Does Citalopram Interact With Mirtazapine? (3+ Tips)

By Ivan Kahwa

Page last updated: 02/01/2024 | Next review date: 02/01/2026

Author bio

Mr Ivan Kahwa is a chemist and phytopharmaceutical scientist with expertise in chemistry, pharmacology, phytochemistry, and Nanobiotechnology. He writes and reviews content on these topics.

Mr Ivan Kahwa’s Highlights:

Guest Researcher at the University of Leipzig, Senior Research Fellow/Scientist, and Lecturer at the Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology.

Professional Experience:

Mr Ivan joined PHARMBIOTRAC as a research fellow/scientist during his master of science tenure. He contributed to the development of most of the phytopharmaceutical products in the project. Furthermore, he participated in carrying out the pharmacological activities of the developed products in laboratory animals such as mice and rats in order to develop proper doses hence leading to pre-clinical studies.

With the above relevant research experience, Ivan started to work with the University of Leipzig on collaborative projects with Mbarara University to develop the chemistry of Ugandan Medicinal plants and their pharmacological activities. This was coupled with several consultative positions by different German NGOs. Mr. Kahwa is also a supporting in the teaching and learning at the Departments of Pharmacy and Pharmaceutical Sciences, Faculty of Medicine, Mbarara University of Science and Technology.

With the increase in antimicrobial resistance globally, Ivan retooled his thinking towards developing new naturally derived antibiotic regimens from Ugandan propolis with the assistance of nanotechnology to improve their delivery to microbial cells. Kahwa has also published over 28 articles in peer-reviewed journals and he is currently reviewing for many journals.

Education:

2023-2027: PhD in Pharmaceutical Sciences (ongoing) with a focus on Pharmaceutical Microbiology and Nanobiology at Mbarara University of Science and Technology.

2022: 2Msc. in Pharmacognosy and Natural Medicine Science at Mbarara University of Science and Technology.

2018: Bachelor of Science (Chemistry) at Mbarara University of Science and Technology.

Publications:

▪ Iqbal, S., Jabeen, F., Kahwa, I., & Omara, T. 2023. Suberosin Alleviates Thiazolidinedione-Induced Cardiomyopathy in Diabetic Rats by Inhibiting Ferroptosis via Modulation of ACSL4-LPCAT3 and PI3K-AKT Signaling Pathways. Cardiovascular Toxicology. https://doi.org/10.1007/s12012-023-09804-7

▪ Gupta, A. K., Yadav, R., Sharma, S., Sawale, J., & Kahwa, I. 2023. Anti-ageing Activity and Antioxidant Activity of Methanol Extracts of Leaves and Flowers of Salvia officinalis and Rosmarinus officinalis. Journal of Young Pharmacists, 15(3), 448–455. https://doi.org/10.5530/jyp.2023.15.60

▪ Tolo, C.U., Kahwa, I., Nuwagira, U., Weisheit, A. and Ikiriza, H., 2023. Medicinal plants used in treatment of various diseases in the Rwenzori Region, Western Uganda. Ethnobotany Research and Applications, 25, pp.1-16.

https://ethnobotanyjournal.org/index.php/era/article/view/4683

▪ Kahwa, I., Ajayi, C.O., Yadav, R., Chauhan, N.S., Shah, K., Abdelgadir, A.A., Shegena, E.A., Daniel, S., Omara, T., Asiimwe, J.B. and Ikiriza, H., 2023. Pharmacognostic and phytochemical studies as an invaluable approach for correct identification of medicinal plants: The case of Artemisia vulgaris L. substituted for Artemisia annua L. in Western Uganda. TMR Integr Med, 7, p.e23004.

https://doi.org/10.53388/TMRIM202307004

▪ Nalimu, F., Oloro, J., Kahwa, I. and Ogwang, P.E., 2021. Review on the phytochemistry and toxicological profiles of Aloe vera and Aloe ferox. Future Journal of Pharmaceutical Sciences, 7, pp.1-21.

