Alcohol and Citalopram (Celexa) Interaction
Consuming alcohol while taking citalopram (Celexa) is not recommended due to increased risks of enhanced central nervous system depression, worsened side effects, and potential interference with treatment efficacy.
Understanding the Interaction
Citalopram (Celexa) is a selective serotonin reuptake inhibitor (SSRI) primarily used to treat major depressive disorder and anxiety disorders. When combined with alcohol, several important interactions can occur:
Pharmacological Effects
- Alcohol can enhance the central nervous system (CNS) depressant effects of citalopram
- Both substances can affect cognitive and motor functions when used together
- Alcohol may interfere with the therapeutic efficacy of citalopram
FDA Guidance
The FDA-approved drug label for citalopram specifically states: "Do not drink alcohol while using citalopram tablets" 1. This clear warning is included in the medication guide that should be provided to all patients.
Specific Risks
Enhanced Side Effects
- Increased drowsiness and sedation
- Greater impairment of cognitive function and motor skills
- Heightened risk of dizziness and coordination problems
- Potential for worsened depression symptoms
Safety Concerns
- Alcohol consumption may worsen underlying mental health conditions
- The combination may increase the risk of suicidal thoughts or behaviors
- Approximately 23% of patients who combine alcohol with psychotropic medications report serious adverse effects 2
Clinical Evidence
Research on citalopram and alcohol has shown:
Citalopram at higher doses (40mg/day) has been shown to actually decrease alcohol consumption and desire to drink in some studies 3, 4, suggesting a biological interaction between the two substances.
In a study of heavy drinkers, citalopram's effects on reducing alcohol intake varied based on baseline consumption levels 5.
While citalopram did not potentiate the cognitive and motor effects of alcohol in clinical trials, the combination is still not recommended due to other risks 1.
Management Approach
For patients prescribed citalopram:
Complete abstinence from alcohol is the safest approach while taking citalopram.
If a patient insists on consuming alcohol despite medical advice:
- Emphasize the increased risks
- Start with very limited alcohol intake to assess individual response
- Never exceed recommended daily limits (1 drink for women, 2 for men) as per general guidelines 6
- Monitor for enhanced sedation or other adverse effects
For patients with alcohol use disorder who are prescribed citalopram:
- Consider specialized addiction treatment
- More intensive monitoring may be required
- Recognize that abstinence is the most important therapeutic intervention for those with alcohol-related liver disease 6
Patient Education Points
When counseling patients about citalopram and alcohol:
- Explain that alcohol may worsen depression symptoms and counteract the beneficial effects of the medication
- Warn about increased risk of sedation, impaired coordination, and judgment
- Emphasize that the FDA explicitly recommends against combining the two substances
- Discuss that approximately 75% of patients report receiving counseling about alcohol-drug interactions, but only 49% follow this advice 2
Conclusion
While some patients may tolerate small amounts of alcohol while taking citalopram, the safest approach is to avoid alcohol completely during treatment. The risks of enhanced CNS depression, worsened side effects, and potential interference with treatment efficacy outweigh any potential benefits of alcohol consumption.