From the Guidelines
Celexa (citalopram) is contraindicated in patients with a known hypersensitivity to citalopram, those taking monoamine oxidase inhibitors (MAOIs), and individuals with congenital long QT syndrome or QT interval prolongation. The use of Celexa with MAOIs is contraindicated due to the risk of serotonin syndrome, a potentially life-threatening condition 1. Additionally, Celexa should not be used in patients with congenital long QT syndrome or those with QT interval prolongation, as it can further prolong the QT interval and increase the risk of dangerous arrhythmias, including Torsade de Pointes and ventricular tachycardia 1.
Key Considerations
- Patients with a history of seizure disorders, bipolar disorder, or bleeding disorders should use Celexa with caution, as it may exacerbate these conditions 1.
- Celexa should be used with caution in patients taking other serotonergic medications, such as St. John's Wort, L-tryptophan, or illicit drugs like ecstasy, due to the increased risk of serotonin syndrome 1.
- The maximum recommended dose of Celexa is 20mg daily for patients with hepatic impairment, those over 60 years old, or patients taking CYP2C19 inhibitors like omeprazole 1.
- Pregnant and breastfeeding women should discuss the risks and benefits of Celexa with their healthcare provider, as there are potential risks to the fetus and infant 1.
Important Interactions
- Celexa may interact with drugs that prolong the QT interval, and caution should be exercised when co-administering these medications 1.
- Celexa may also interact with drugs metabolized by CYP2D6, and the dose of these medications may need to be adjusted accordingly 1.
From the FDA Drug Label
The use of MAOIs intended to treat psychiatric disorders with citalopram tablets or within 14 days of stopping treatment with citalopram tablets are contraindicated because of an increased risk of serotonin syndrome The use of citalopram tablets within 14 days of stopping an MAOI intended to treat psychiatric disorders is also contraindicated Starting citalopram tablets in a patient who is being treated with MAOIs such as linezolid or intravenous methylene blue is also contraindicated because of an increased risk of serotonin syndrome Concomitant use in patients taking pimozide is contraindicated Citalopram tablets are contraindicated in patients with a hypersensitivity to citalopram or any of the inactive ingredients in citalopram tablets.
The contraindications for Celexa (citalopram) are:
- Use of MAOIs intended to treat psychiatric disorders with citalopram tablets or within 14 days of stopping treatment with citalopram tablets
- Use of citalopram tablets within 14 days of stopping an MAOI intended to treat psychiatric disorders
- Starting citalopram tablets in a patient who is being treated with MAOIs such as linezolid or intravenous methylene blue
- Concomitant use in patients taking pimozide
- Patients with a hypersensitivity to citalopram or any of the inactive ingredients in citalopram tablets 2
From the Research
Contraindications for Celexa
The following are contraindications for Celexa:
- Dosages greater than 40 mg per day (or greater than 20 mg per day for patients 60 and older) due to the risk of abnormal changes in the electrical activity of the heart 3
- Patients with a history of QT prolongation or torsades de pointes, as Celexa can cause these conditions 4
- Patients with congenital long QT syndrome, as they are at risk for severe torsades de pointes 5
- Patients taking doses between 20 and 60mg of Celexa per day, especially if they have comorbid medical conditions such as hypertension 6
- Overdose, as it can lead to QTc prolongation and torsades de pointes 3, 6