Is it okay to take Buspar (buspirone) and citalopram together?

Safety of Taking Buspirone and Citalopram Together

Taking buspirone (Buspar) and citalopram together is generally safe but requires monitoring for serotonin syndrome due to their combined serotonergic effects.

Medication Interactions

Buspirone and citalopram can be used together, but there are important considerations:

• Both medications affect serotonin levels in the brain through different mechanisms:

  • Citalopram is a selective serotonin reuptake inhibitor (SSRI) that increases serotonin by blocking its reuptake
  • Buspirone acts primarily on 5-HT1A serotonin receptors

• The FDA drug label for citalopram specifically mentions that concomitant use with other serotonergic drugs (including buspirone) may increase the risk of serotonin syndrome 1

• While this combination is not contraindicated, it requires careful monitoring due to the potential for additive serotonergic effects

Risk of Serotonin Syndrome

The primary concern with this combination is serotonin syndrome, which can manifest as:

• Mental status changes (agitation, confusion, hallucinations)
• Autonomic instability (tachycardia, hypertension, hyperthermia)
• Neuromuscular symptoms (tremor, rigidity, myoclonus)
• Gastrointestinal symptoms (nausea, vomiting, diarrhea) 2

There have been case reports of possible serotonin syndrome when buspirone was added to fluoxetine (another SSRI similar to citalopram) 3.

Recommendations for Safe Use

If this combination is necessary:

1. Start with low doses:

   • Begin with lower doses of both medications
   • Increase doses gradually while monitoring for side effects

2. Monitor closely for symptoms of serotonin syndrome, especially:

   • During the first 24-48 hours after starting the combination
   • After any dose increases 2

3. Be aware of drug interactions:

   • Citalopram may have QT prolongation effects at doses exceeding 40mg/day 2
   • Buspirone's metabolism can be affected by other medications, though citalopram has minimal effects on CYP450 isoenzymes compared to other SSRIs 2

4. Discontinue both medications immediately if signs of serotonin syndrome develop and seek medical attention 1

Potential Benefits of the Combination

This combination may be beneficial in certain clinical scenarios:

• For treatment-resistant depression, buspirone augmentation of SSRIs has shown some efficacy 4
• For patients with both anxiety and depression, as both medications target different aspects of these conditions

Conclusion

While the combination of buspirone and citalopram can be used together with appropriate monitoring, patients should be educated about the potential signs of serotonin syndrome and instructed to seek immediate medical attention if these symptoms develop. Regular follow-up appointments are essential to assess effectiveness and monitor for adverse effects.