dose.

• meclofenamate

  Monitor Closely (1)citalopram, meclofenamate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• mefenamic acid

  Monitor Closely (1)citalopram, mefenamic acid. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• mefloquine

  Serious - Use Alternative (1)mefloquine and citalopram both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• meloxicam

  Monitor Closely (1)citalopram, meloxicam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• meperidine

  Monitor Closely (1)citalopram and meperidine both increase serotonin levels. Use Caution/Monitor. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.Serious - Use Alternative (1)meperidine, citalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• metformin

  Monitor Closely (1)citalopram increases effects of metformin by pharmacodynamic synergism. Use Caution/Monitor.

• methadone

  Monitor Closely (1)methadone and citalopram both increase QTc interval. Use Caution/Monitor. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome like reactions. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• methamphetamine

  Monitor Closely (1)methamphetamine, citalopram. Either increases effects of the other by unknown mechanism. Use Caution/Monitor. Risk of serotonin syndrome.

• methyclothiazide

  Monitor Closely (1)methyclothiazide, citalopram. pharmacodynamic synergism. Use Caution/Monitor. Possible additive hyponatremia.

• methylene blue

  Serious - Use Alternative (1)methylene blue and citalopram both increase serotonin levels. Avoid or Use Alternate Drug. Methylene blue may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first.

• methylphenidate transdermal

  Monitor Closely (1)methylphenidate transdermal will increase the level or effect of citalopram by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

• metoclopramide

  Serious - Use Alternative (1)metoclopramide and citalopram both increase serotonin levels. Avoid or Use Alternate Drug. Additive effects; increased risk for serotonin syndrome, neuroleptic malignant syndrome, dystonia, or other extrapyramidal reactions

• metoclopramide intranasal

  Serious - Use Alternative (1)citalopram, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

• metolazone

  Monitor Closely (1)metolazone, citalopram. pharmacodynamic synergism. Use Caution/Monitor. Possible additive hyponatremia.

• metoprolol

  Monitor Closely (1)citalopram increases levels of metoprolol by decreasing metabolism. Use Caution/Monitor. Increased metoprolol plasma levels have been associated with decreased cardioselectivity.

• midazolam intranasal

  Monitor Closely (1)midazolam intranasal, citalopram. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

• midostaurin

  Serious - Use Alternative (1)citalopram and midostaurin both increase QTc interval. Avoid or Use Alternate Drug.

• mifepristone

  Monitor Closely (2)mifepristone, citalopram. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
  
  mifepristone will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If concurrent therapy considered essential, ECG monitoring recommended

• milnacipran

  Serious - Use Alternative (1)citalopram and milnacipran both increase serotonin levels. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• mirabegron

  Monitor Closely (1)mirabegron will increase the level or effect of citalopram by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• mirtazapine

  Monitor Closely (1)citalopram and mirtazapine both increase serotonin levels. Use Caution/Monitor. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.Serious - Use Alternative (1)citalopram and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.

• mitotane

  Monitor Closely (1)mitotane decreases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.

• mobocertinib

  Serious - Use Alternative (1)mobocertinib and citalopram both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.

• modafinil

  Monitor Closely (1)modafinil will increase the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Citalopram 20 mg/day is the maximum recommended dose for patients taking CYP2C19 inhibitors because of the risk of QT prolongation.

• morphine

  Monitor Closely (1)citalopram and morphine both increase serotonin levels. Use Caution/Monitor. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.Serious - Use Alternative (1)morphine, citalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• moxifloxacin

  Monitor Closely (1)moxifloxacin and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• nabumetone

  Monitor Closely (1)citalopram, nabumetone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• nafcillin

  Monitor Closely (1)nafcillin will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• naproxen

  Monitor Closely (1)citalopram, naproxen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• naratriptan

  Serious - Use Alternative (1)citalopram, naratriptan. Mechanism: unknown. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome. If concomitant treatment with citalopram and a triptan is clinically warranted, careful observation of the patient is advised, particularly during treatment initiation and dose increases.