https://doi.org/10.1186/s43094-021-00296-2

▪ Elamin, O.H.S., Ali, M.A., Elgezuli, I.A.A., Bashir, M.A. and Kahwa, I., 2021. Diagnosis of pre-and post-treatment of echinococcus granulosus with counter current immune electrophoresis and bacterial co-agglutination. Journal of Microbiology and Infectious Diseases, 11(02), pp.88-94.

https://doi.org/10.5799/jmid.951600

Published book Chapter

▪ Kahwa, I., Ayesiga, I., Nakalema, S., Alinaiswe, R., Mbabazi, R. and Iqbal, S., 2023. Natural products in the management of onchocerciasis. In Natural Products in Vector-Borne Disease Management (pp. 63-80). Academic Press. Book Chapter.

https://doi.org/10.1016/B978-0-323-91942-5.00012-4

Submitted manuscripts Under Review:

▪ Comparison of the Wound Healing Activity of the Leaf and Leaf Ash Extracts of Vernonia amygdalina in Rats. Journal name: Clinical Phytoscience

▪ Ethnobotanical Survey of Medicinal plants used in the management of cancer in Uganda. Journal name: Journal of Herbal Medicine

▪ Ethnobotanical survey and phytochemical screening of medicinal plants used in treatment of epilepsy by PROMETRA-Uganda Traditional Health Practitioners in Mpigi District, Uganda. Journal name: Journal of Ethnopharmacology

Submitted book chapters under review

1.Book title: Algae as a Natural Solution for Water-Food-Energy Nexus, Section 4: Microalgae and cyanobacteria for food applications, Chapter 4.6: Safety, toxicological and allergenic aspects of using algae for food. Authors: Christine Kyarimpa, Tom Omute, Caroline K. Nakiguli, Alice V. Khanakwa4, Christopher Angiro, Ivan Kahwa, Fortunate Ahumuza, Timothy Omara*. Publisher: Springer Nature Singapore Pte Ltd. 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore.

2.Book title: Nutraceuticals Inspiring the Contemporary Therapy for Lifestyle Diseases. Chapter: Nutraceutical applications of Seaweeds and their Phytocompounds in Nutrition and Treatment of Diseases. Authors: Ivan Kahwa, Timothy Omara , Innocent Ayesiga , Gael Noel Neh Neba Ambe , Zehbanaz Javidbhai Panwala , Rachel Mbabazi , Shabnoor Iqbal , Christine Kyarimpa , Christine Betty Nagawa , Kamal Shah ,Nagendra Singh Chauhan* Publisher: CRC Press

You can view my works on the following professional sites:

Research Gate: https://www.researchgate.net/profile/Ivan-Kahwa

Google Scholar: https://scholar.google.com/citations?user=tOwrvqoAAAAJ&hl=en

ORCID: https://orcid.org/0000-0002-6440-3437

Linkedin: https://de.linkedin.com/in/ivan-kahwa-865450159

Ivan Kahwa

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In this article, we are going to discuss whether there are drug interactions between citalopram and mirtazapine or not, what does research suggest, side effects that can occur while taking both medications together, and what is the replacement drug for citalopram if you are taking mirtazapine.

Does citalopram interact with mirtazapine?

Yes, citalopram can interact with mirtazapine. Although the interaction between citalopram and mirtazapine is rare, if it happens, it can increase the risk of serotonin syndrome.

Serotonin syndrome is a life-threatening condition that happens due to the accumulation of serotonin in the body which can lead to body toxicity.

What does research suggest?

Research was conducted on the co-administration of citalopram (Selective Serotonin Reuptake Inhibitor) and Mirtazapine (Tetra-cyclic antidepressant) in the treatment of patients suffering from resistant depression. Mirtazapine is a good antidepressant but can cause side effects especially when paired with other antidepressants such as citalopram.

The patients were grouped into 2 groups, some of them received an SSRI alone, and the other group received an SSRI in combination with mirtazapine for the treatment of resistant Depression. (1)

The results showed that there was little difference in symptomatic improvement in the patients who were treated with the two antidepressants ( SSRI and Mirtazapine) compared to the patients who received an SSRI alone.

