Does Citalopram Interact With Nortriptyline?(1+ Interaction)

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 will answer: “Does Citalopram interact with Nortriptyline?” We will also discuss the potential side effects and benefits of this combination.

Does Citalopram interact with Nortriptyline?

Yes, Citalopram and Nortriptyline can interact, potentially leading to serious side effects.

Nortriptyline is classified as a Tricyclic antidepressant (TCA). It exerts its therapeutic effects by blocking the reuptake of norepinephrine and serotonin. This action allows serotonin and norepinephrine to remain more available in the synaptic cleft.

On the other hand, Citalopram belongs to the selective serotonin reuptake inhibitor (SSRI) class. It functions by increasing serotonin levels in the brain, primarily by inhibiting the reuptake of serotonin by nerve cells. This elevation of serotonin contributes to an improvement in mood-related symptoms.

However, if Citalopram and Nortriptyline are prescribed together, you should be mindful of the potential risks associated with this combination. This interaction can result in two significant and concerning side effects: (1,2)

Serotonin syndrome
QT prolongation

Potential interactions between Citalopram and Nortriptyline

When Citalopram and Nortriptyline are taken together, the following interactions can occur:

Serotonin syndrome

Serotonin syndrome is a serious condition that occurs because of serotonin excess in the brain. It can be life-threatening as well.

Serotonin is a neurotransmitter responsible for regulating mood and reducing anxiety.

When medications affecting serotonin levels in the brain are combined, such as the simultaneous use of Citalopram and Nortriptyline the risk of serotonin syndrome is high.

Signs and symptoms of Serotonin syndrome

Serotonin syndrome can present with a range of signs and symptoms. Some of the common indicators include: (3)

Agitation
Confusion
Rapid Heart Rate
High Blood Pressure
Dilated Pupils
Muscle Rigidity
Excessive Sweating
Fever

In severe cases, serotonin syndrome can manifest more extreme symptoms, including seizures, a high fever, irregular heartbeats, unconsciousness, and, if left untreated, it can become life-threatening.

QT prolongation

QT prolongation refers to an abnormality in the electrocardiogram (ECG) reading that shows a lengthened QT interval. The QT interval represents the time it takes for the heart’s ventricles to contract and then reset for the next heartbeat.

When this interval is prolonged, it can increase the risk of irregular heartbeats, particularly a specific type called Torsade de Pointes, which can lead to life-threatening arrhythmias. (4)

The QT prolongation on an electrocardiogram (ECG) and irregular heartbeats are possible side effects of both Citalopram and Nortriptyline. Combining these two medications can lead to an increased risk of QT prolongation, especially in older people. (1,2)

Signs and Symptoms of QT prolongation

The combination of Citalopram and Nortriptyline can lead to irregular heart rhythms and prolonged QT interval, which can pose significant risks. Some of the signs and symptoms associated with these conditions include: (4)

Irregular Heart Rhythms
Palpitations
Dizziness
Lightheadedness
Fainting (Syncope)
Shortness of Breath
Prolonged QT Interval on ECG
Ventricular Arrhythmias, such as Torsade de Pointes (in severe cases)

Additive side effects

The combination of citalopram and nortriptyline can also lead to some additive side effects, including: (1,2)

Headache
Insomnia
Sedation
Dry mouth
Constipation
Diarrhea

How to manage the side effects of taking Citalopram with Nortriptyline?

Here are some tips to manage these potential side effects if your doctor has prescribed Citalopram and Nortriptyline.

Consult your doctor for medical attention and dose adjustments.
Avoid alcohol and caffeine, which can interact with Citalopram and Nortriptyline.
Take these medications as advised; do not alter your dose without your doctor’s guidance.
Be vigilant for potential side effects.
Maintain a consistent medication schedule to stabilise blood levels and reduce potential side effects.
Stay adequately hydrated, especially to address dry mouth, a common side effect of Nortriptyline.

What are the potential Benefits of combining Citalopram and Nortriptyline?

The combination of Citalopram and Nortriptyline offers several potential benefits when used under the supervision of a healthcare provider in the treatment of moderate-to-severe depression.

Combining medications like Citalopram and Nortriptyline with psychotherapy can provide a comprehensive approach to treating depression.

Studies suggest that this combination may be superior to psychotherapy alone when dealing with moderate-to-severe depression, offering patients a more holistic approach to their mental health.

This combination has been shown to reduce the severity of depressive symptoms significantly. Patients may experience a notable improvement in their overall mood and well-being. (5)

Your doctor might prescribe you Citalopram and Nortriptyline if the benefits outweigh the potential side effects.

Conclusion

Citalopram and Nortriptyline can interact, causing serotonin syndrome, irregular heartbeats and QT prolongation. This combination also has potential benefits that might outweigh the potential risks.

However, the decision to combine these medications should be guided by healthcare providers who can weigh the risks and benefits. Patients should monitor their health and seek medical attention for side effects, ensuring the most appropriate treatment.