• nefazodone

  Monitor Closely (1)nefazodone increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.Serious - Use Alternative (1)citalopram and nefazodone both increase serotonin levels. Avoid or Use Alternate Drug.

• nelfinavir

  Monitor Closely (1)nelfinavir increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .

• netupitant/palonosetron

  Serious - Use Alternative (1)netupitant/palonosetron, citalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• nevirapine

  Monitor Closely (1)nevirapine will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• nicardipine

  Monitor Closely (1)nicardipine increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• nilotinib

  Monitor Closely (1)nilotinib and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• nortriptyline

  Serious - Use Alternative (2)citalopram and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug. Citalopram may increase TCA levels. Increased risk of serotonin syndrome or neuroleptic malignant syndrome. Potential risk for QT prolongation. ECG monitoring is recommended.
  
  citalopram and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.

• octreotide

  Monitor Closely (1)octreotide and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• ofloxacin

  Monitor Closely (1)ofloxacin and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• olanzapine

  Serious - Use Alternative (1)citalopram and olanzapine both increase QTc interval. Avoid or Use Alternate Drug. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval in rare instances

• oliceridine

  Monitor Closely (1)citalopram, oliceridine. Either increases toxicity of the other by serotonin levels. Modify Therapy/Monitor Closely.

• olodaterol inhaled

  Monitor Closely (1)citalopram and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. Drugs that prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias

• olopatadine intranasal

  Serious - Use Alternative (1)citalopram and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• omeprazole

  Monitor Closely (1)omeprazole will increase the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Citalopram 20 mg/day is the maximum recommended dose for patients taking CYP2C19 inhibitors because of the risk of QT prolongation.

• ondansetron

  Serious - Use Alternative (2)citalopram and ondansetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.
  
  ondansetron, citalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• osilodrostat

  Monitor Closely (1)osilodrostat and citalopram both increase QTc interval. Use Caution/Monitor.

• osimertinib

  Monitor Closely (1)osimertinib and citalopram both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.

• oxaliplatin

  Monitor Closely (1)oxaliplatin will increase the level or effect of citalopram by Other (see comment). Use Caution/Monitor. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval.Serious - Use Alternative (1)citalopram and oxaliplatin both increase QTc interval. Avoid or Use Alternate Drug.

• oxaprozin

  Monitor Closely (1)citalopram, oxaprozin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• oxycodone

  Monitor Closely (1)oxycodone increases effects of citalopram by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Opioids may enhance the serotonergic effects of SSRIs and increase risk for serotonergic syndrome.

• ozanimod

  Monitor Closely (1)ozanimod and citalopram both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.Serious - Use Alternative (1)ozanimod increases toxicity of citalopram by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.

• paliperidone

  Monitor Closely (1)paliperidone and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• palonosetron

  Serious - Use Alternative (1)palonosetron, citalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• panobinostat

  Serious - Use Alternative (1)citalopram and panobinostat both increase QTc interval. Avoid or Use Alternate Drug. Panobinostat is known to significantly prolong QT interval. Panobinostat prescribing information states use with drugs known to prolong QTc is not recommended.

• paroxetine

  Serious - Use Alternative (1)citalopram and paroxetine both increase serotonin levels. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• pasireotide

  Monitor Closely (1)citalopram and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.

• pazopanib

  Monitor Closely (1)pazopanib and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• pentamidine

  Monitor Closely (1)pentamidine and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• pentazocine

  Monitor Closely (1)citalopram and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

• perphenazine

  Monitor Closely (1)citalopram and perphenazine both increase QTc interval. Use Caution/Monitor.

• phenelzine

  Contraindicated (1)phenelzine and citalopram both increase serotonin levels. Contraindicated. At least 2 weeks should elapse between discontinuation of MAOI therapy and the start of citalopram therapy, and at least 2 weeks between discontinuation of citalopram therapy and commencement of MAOI therapy.

