From the Guidelines
It's generally safe to take hydroxyzine with citalopram, but you should consult your healthcare provider before combining these medications. Both medications can be prescribed together, as hydroxyzine is an antihistamine used for anxiety or allergies while citalopram is an SSRI antidepressant. However, there is a potential risk when combining these medications because both can affect heart rhythm by prolonging the QT interval, especially at higher doses, as noted in the clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders 1. This risk is greater if you have pre-existing heart conditions, electrolyte abnormalities, or are taking other medications that affect heart rhythm.
Some key considerations when taking these medications together include:
- Increased drowsiness, dizziness, and dry mouth as potential side effects
- The need for careful monitoring, especially in the first 24 to 48 hours after dosage changes, due to the potential for serotonin syndrome or other adverse effects 1
- The importance of starting the second non-MAOI serotonergic drug at a low dose and increasing the dose slowly to minimize risks 1
- The potential for anticholinergic effects, such as dryness of mouth and eyes, constipation, and inhibition of micturition, associated with first-generation antihistamines like hydroxyzine 1
If you experience unusual symptoms like heart palpitations, severe dizziness, or fainting after taking these medications together, seek medical attention immediately. Your doctor should determine appropriate dosing based on your specific health situation and monitor you accordingly, taking into account the potential for drug-drug interactions and the need for careful dose titration 1.
From the FDA Drug Label
Caution is recommended during the concomitant use of drugs known to prolong the QT interval. These include Class 1A (e.g., quinidine, procainamide) or Class III (e.g., amiodarone, sotalol) antiarrhythmics, certain antipsychotics (e.g., ziprasidone, iloperidone, clozapine, quetiapine, chlorpromazine), certain antidepressants (e.g., citalopram, fluoxetine), certain antibiotics (e.g., azithromycin, erythromycin, clarithromycin, gatifloxacin, moxifloxacin); and others (e.g., pentamidine, methadone, ondansetron, droperidol).
- Key Considerations:
- Hydroxyzine should be used with caution in patients taking citalopram, as both drugs can prolong the QT interval.
- Patients should be monitored closely for signs of QT prolongation and torsades de pointes.
- The dosage of hydroxyzine and citalopram may need to be adjusted to minimize the risk of QT prolongation. 2
From the Research
Interaction between Hydroxyzine and Citalopram
- There is no direct evidence in the provided studies regarding the interaction between hydroxyzine and citalopram 3, 4, 5, 6.
- However, it is known that hydroxyzine is an antihistamine medication used to treat anxiety, while citalopram is an antidepressant 3, 4.
- Studies have shown that hydroxyzine is effective in treating generalized anxiety disorder (GAD) and is comparable to other anxiolytic agents such as benzodiazepines and buspirone in terms of efficacy and tolerability 3, 6.
- Citalopram, on the other hand, is an antidepressant that has been used to treat various anxiety disorders, including GAD 4.
- While there is no direct evidence on the interaction between hydroxyzine and citalopram, it is possible that they may be used together in the treatment of anxiety disorders, but this should be done under the guidance of a healthcare professional due to potential interactions and side effects 3, 4, 5, 6.
Potential Side Effects and Interactions
- Hydroxyzine has been associated with side effects such as sleepiness and drowsiness, and may interact with other medications that have sedative effects 3, 6.
- Citalopram may also have side effects such as drowsiness, and may interact with other medications that affect the central nervous system 4.
- The use of benzodiazepines, which are sometimes used to treat anxiety disorders, has been associated with dependence and withdrawal symptoms, and should be used with caution 5.