The trial showed that the results were difficult to interpret as there was little improvement in the treatment of resistant depression in patients taking citalopram with mirtazapine compared to patients taking citalopram or an SSRI alone.

What are the side effects of citalopram with mirtazapine?

When citalopram is concomitantly used with mirtazapine, it can result in adverse effects such as:

Drowsiness and dizziness.
Weight gain and increased appetite.
Nausea and vomiting.
Dry mouth.
anxiousness and confusion.
Constipation. (2)

Both medications can result in these side effects if taken separately. Therefore you must take caution as using these drugs concomitantly can increase the risk of experiencing these side effects more, especially if used for a long time.

It is important that your healthcare provider adjusts the dose of citalopram and mirtazapine, because if the dose is very high, this may lead to increasing the risk of serotonin syndrome.

A rare but life-threatening condition that happens due to the accumulation of serotonin in the body, which may involve symptoms such as raised blood pressure and heart rate, sweating, hallucinations, confusion, and incoordination. (3)

If you experience any of these symptoms or any other symptoms, contact your physician or healthcare provider immediately.

What to do if you have taken citalopram and mirtazapine together?

If you have taken citalopram and mirtazapine together, you should contact your physician or healthcare provider and you must be aware of any symptoms that may arise, your physician or healthcare provider will take some precautions such as:

Dose adjustment. Your healthcare provider may need to adjust either the dose of citalopram or mirtazapine to decrease the risk of serotonin syndrome.

Dosing time adjustment. Your healthcare provider may request that you take the drugs at different time intervals to avoid possible interactions.

Monitoring. Monitoring your symptoms is crucial to decrease the risk of serotonin syndrome.

It is important to adhere to your medications and take them as prescribed by your healthcare provider, don’t skip your drug doses or change your treatment plan without the consultation of your healthcare provider.

What is the replacement drug for citalopram if you take mirtazapine?

There are other antidepressants that can be replaced for citalopram while taking mirtazapine, your physician or healthcare provider may choose a different replacement drug for citalopram while taking mirtazapine if it’s not compatible with you, such as Selective Norepinephrine Reuptake Inhibitor (SNRI).

Venlafaxine is an example of an SNRI antidepressant, venlafaxine can be more tolerated by patients who experience adverse effects from citalopram. (4)

Mirtazapine can also be used in combination with sertraline (Zoloft), or escitalopram (Lexapro) in treating depression and was shown effective in many individuals with fewer side effects.

There are also alternative non-pharmacological therapies to be used along with mirtazapine that can help manage the symptoms of depression such as:

Patient counselling
Support groups
behavioural therapies
Herbal remedies
exercises
meditation
yoga
deep breathing techniques.

Conclusion

Citalopram can interact with mirtazapine, they are both used in the treatment of depression, we also discussed the possible adverse effects when you concomitantly take citalopram and mirtazapine, what to do in case of taking them together, and what is the replacement drug for citalopram if you take mirtazapine.

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References

1.-

Kessler D, Burns A, Tallon D, Lewis G, MacNeill S, Round J, et al. Discussion and conclusion [Internet]. www.ncbi.nlm.nih.gov. NIHR Journals Library; 2018 [cited 2023 Oct 11]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK533898/#s6-1

2.-

Mirtazapine: MedlinePlus Drug Information [Internet]. medlineplus.gov. Available from: https://medlineplus.gov/druginfo/meds/a697009.html

3.-

The serotonin syndrome. American Journal of Psychiatry. 1991 Jun;148(6):705–13. Available from: https://pubmed.ncbi.nlm.nih.gov/2035713/

4.-

Kessler D, Burns A, Tallon D, Lewis G, MacNeill S, Round J, et al. Introduction (Internet). www.ncbi.nlm.nih.gov. NIHR Journals Library; 2018. Available from: https://www.ncbi.nlm.nih.gov/books/NBK533902/#:~:text=In%20patients%20who%20have%20not,significantly%20higher%20remission%20rates%20than

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Does citalopram interact with mirtazapine? (3+ tips)