• phenobarbital

  Monitor Closely (1)phenobarbital will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• phentermine

  Serious - Use Alternative (1)citalopram, phentermine. Either increases toxicity of the other by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of serotonin syndrome.

• phenytoin

  Monitor Closely (1)phenytoin will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• pimavanserin

  Serious - Use Alternative (1)citalopram and pimavanserin both increase QTc interval. Avoid or Use Alternate Drug. Coadministration may increase the risk of QT prolongation and cardiac arrhythmia.

• pimozide

  Contraindicated (1)citalopram and pimozide both increase QTc interval. Contraindicated.

• piroxicam

  Monitor Closely (1)citalopram, piroxicam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• pitolisant

  Serious - Use Alternative (1)citalopram and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.

• ponesimod

  Serious - Use Alternative (1)citalopram and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• posaconazole

  Monitor Closely (1)posaconazole will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome like reactions. ECG monitoring is recommended, along with drugs that may prolong the QT interval.Serious - Use Alternative (1)citalopram and posaconazole both increase QTc interval. Contraindicated.

• prasugrel

  Monitor Closely (1)citalopram increases effects of prasugrel by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• pregabalin

  Monitor Closely (1)pregabalin, citalopram. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• primaquine

  Serious - Use Alternative (1)citalopram and primaquine both increase QTc interval. Avoid or Use Alternate Drug.

• primidone

  Serious - Use Alternative (1)primidone will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• procainamide

  Monitor Closely (1)procainamide and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• procarbazine

  Contraindicated (1)procarbazine and citalopram both increase serotonin levels. Contraindicated. At least 2 weeks should elapse between discontinuation of MAOI therapy and the start of citalopram therapy, and at least 2 weeks between discontinuation of citalopram therapy and commencement of MAOI therapy.

• prochlorperazine

  Monitor Closely (1)citalopram and prochlorperazine both increase serotonin levels. Use Caution/Monitor. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• promethazine

  Monitor Closely (1)citalopram and promethazine both increase serotonin levels. Use Caution/Monitor. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• propafenone

  Monitor Closely (1)propafenone and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• propranolol

  Monitor Closely (1)citalopram increases levels of propranolol by decreasing metabolism. Use Caution/Monitor.

• protriptyline

  Serious - Use Alternative (2)citalopram and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug. Citalopram may increase TCA levels. Increased risk of serotonin syndrome or neuroleptic malignant syndrome. Potential risk for QT prolongation. ECG monitoring is recommended.
  
  citalopram and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.

• quetiapine

  Monitor Closely (1)quetiapine, citalopram. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT interval and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT. ECG monitoring is recommended.

• quinidine

  Monitor Closely (1)quinidine and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• quinine

  Monitor Closely (1)quinine and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• quizartinib

  Monitor Closely (1)quizartinib, citalopram. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

• ranolazine

  Monitor Closely (1)ranolazine and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• rasagiline

  Serious - Use Alternative (1)rasagiline and citalopram both increase serotonin levels. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• remifentanil

  Serious - Use Alternative (1)remifentanil, citalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• remimazolam

  Monitor Closely (1)remimazolam, citalopram. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

• ribociclib

  Serious - Use Alternative (2)ribociclib will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  ribociclib and citalopram both increase QTc interval. Avoid or Use Alternate Drug.

• rifabutin

  Monitor Closely (1)rifabutin will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rifampin

  Monitor Closely (2)rifampin will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  rifampin will decrease the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

• rifapentine

  Monitor Closely (1)rifapentine will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rilpivirine

  Monitor Closely (1)rilpivirine increases toxicity of citalopram by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsades de Pointes.

• risperidone

  Monitor Closely (1)citalopram will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.Serious - Use Alternative (1)citalopram and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

• ritonavir

  Monitor Closely (1)ritonavir increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased risk of serotonin syndrome. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• rivaroxaban

  Monitor Closely (1)citalopram increases effects of rivaroxaban by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• rizatriptan

  Serious - Use Alternative (1)citalopram, rizatriptan. Mechanism: unknown. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome. If concomitant treatment with citalopram and a triptan is clinically warranted, careful observation of the patient is advised, particularly during treatment initiation and dose increases.

