What are the serious contraindications of taking Citalopram (Celexa), Trazodone, Amitriptyline, and Rizatriptan?

From the Guidelines

Taking Celexa (citalopram), trazodone, amitriptyline, and rizatriptan together poses significant risks due to potential serotonin syndrome, a potentially life-threatening condition caused by excessive serotonin levels in the brain. All four medications affect serotonin: Celexa is an SSRI, trazodone and amitriptyline are antidepressants with serotonergic properties, and rizatriptan is a triptan that also affects serotonin receptors. Using these medications concurrently can lead to symptoms like agitation, confusion, rapid heart rate, high blood pressure, dilated pupils, muscle rigidity, and in severe cases, seizures or loss of consciousness. Additionally, combining these medications may increase the risk of QT interval prolongation, which can cause dangerous heart rhythm abnormalities, as noted in the study by 1. The combination may also intensify side effects like drowsiness, dizziness, and confusion. Before taking any combination of these medications, you should consult with your healthcare provider who can evaluate your specific medical history, consider alternative treatments, or carefully monitor you if this combination is deemed necessary for your condition. It's also worth noting that, according to 1, the risk of serotonin syndrome with combining triptans and SSRIs or SNRIs is low, but there are still theoretical concerns regarding drug-drug interactions with triptans and some commonly used perioperative medications. Some key points to consider when taking these medications together include:

• Monitoring for symptoms of serotonin syndrome, especially in the first 24 to 48 hours after dosage changes, as recommended by 1.
• Being aware of the potential for QT interval prolongation and dangerous heart rhythm abnormalities.
• Considering alternative treatments for acute headache, if needed, as suggested by 1.
• Carefully evaluating the patient's specific medical history and monitoring them closely if this combination is deemed necessary for their condition. In terms of specific guidance, the study by 1 recommends starting the second non-MAOI serotonergic drug at a low dose, increasing the dose slowly, and monitoring for symptoms, especially in the first 24 to 48 hours after dosage changes. Ultimately, the decision to take these medications together should be made in consultation with a healthcare provider, taking into account the individual patient's needs and medical history, and with careful consideration of the potential risks and benefits, as emphasized by 1 and 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 serious contraindications of taking citalopram (Celexa) include:

• MAOIs: due to increased risk of serotonin syndrome
• Pimozide: concomitant use is contraindicated
• Hypersensitivity: to citalopram or any of the inactive ingredients There is no information about trazadone, amitriptline, and rizatriptan in the provided drug label 2.

From the Research

Serious Contraindications of Taking Celexa, Trazodone, Amitriptyline, Rizatriptan

• The combination of certain medications such as selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), and triptans can increase the risk of serotonin syndrome, a potentially life-threatening condition 3, 4.
• Serotonin syndrome is characterized by symptoms such as neuromuscular excitation, autonomic instability, and altered mental status, and can be fatal if left unrecognized and untreated 3.
• The use of trazodone, an antidepressant with a unique mechanism of action, can be beneficial for patients with major depressive disorder and concomitant conditions such as insomnia, anxiety, or psychomotor agitation 5.
• However, trazodone can also increase the risk of serotonin syndrome when used in combination with other medications that affect serotonin levels, such as SSRIs and triptans 3, 4.
• Amitriptyline, a TCA, has been shown to be effective in the treatment of chronic depression and migraine prevention, but can also have significant side effects such as anticholinergic effects, weight gain, and sexual dysfunction 6, 7.
• Rizatriptan, a triptan, is used to treat migraine headaches, but can also increase the risk of serotonin syndrome when used in combination with other medications that affect serotonin levels 4.
• The combination of Celexa (an SSRI), trazodone, amitriptyline, and rizatriptan can increase the risk of serotonin syndrome and other adverse effects, and should be used with caution and under close medical supervision 3, 4, 6, 7, 5.