What happens if you stop taking Celexa (citalopram) while taking Ciprofloxacin?

Abrupt Discontinuation of Citalopram While Taking Ciprofloxacin

Abruptly stopping citalopram (Celexa) while taking ciprofloxacin is not recommended as it can lead to SSRI discontinuation syndrome, while there is no significant interaction between these medications that would require discontinuation. 1

Drug Interaction Profile

• Citalopram and ciprofloxacin have minimal interaction concerns as citalopram is primarily metabolized through CYP3A4 and CYP2C19, with minimal involvement of CYP1A2 (which ciprofloxacin inhibits) 1
• Citalopram has a relatively clean drug interaction profile compared to other SSRIs, with the least effect on CYP450 isoenzymes and therefore a lower propensity for drug interactions 1, 2
• Unlike clozapine (which has a significant interaction with ciprofloxacin due to CYP1A2 inhibition), citalopram does not require dose adjustment when taking ciprofloxacin 1, 3

Risks of Abrupt Citalopram Discontinuation

• Discontinuation syndrome from abruptly stopping citalopram can include dizziness, fatigue, lethargy, general malaise, myalgias, chills, headaches, nausea, vomiting, diarrhea, insomnia, imbalance, vertigo, sensory disturbances, paresthesias, anxiety, irritability, and agitation 2, 4
• In rare cases, abrupt discontinuation of citalopram has been associated with new onset hypertension, which resolved upon restarting the medication 5
• Discontinuation symptoms typically begin within hours to days after stopping the medication and can last 1-4 weeks 2
• The risks of discontinuing citalopram likely outweigh the theoretical risks of continuing it during ciprofloxacin treatment 1

QT Interval Considerations

• Both medications have some QT interval concerns, but at standard doses this is not typically a reason to avoid the combination 1
• Citalopram may cause QT prolongation at daily doses exceeding 40 mg/day and should be used with caution in patients with long QT syndrome 2, 1
• Monitoring for signs of QT prolongation (dizziness, palpitations, syncope) may be prudent in patients taking both medications, especially at higher doses 1

Clinical Management Recommendations

• Continue citalopram at the current dose while taking ciprofloxacin, with standard monitoring for side effects 1
• If discontinuation of citalopram is necessary for other reasons, it should be done gradually by tapering the dose to minimize withdrawal symptoms 2, 4
• If both medications are needed concurrently, no special dose adjustment of citalopram is required 1
• Monitor for common side effects of ciprofloxacin, which include gastrointestinal disturbances (4.9%), central nervous system effects (1.5%), and skin reactions (1.1%) 6, 7

Important Precautions

• Combining SSRIs like citalopram with other serotonergic medications can potentially cause serotonin syndrome, but ciprofloxacin is not known to significantly increase this risk 2
• Parental oversight of medication regimens is of paramount importance in children and adolescents taking these medications 2
• If signs of serotonin syndrome develop (agitation, confusion, fever, tachycardia, tachypnea, diaphoresis, mydriasis, tremor, clonus, hyperreflexia, hypertonia), seek immediate medical attention 2