• rolapitant

  Monitor Closely (1)rolapitant will increase the level or effect of citalopram by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Rolapitant may increase plasma concentrations of CYP2D6 substrates for at least 28 days following rolapitant administration.

• romidepsin

  Monitor Closely (1)romidepsin and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• rucaparib

  Monitor Closely (1)rucaparib will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• safinamide

  Monitor Closely (1)citalopram, safinamide. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Monitor patients for symptoms of serotonin syndrome if SSRIs are coadministered with safinamide.

• salicylates (non-asa)

  Monitor Closely (1)citalopram, salicylates (non-asa). Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• salmeterol

  Monitor Closely (1)citalopram and salmeterol both increase QTc interval. Use Caution/Monitor.

• salsalate

  Monitor Closely (1)citalopram, salsalate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• SAMe

  Monitor Closely (1)citalopram and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.

• saquinavir

  Monitor Closely (1)saquinavir and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.Serious - Use Alternative (1)saquinavir will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• secobarbital

  Monitor Closely (1)secobarbital will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• selegiline

  Contraindicated (1)selegiline and citalopram both increase serotonin levels. Contraindicated. At least 2 weeks should elapse between discontinuation of MAOI therapy and the start of citalopram therapy, and at least 2 weeks between discontinuation of citalopram therapy and commencement of MAOI therapy.

• selegiline transdermal

  Contraindicated (1)selegiline transdermal and citalopram both increase serotonin levels. Contraindicated. At least 2 weeks should elapse between discontinuation of MAOI therapy and the start of citalopram therapy, and at least 2 weeks between discontinuation of citalopram therapy and commencement of MAOI therapy.

• selinexor

  Serious - Use Alternative (1)selinexor, citalopram. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

• selpercatinib

  Monitor Closely (1)selpercatinib increases toxicity of citalopram by QTc interval. Use Caution/Monitor.

• serdexmethylphenidate/dexmethylphenidate

  Monitor Closely (1)serdexmethylphenidate/dexmethylphenidate increases effects of citalopram by decreasing metabolism. Use Caution/Monitor. Potential risk for serotonin syndrome or neuroleptic malignant syndrome-like reactions, caution should be observed during coadministration.

• sertraline

  Serious - Use Alternative (2)citalopram and sertraline both increase serotonin levels. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.
  
  citalopram and sertraline both increase QTc interval. Avoid or Use Alternate Drug.

• sevoflurane

  Serious - Use Alternative (1)citalopram and sevoflurane both increase QTc interval. Avoid or Use Alternate Drug.

• siponimod

  Serious - Use Alternative (1)citalopram and siponimod both increase QTc interval. Avoid or Use Alternate Drug.

• sodium sulfate/?magnesium sulfate/potassium chloride

  Monitor Closely (1)sodium sulfate/?magnesium sulfate/potassium chloride increases effects of citalopram by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using bowel preps together with drugs that lower the seizure threshold.

• sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol

  Monitor Closely (1)citalopram, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

• sodium sulfate/potassium sulfate/magnesium sulfate

  Monitor Closely (1)sodium sulfate/potassium sulfate/magnesium sulfate increases effects of citalopram by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using bowel preps together with drugs that lower the seizure threshold.

• solifenacin

  Serious - Use Alternative (1)citalopram and solifenacin both increase QTc interval. Avoid or Use Alternate Drug.

• sorafenib

  Monitor Closely (1)sorafenib and citalopram both increase QTc interval. Use Caution/Monitor.

• sotalol

  Monitor Closely (1)sotalol and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• sparsentan

  Monitor Closely (1)sparsentan will decrease the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Sparsentan (a CYP2C19 inducer) decreases exposure of CYP2C19 substrates and reduces efficacy related to these substrates.

• St John's Wort

  Serious - Use Alternative (1)citalopram and St John's Wort both increase serotonin levels. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• stiripentol

  Monitor Closely (2)stiripentol, citalopram. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.
  
  stiripentol will increase the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Citalopram dose is not to exceed 20 mg/day if used with a moderate CYP2C19 inhibitor. Monitor closely for evidence of citalopram toxicity (eg, serotonin syndrome, QT prolongation)

• sufentanil

  Serious - Use Alternative (1)sufentanil, citalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• sufentanil SL

  Monitor Closely (1)sufentanil SL, citalopram. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

• sulindac

  Monitor Closely (1)citalopram, sulindac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• sumatriptan

  Serious - Use Alternative (1)citalopram, sumatriptan. Mechanism: unknown. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome. If concomitant treatment with citalopram and a triptan is clinically warranted, careful observation of the patient is advised, particularly during treatment initiation and dose increases.

• sumatriptan intranasal

  Serious - Use Alternative (1)citalopram, sumatriptan intranasal. Mechanism: unknown. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome. If concomitant treatment with citalopram and a triptan is clinically warranted, careful observation of the patient is advised, particularly during treatment initiation and dose increases.

• sunitinib

  Monitor Closely (1)sunitinib and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• tacrolimus

  Monitor Closely (1)tacrolimus and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• tapentadol

  Monitor Closely (1)citalopram and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely.

• tazemetostat

  Monitor Closely (1)tazemetostat will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• tecovirimat

  Monitor Closely (2)tecovirimat will increase the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Tecovirimat is a weak inhibitor of CYP2C8 and CYP2C19. Monitor for adverse effects if coadministered with sensitive substrates of these enzymes.
  
  tecovirimat will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.

• tedizolid

  Serious - Use Alternative (1)tedizolid, citalopram. Either increases effects of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. both increase serotonin levels; increased risk of serotonin syndrome.

• telavancin

  Monitor Closely (1)telavancin and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• terbinafine

  Monitor Closely (1)terbinafine will increase the level or effect of citalopram by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.

• tetrabenazine

  Serious - Use Alternative (1)citalopram and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

• thioridazine

  Serious - Use Alternative (1)thioridazine and citalopram both increase QTc interval. Avoid or Use Alternate Drug. Thioridazine should be avoided in combination with drugs that are known to prolong QTc interval.

• thiothixene

  Monitor Closely (1)thiothixene and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• ticagrelor

  Monitor Closely (1)citalopram increases effects of ticagrelor by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• ticlopidine

  Monitor Closely (1)ticlopidine increases levels of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Citalopram 20 mg/day is the maximum recommended dose for patients taking CYP2C19 inhibitors because of the risk of QT prolongation.

• timolol

  Monitor Closely (1)citalopram increases levels of timolol by decreasing metabolism. Use Caution/Monitor.

• tipranavir

  Monitor Closely (1)tipranavir increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• tirofiban

  Monitor Closely (1)citalopram increases effects of tirofiban by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• tizanidine

  Monitor Closely (1)citalopram will increase the level or effect of tizanidine by Other (see comment). Use Caution/Monitor. Monitor for increased psychomotor impairment and adverse effects.

• tolmetin

  Monitor Closely (1)citalopram, tolmetin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• toremifene

  Monitor Closely (1)toremifene and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• torsemide

  Monitor Closely (1)torsemide, citalopram. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Possible additive hyponatremia.

• tramadol

  Monitor Closely (1)citalopram and tramadol both increase serotonin levels. Use Caution/Monitor. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• tranylcypromine

  Contraindicated (1)tranylcypromine and citalopram both increase serotonin levels. Contraindicated. At least 2 weeks should elapse between discontinuation of MAOI therapy and the start of citalopram therapy, and at least 2 weeks between discontinuation of citalopram therapy and commencement of MAOI therapy.

• trazodone

  Monitor Closely (1)citalopram and trazodone both increase serotonin levels. Use Caution/Monitor. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.Serious - Use Alternative (1)citalopram and trazodone both increase QTc interval. Avoid or Use Alternate Drug.

• triclabendazole

  Monitor Closely (2)triclabendazole and citalopram both increase QTc interval. Use Caution/Monitor.
  
  triclabendazole will increase the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. If plasma concentrations of the CYP2C19 substrates are elevated during triclabendazole, recheck plasma concentration of the CYP2C19 substrates after discontinuation of triclabendazole.

• trimipramine

  Serious - Use Alternative (2)citalopram and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug. Citalopram may increase TCA levels. Increased risk of serotonin syndrome or neuroleptic malignant syndrome. Potential risk for QT prolongation. ECG monitoring is recommended.
  
  citalopram and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.

• triptorelin

  Serious - Use Alternative (1)triptorelin increases toxicity of citalopram by QTc interval. Avoid or Use Alternate Drug. Increases risk of torsades de pointes.

• tucatinib

  Serious - Use Alternative (1)tucatinib will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.

• umeclidinium bromide/vilanterol inhaled

  Serious - Use Alternative (1)citalopram increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• valbenazine

  Monitor Closely (1)valbenazine and citalopram both increase QTc interval. Use Caution/Monitor.

• valerian

  Monitor Closely (1)valerian and citalopram both increase sedation. Use Caution/Monitor.

• vandetanib

  Monitor Closely (1)vandetanib and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.Serious - Use Alternative (1)citalopram, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.

• vardenafil

  Monitor Closely (1)vardenafil and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• vemurafenib

  Serious - Use Alternative (1)vemurafenib and citalopram both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.

• venlafaxine

  Serious - Use Alternative (1)citalopram and venlafaxine both increase serotonin levels. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• vilanterol/fluticasone furoate inhaled

  Serious - Use Alternative (1)citalopram increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• vilazodone

  Serious - Use Alternative (1)citalopram, vilazodone. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• voclosporin

  Monitor Closely (1)voclosporin, citalopram. Either increases effects of the other by QTc interval. Use Caution/Monitor.

• vonoprazan

  Monitor Closely (1)vonoprazan will increase the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

• vorapaxar

  Monitor Closely (1)citalopram, vorapaxar. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive antiplatelet effect may occur; SSRIs and SNRIs may cause platelet serotonin depletion .

• voriconazole

  Monitor Closely (1)voriconazole increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.Serious - Use Alternative (1)citalopram and voriconazole both increase QTc interval. Avoid or Use Alternate Drug.

• vorinostat

  Monitor Closely (1)vorinostat and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.Serious - Use Alternative (1)citalopram and vorinostat both increase QTc interval. Avoid or Use Alternate Drug.

• vortioxetine

  Serious - Use Alternative (1)citalopram, vortioxetine. Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug.

• voxelotor

  Serious - Use Alternative (1)voxelotor will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.

• warfarin

  Monitor Closely (1)citalopram, warfarin. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Serotonin release by platelets plays an important role in hemostasis. SSRIs and SNRIs may increase anticoagulation effect of warfarin. .

• zanubrutinib

  Monitor Closely (1)citalopram, zanubrutinib. Either increases effects of the other by anticoagulation. Modify Therapy/Monitor Closely. Zanubrutinib-induced cytopenias increases risk of hemorrhage. Coadministration of zanubritinib with antiplatelets or anticoagulants may further increase this risk.

• ziprasidone

  Contraindicated (1)ziprasidone and citalopram both increase QTc interval. Contraindicated.Serious - Use Alternative (1)citalopram and ziprasidone both increase QTc interval. Contraindicated.

• zolmitriptan

  Serious - Use Alternative (1)citalopram, zolmitriptan. Mechanism: unknown. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome. If concomitant treatment with citalopram and a triptan is clinically warranted, careful observation of the patient is advised, particularly during treatment initiation and dose increases.